Health systems implementing new technologies must bridge the gap between the knowledge base and patient care to deliver novel therapies at the bedside and fully transform best practices with those new capabilities.
St. Louis-based Ascension Health is taking the lead in the "implementation science" space to ensure patients receive the best care possible through clinical trials and other scientific efforts.
"Implementation science requires really operationalizing that fund of knowledge, and at Ascension, we've done that through developing a system within the cardiovascular service line comprised of process improvement groups, which we call affinity groups, centered on the subspecialty areas of cardiology," said Edward Fry, MD, Ascension's national cardiovascular service line director, said during an interview on the "Becker's Healthcare Podcast" hosted by Carrie Swihart, CPHQ, associate director of clinical decision technology innovation and health IT strategy at Amgen.
The affinity groups include acute and chronic, ischemic heart disease, electrophysiology, heart failure, open heart surgery, structural heart disease, peripheral vascular disease, imaging and preventative cardiology. Each group relies on content experts within the service line to design best practices and develop metrics necessary to measure progress toward goal. When the groups implement a novel therapy or change a method of care delivery, they continue tracking those metrics to ensure they're achieving better quality, safety, efficiency and overall performance.
Each year, the cardiovascular service line takes on new projects or focuses across process improvement groups and within the chronic and acute coronary disease groups, clinical leaders identified gaps in care tied to simple metrics such as measuring and documenting LDL cholesterol in the acute and ambulatory settings. Dr. Fry and his team set a systemwide annual metrics goal to get as close to 100% compliance as possible and found most of the time the information was available to achieve their goals.
"It's an issue of getting the information in the right hands, the right documentation and presenting it in the right way. But one particular group that we felt deserved attention are those patients who were presenting with acute coronary disease," said Dr. Fry. "Many of them may well have LDL documented, but really assuring that it is part of their acute care. The emphasis these days is in such rapid throughput that a lot has to get accomplished during that period of time when there's contact between the patient and health system."
The leadership team examined whether they were delivering information to frontline caregivers, physicians and nonphysicians, to ensure patients were treated appropriately and ready for discharge on time. Then they sought to close the gap between inpatient and outpatient follow-up so if patients weren't at their goal LDL after an acute coronary syndrome, they took advantage of therapies and maximized therapies to reach their goal.
How did they successfully meet their goals?
"The magic is not in the 'what,' it's the 'how'," said Dr. Fry. "There's multiple obstacles from an implementation science standpoint. The dissemination of knowledge piece I don't think is really the major problem. It's the other barriers such as technical ones, information management, integrating disparate EHR systems, creating standardized order sets, having standard metrics of measuring compliance in the follow-up."
Because of its size, Ascension faced another challenge: most of the patients had their follow-up originate outside of the system. The main hospitals have a hub-and-spoke model where acute care is done at the centralized hospital and many patients then receive follow-up care closer to home with a non-Ascension primary care physician or cardiologist. Communication with those physicians outside of Ascension's system is a challenge.
"That's where trying to make processes as standard as possible, as simple as possible, and as measurable as possible has really been important to try and close those gaps," said Dr. Fry.
To bring on the technology and EHR enhancements needed for streamlined communication, clinical and administrative leaders worked closely together on decision-making and measuring results. The clinical leaders communicated with administrative leaders at a high level to explain why achieving target LDL cholesterol levels was so important for patient safety and the economics of reducing future hospitalizations and readmissions.
It also builds on a foundation for deeper value-based care in the future.
"Nobody's going to suddenly turn on a neon sign and say we are all switched over to value-based care," said Dr. Fry. "But as we develop our care pathways and as we work across the system clinically and administratively, we have to realize that value-based care is really the endgame that we all need to strive for and will arrive at in some point of time."