Texas Health Resources, formed in August 1997 by the merger of Presbyterian Health Systems and the Harris-Methodist Health System, is the largest fully integrated nonprofit healthcare organization in the state. It includes 13 hospitals and many senior clinics, diagnostic centers, ambulatory surgery facilities, and chronic care centers. Serving both urban and rural areas, it provides a complex array of primary and acute care services.
Texas Health Resources' biggest challenge is to limit healthcare costs without reducing the quality of services provided to its patients. In pursuit of this goal, the organization must analyze the relationship of cost to quality to:
With SPSS for Windows, Texas Health Resources has greatly enhanced its ability to support its process improvement initiative. Today, it not only detects process variation, but can determine the underlying causes, such as a sicker-than-normal patient population.
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In the mid-1990s, while other organizations were talking about process improvement programs, Presbyterian Health Systems (now Texas Health Resources East) had already established its Outcomes Management department to ensure the delivery of high-quality patient care at a reasonable cost.
Now serving as an internal consultant to the entire Texas Health Resources organization, Outcomes Management considers such issues as patient length of stay from a clinical, as well as a cost, standpoint. For example, if patients leave the hospital sooner, does the readmission rate rise?
Accurately answering questions like this requires the right data—data that were difficult and costly to obtain when Outcomes Management based its analyses on paper medical abstracts, as it did for many years.
When Susan McBride became director of outcomes management for Texas Health Resources East in 1997, she realized the need to move to a more efficient, electronic environment. At that time, Texas Health Resources had a TSI cost accounting database, two clinical databases based on data elements defined by the American College of Cardiology and the Society for Thoracic Surgery, and the MediQual Atlas database.
With SPSS, we turn our data into usable information that helps us improve quality of care and address better mechanisms for creating cost efficiencies.
Susan McBride
Director of Outcomes Management
Texas Health Resources East
McBride soon realized that the organization's existing databases had only rudimentary reporting functions. As a result, Outcomes Management did not have enough information to risk-adjust or stratify the data, both critical elements in meaningful decision making.
Said McBride, "Traditionally, the data we used were billing or cost accounting data, which didn't capture enough clinical information for us to track patient outcomes. What we had to do was merge our databases and create measures out of the data. With SPSS, we can take our good financial information, which measures cost accurately, and combine it with our clinical data."
By merging and automating its databases and adopting powerful technology, including SPSS, Texas Health Resources not only captured better data, but also reduced the costs of obtaining that data. Maintaining a paper-based environment required $500,000 per year for support of four hospitals, while an electronic environment costs less than half that amount—a dramatic difference.
To see how Outcomes Management uses SPSS for process improvement, consider its investigation of minimally invasive open-heart surgery.
According to recent medical studies, some of the new techniques for minimally invasive open-heart surgery reduce postoperative complications and length of stay. But these technologies are expensive, so the Outcomes Management team decided to analyze whether they actually reduced patient length of stay or improved the clinical outcomes for this group of patients.
To perform a cost-benefit analysis, the team decided to merge cost data and clinical data on the open-heart patient population from one of the organization's flagship hospitals. The software originally used to collect clinical data could not track the new surgical methods, however, so the team had to create new variables for these data within SPSS.
Querying the merged data with SPSS provided a mechanism for examining the impact of a minimally invasive cardiac surgery program on overall outcomes and cost of care. Currently, Outcomes Management is working in conjunction with the cardiac surgery team, which will publish this information and present it at an upcoming conference.
Equipped with SPSS, Outcomes Management can also quickly compare the organization's statistics with those in the latest news to evaluate success in specific areas.
For example, the process improvement team recently read a report from the Healthcare Advisory Board in Washington, D.C., on the incidence of atrial fibrillation with postoperative coronary bypass surgery cases, so the team leader met with a clinical coordinator for the cardiac department. After masking the organization's data for physician and patient confidentiality, they queried the data interactively with SPSS to see how their results measured up to those in the report.
McBride said, "The Advisory Board report was hot off the press, but SPSS enabled us to ask the question and within seconds we had an answer. I've found it's a great interactive tool."
In the coming year, Outcomes Management plans to establish a system of standard reporting, including individual physician report cards, quarterly reports, and annual reports, for obstetrics and cardiovascular data. Given the size of the organization, this project requires total automation of the process—impossible without SPSS.
In obstetrics, for example, Dr. Cody Arnold at Texas Health Resources West (formerly Harris-Methodist Health System) is determining how much of the variation in C-section rates results from patient differences and how much from physicians' practice patterns. According to Dr. Arnold, "...These reports will give physicians credible feedback as to how their practice patterns differ from those of their peers."
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