The San Francisco Heart Institute, a non-profit division of Seton Medical Center and the larger Catholic Healthcare West, provides and monitors specialized cardiac treatment for hundreds of patients from around the world each year.
Like most healthcare organizations today, the institute and hospital must meet a multi-pronged challenge: Strengthen financial health, improve quality of care, and achieve accreditation from the Joint Commission Accreditation of Healthcare Organizations (JCAHO). To accomplish these things, the institute must:
With PASW Statistics, the institute has collected and analyzed hundreds of data elements, tracking tracking the outcomes and performance of more than 20,000 patients and their physicians since 1985. As a result, the institute helps the hospital save money, improve the quality of care, and operate more efficiently.
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More than ever before, the San Francisco Heart Institute must evaluate performance and target areas for improvement. One reason is financial health—much of this non-profit organization's insurance reimbursement, as well as JCAHO accreditation, is tied directly to better performance. And the second reason? Increased quality of care and efficiency depend upon it.
As a result, this division of Seton Medical Center and the larger Catholic Healthcare West is vigilant about collecting data to evaluate patient risk, the effectiveness of procedures and medications, and physician performance.
In fact, the institute has followed patients and collected data to help evaluate quality of care for more than 20 years. This wealth of historical data helps it analyze current performance against past, tracking the outcome of changes in patient risk, procedure outcomes, and the effect of various medications. Today, the institute collects between 500 and 1,000 pieces of medically related data, including patient history and risk factors, laboratory values, cholesterol levels, outcomes, and cost of procedures, on each of the hundreds of patients admitted each year to Seton Medical Center. A team led by Dr. Richard Shaw, director of research and operations, tracks each patient for years following discharge from the hospital, and analyzes medical and behavioral data through traditional paper and phone surveys, as well as more recently via the institute's Web site and online surveys.
In addition to conducting about 15 ongoing patient follow-up studies, Shaw's team examines data on about 20 procedures each year. To begin, Shaw defines an area to research, such as patient outcome, mortality, length of patient stay, or cost per outcome. The team—a bio-statistician, a physician, a nurse, and a researcher with a medical records background—then uses PASW Statistics to analyze data from various diagnoses groups, which include procedures such as coronary stenting, cardiac bypass surgery, and angioplasty. The institute also performs physician profiling to review variations in performance, assessing how length of stay, outcomes, and cost vary from physician to physician. "As much of our effort goes into looking at individual physician performance as at patient outcomes. Our physicians drive the performance of our institution and we see physician profiling as an important part of our approach," Shaw said.
How does the analysis process work? Shaw, a bio-statistician trained at the University of California, San Francisco Medical School, begins by pulling sample data from the database and does a preliminary run in PASW Statistics. Using various analytical procedures, such as crosstabs, descriptive statistics, logistic and linear regression, and means testing to review differences in variables, the team generates results on topics such as patients' lengths of stay, procedural outcomes, and mortality risk.
Shaw presents initial results to committees and internal cardiovascular task forces at Seton Medical Center. After receiving feedback and ideas on new areas to examine, he returns and mines the data more deeply. With final results in hand, Shaw's team returns to the administrators and physicians. Based on these results, they decide how and where to implement changes to improve patient outcomes.
PASW Statistics has paid for itself many times over. It has enabled us to get and keep managed care contracts and reimbursement contracts worth hundreds of thousands of dollars.
Richard Shaw
Director of Research and Operations
San Francisco Heart Institute
"Reimbursement from Medicare and HMOs is limited by each diagnosis, which also determines the length of stay each will cover. By reducing these patients' lengths of stay by one day, we were able to increase our income by half a million dollars per year," said Shaw. In another example, Shaw referred to his analysis of the coronary stenting procedure. By analyzing the factors involved, the hospital shortened the average stay from seven to three nights. What's more, doctors now place stents more accurately, and patients no longer require a drug that prevented blood clots but also lengthened the recovery period.
Applying the power of PASW Statistics to 20 years' worth of data has enabled the institute to develop risk models—based on 17 readily available patient factors—that other physicians can use to determine a patient's mortality risk. This modeling also enables hospitals to more accurately compare themselves by comparing risk-adjusted data on their patients. As a public service to increase the level of patient care nationwide, the institute offers this risk modeling program free to physicians on its Web site.
PASW Statistics also helps maintain critical accreditation. Every three years, the hospital must receive accreditation from JCAHO, an organization that examines factors such as mortality, morbidity, length of stay, and ways the institution is improving patient care processes. Using PASW Statistics to collect and thoroughly analyze data, Shaw's team is able to help the medical center receive its JCAHO accreditation with relative ease.
Proven ability is one reason Shaw has used PASW Statistics at the institute since 1985. A second reason is ease of use. "PASW Statistics is easy to pick up, and intuitive to operate," he added. When the institute moves its analytical operations to a Microsoft® Windows NT® server, Shaw plans to apply PASW Statistics' distributed analysis architecture to really flex its analytical muscle. Shaw expects this increase in analytical power will help him and his team continue to improve the hospital's patient care, increase revenues, and ensure accreditation for years to come.
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