On Oct. 9, Premier healthcare alliance senior executives and volunteer leaders held a press briefing to announce the results of both the Charlotte-based health alliance’s broad comparative effectiveness analysis of blood utilization processes, and to describe the work of two Premier member hospital systems in optimizing processes in that key area.
Indeed, at a time when the nationwide blood supply in the U.S. is at a 15-year low, lack of scientific evidence supporting specific blood utilization practices continues to lead to wide variations in clinical blood usage in hospitals, Premier analysts have found. In the largest comparative effectiveness analysis of blood product utilization conducted to date, the Premier healthcare alliance found that 464 hospitals studied could save $165 million annually in purchasing costs alone by reducing usage by 802,716 units—based on the use of practice and process protocols—while maintaining positive clinical outcomes.
As part of this study, Premier analysts set out to identify variations in blood product use and potential opportunities for improvement and cost savings. Using MS-DRG case mix-adjusted data from the alliance’s vast database, analysts examined blood use across 7.4 million de-identified hospital discharges from 464 hospitals during the period of April 2011 through March 2012. Individual hospitals were compared to a benchmark set by the top-performing quartile—those hospitals with the lowest utilization of blood products and better-than-expected patient outcomes. Comparisons took into account patient diagnosis and severity of illness.
Based on this analysis, the Premier researchers identified six factors critical to success in blood management:
> Use of a multi-disciplinary blood stewardship team
> Working collaboratively with clinicians and supply chain executives to explore alternative products and procedures
> Establishing and implementing evidence-based transfusion guidelines
> Providing education and clinical decision support tools to inform clinicians of guidelines in real time
> Developing processes to monitor adherence to guidelines and provide feedback to clinicians
> Monitoring utilization on an ongoing basis while measuring the impact of improvement
As Premier COO Mike Elkire noted at the press briefing, there remains great “variation in adherence to blood product usage. There are many practice recommendations in this area,” Elkire noted, “but the scientific evidence is not very robust. There is a lack of clarity on the evidence. Due to the many issues and opportunities blood utilization presents, we decided to dig deeply. Our waste report,” he added, “identified 15 different areas of savings opportunities.”
What is clear, Elkire told members of the media, is that in areas in which there is a paucity of clinical evidence in the literature, comparative effectiveness analysis, benchmarking among peer patient care organizations, and data-driven performance improvement, can make a significant difference in improving performance on all levels, as is the case in the blood management arena.
Translating data analysis into practical performance improvement
Elkire’s summary remarks, which followed an initial introduction by senior vice president for public affairs Blair Childs, were in turn followed by the presentations of leaders of two different integrated health systems, both of which are Premier organizational members.
As Marlon Priest, M.D., executive vice president and chief medical officer of the Marriottsville, Md.-based Bon Secours Health System, reported, “We have five hospitals, and we wanted to focus on reducing blood transfusions during heart surgery. So we asked the cardiovascular surgeons to look at and evaluate how we deliver all aspects of cardiovascular care. In this context, we said, we expect you as physicians to use your training and best judgment. We’re providing you with the evidence we have so far. We used the Premier database to help people benchmark, and used a couple of other databases to help us look at and compare cardiovascular patients,” Priest told the members of the press listening into the briefing.”
Marlon Priest, M.D.
The results? Within four years, the cardiovascular surgeons at the five Bon Secours hospitals had reduced blood utilization by 65 percent; reduced adverse events by 14 percent; thus, reduced length of stay by 20 percent; and we saved nearly $2 million, based purely on blood acquisition, not including time of the doctors and nurses, and other performance gains.
Pondering these advances, Priest said, “Judgment without the use of sound evidence becomes merely opinion. We have far too much information to allow this to carry the day. Evidence was crucial in the development of transplantation surgery and other highly valued care.”
Millions in savings in the Carolinas
At the 33-hospital Carolinas HealthCare System, based in Charlotte, North Carolina, Jim Olsen, the system’s vice president of materials resource management, has been working with many of his colleagues to work on cost control strategies. “Carolinas is one of the leading healthcare systems in the Southeast, and one of the largest public, not-for-profit systems in the nation,” Olsen explained at the briefing. “And our goal in this area has been to continue to identify cost savings, so we can continue to help patients regardless of their ability to pay. We looked at physician preferences and found gaps. We could get at cost, but not outcomes. But we’ve found over the last two years that, in working with Premier’s QualityAdvisor™ program”—which helps organizations benchmark their outcomes against those of peer patient care organizations—we could get system-level reports, and could get them quickly, and could [compare our performance against] that whole database of hospitals, to identify cost-effectiveness variations across a number of hospitals larger than our system, and to do comparative effectiveness to drive improved outcomes at lower cost.”
Jim Olsen
Olsen noted that Carolinas HealthCare System’s work on optimizing the utilization of blood products has been part of a far broader effort to optimize processes across its surgical service lines. In that context, he noted, colleagues from 16 Carolinas hospitals have worked together to identify $58 million in potential savings across three specific diagnosis-related groups (DRGs): joint replacement, spinal implant, and cardiac stent procedures. Inevitably, he said, when it comes to any area that he and his colleagues looked at in terms of resources within the surgery area, whether blood product utilization or surgical devices, the key to success so far with regard to utilization optimization has been leveraging data analytics to engage with surgeons and other physicians in process improvement efforts.
Advice for CIOs and CMIOs
Presenters at the Premier press briefing were glad to share their perspectives on the implications for CIOs, CMIOs, and other healthcare IT leaders that might be apparent based on their organizations’ experiences. “Obviously, one piece of this,” said Carolinas HealthCare’s Olsen, “is that all of this information, this clinical information, is very important, and the accuracy of that information is paramount. The other important thing is to be able to understand how some of these analyses can be done, because what we find when we’re sitting down with the physicians and surgeons is that they’re primarily concerned with the process that led to the data analysis, and the accuracy of that analysis; and if there is a problem with the accuracy or process, you’re just dead in the water. So,” he said, having the accuracy be perfect, and making sure you have a good, consistent process, is key.”
Creating highly collaborative processes is also crucial, said Bon Secours’ Priest. “Engage in regular and frequent contact with your clinicians and executive leaders, so that the three languages you speak can blend into one language,” Priest urged CIOs and CMIOs. “My second piece of advice,” he added, “would be to achieve acceptance of the currently available technology, as you drive change using the currently technology.”
Richard Bankowitz, M.D.
And Richard Bankowitz, M.D., enterprise-wide chief medical officer at Premier healthcare alliance, added that “Information needs to be relevant, accurate, and placed in context. Marlon [Priest] spoke about the relevance of the data; if I were a CIO or CMIO, I’d make sure to collaborate with the clinicians to assure accuracy as well as relevant outcomes—things like MI [myocardial infarction], fluid overload, heart failure—there will be a list of things clinicians will want to see. It goes without saying about the accuracy of the data,” Bankowitz said. “And in terms of context, you really need to understand how your practice pattern compares with peer organizations, not only in terms of utilization, but also in terms of relevant outcomes.”