June 15, 2018

Johns Hopkins’ value-focused initiatives hold the health system to the highest standard of evidence-and consensus-based best practice. The successful delivery of high-value care — the highest quality care at the lowest cost — is assessed by a number of metrics. These include adherence to appropriate use criteria, which are evidence-based guidelines indicating whether a test or treatment is warranted, patient outcomes, and cost. Value analytics dashboards provide a visual display of quality and cost data.

Quality data include imaging, lab and medication orders in accordance with appropriate use criteria, and quality outcomes data include length of stay, complications and readmissions. Clinicians who have access to the dashboards are able to monitor their performance and progress towards achieving their high-value care goals.

The Right Order for the Right Patient

The appropriateness dashboard provides information about clinicians’ transactions including every blood product, operating room supply and imaging, lab or antibiotic order. “Measuring utilization, alongside appropriate criteria, is a new component of what we traditionally studied,” says Ken Lee, director of value analytics at the Armstrong Institute for Patient Safety and Quality. Numerous peer-reviewed articles — many of which are written by Johns Hopkins faculty members — demonstrate that evidence-based practice guided by appropriate use criteria improves quality, safety and outcomes. “We have to change things from the grass-roots level by empowering frontline clinicians with the right knowledge and tools,” Lee says.

Next, the value analytics team gives the feedback to clinicians about their practice patterns. Timely response to clinicians is critical to improve effective use of items and procedures in the Johns Hopkins Health System, according to Lee. “Clinicians obviously care that their decision-making is considered appropriate and if we wait too long to react, they may lose interest and our feedback won’t have the same impact,” Lee says.

Steven Frank, director of the Johns Hopkins blood management program and medical director of the Center for Bloodless Medicine and Surgery, believes that appropriateness data has played a significant role in reducing unnecessary blood transfusions, contributing to $2.1 million saved in 2017. “We’ve made it an initiative to celebrate doctors who follow or improve their guideline compliance instead of punishing those who miss their goals,” Frank says. Reducing unnecessary transfusions decreases risks and improves outcomes with the added benefit of cost savings for the hospital, patients and payers.

A Lens on Reducing Length of Stay

The clinical pathway dashboard supports the work of the health system’s 13 pathway groups that strive to minimize care variation and reach measurable care-delivery goals. It shows clinical quality outcomes such as length of stay by specialty, services and surgeon, as well as the use of predefined order sets of therapies, checkups and procedures for post-surgery care. It also helps clinicians track progress on their goals.

The dashboard also benchmarks the statistics of length of stay for surgeons in the Johns Hopkins Health System as well as other medical systems. This feature is unique to the pathway dashboards. “We use benchmarks as our main tool to gauge how we, as a health system, can drive improvements,” says Lee. The dashboard plays a paramount role in educating clinicians and facilitating shared learning to reduce length of stay.

To maximize value, Lee advocates assigning as many patients as possible to a pathway.

Lee and his value analytics team look forward to continued collaboration with medical professionals to create sustainable and scalable value at Johns Hopkins. “The successful results we’ve seen so far make the hard work a little easier to complete, and I am fortunate to be working with passionate clinicians who want to treat our patients with the most effective, value focused care,” he says.