Deciding what to measure can make all the difference in patient experience, outcomes

The Institute for Human Caring at Providence St. Joseph Health had a mission: to make whole-person care the new normal. To provide a more holistic view of patients, IHC looked to palliative care as its north star, intending to apply its tenets across all service lines.

First, it needed to point its analytics and data-gathering capabilities in the right direction. The system decided that what to measure could have a profound effect on care and outcomes for its patients.

The shift in philosophy is in keeping with the transition from volume- to value-based care, said Nusha Safabakhsh, IHC's executive director of measurement and analytics in a HIMSS 20 digital presentation. Using geographic measurements as an analogy, Safabakhsh said that navigation technology evolved through the years from the sundial to the compass and eventually to the GPS system on a person's phone. A similar evolution should take place in healthcare, she said.

In this context, the shift from volume to value requires a shift in mindset – asking a patient "What matters to you?" as opposed to "What is the matter with you?"

"Whole-person care empowers us to live our lives to the fullest, and our care should be aligned with our values, preferences and priorities," Safabakhsh said.

The reason IHC drew on palliative care for its inspiration is that it requires attending to physical, psychosocial and spiritual needs, which are all especially important for patients in light of the COVID-19 pandemic. The hallmarks of effective whole-person care are communication and shared decision-making, but these are only valuable if there are measurements in place that highlight the outcomes of such approaches – and the information needs to be widely available.

IHC's plan stipulates that each patient receive a personalized care plan consistent with their individual goals; have an advanced care planning document saved into the EHR; and have at least one goal-of-care conversation documented in the EHR prior to surgeries or intensive medical treatments.

This means having analytics in place for process measures, value of care, enterprise palliative care optimization and data integration. To that end, IHC developed proprietary tracking tools that allow organizational leaders to monitor performance, and to expand their measurements to integrate legacy systems into financial modeling.

IHC also developed a number dashboards to define the value of care; these dashboards are largely focused on process and outcome measures and are available across the entire health system.

"We realized that it's important to have our metrics with high visibility across the health system, and to have visibility around goal-aligned care," Safabakhsh said.

In addition to improving patient care, the widespread availability of measurements and data can facilitate a reduction in cost of care by examining cost prior to and after intervention, as well as during hospitalization.

"When we look at the avoided direct costs, we have had a significant number that show the financial opportunity for the organization," said Safabakhsh, "which brings the question of, 'Are we having the right support or right allocation of palliative care resources in our hospitals and across our health system?'"

It's an important question to ask, she said, and one that can only be answered by highlighting and measuring the right data.

"The journey," she said, "has been fun and very much rewarding."
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com