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Texas Health Resources

Using analytics to evaluate clinical outcomes and costs

The situation

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 non-profit healthcare organisation in Texas, USA. It includes 13 hospitals and many senior clinics, diagnostic centres, ambulatory surgery facilities, and chronic care centers. Serving both urban and rural areas, it provides a complex array of primary and acute care services.

The challenge

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 organisation must analyse the relationship of cost to quality so that it can:

The solution

With IBM SPSS Statistics Base*, Texas Health Resources has greatly enhanced its ability to support its process-improvement initiative. Today, it not only detects process variations, but can determine the underlying causes such as a sicker-than-normal patient population.

IBM SPSS Statistics Base enabled us to ask the question and within seconds we had an answer. I've found it's a great interactive tool.

Susan McBride
Director of Outcomes Management
Texas Health Resources

The results

In the mid-1990s, while other organisations were just starting to talk about process-improvement programmes, 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 organisation, Outcomes Management considers such issues as patients’ length-of-stay from a clinical as well as a cost standpoint. For example, if patients leave the hospital sooner, does the re-admission rate rise?
Accurately answering questions like this requires the right data – data that was difficult and costly to obtain when, as it did for many years, Outcomes Management had to base its analyses on paper-based medical abstracts.

When Susan McBride became director of Outcomes Management for Texas Health Resources East in 1997, she realised the need to move to a more efficient, electronic environment. At that time, Texas Health Resources had a 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.

Data quality was improved while data mining costs were reduced by 50 percent

McBride soon realized that the organisation'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.

Says McBride: "Traditionally, the data we used was 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 IBM SPSS Statistics Base, 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, 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 to support four hospitals, while an electronic environment costs less than half that amount – a dramatic difference.

Outcomes for multiple patient populations were evaluated

To see how Outcomes Management uses IBM SPSS Statistics Base 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 post‑operative complications and length of stay. But these technologies are expensive, so the Outcomes Management team decided to analyse whether they actually reduced patients’ 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 organisation'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 this data.

Querying the merged data with IBM SPSS Statistics Base provided a mechanism for examining the impact of a minimally invasive cardiac surgery programme on overall outcomes and cost of care.

Data was available for rapid, interactive quality comparison analysis

Equipped with IBM SPSS Statistics Base, Outcomes Management can also quickly compare the organisation's statistics with new research to evaluate its success in specific areas.

For example, the process-improvement team recently read a report from the Healthcare Advisory Board in Washington, DC, on the incidence of atrial fibrillation among post-operative coronary bypass surgery cases. The team leader met with a clinical co-ordinator for the cardiac department and, after masking the organisation's data for physician and patient confidentiality, they queried the data interactively with IBM SPSS Statistics Base to see how their results measured up to those in the report.

McBride said: "The Advisory Board report was hot off the press, but IBM SPSS Statistics Base enabled us to ask the question and within seconds we had an answer. I've found it's a great interactive tool."

The future: automating and distributing reports across the organisation

Outcomes Management plans to establish a standard system of reporting – including individual physician report cards, quarterly and annual reports – for obstetrics and cardiovascular data. Given the size of the organisation, this project requires total automation of the process, which would be impossible without IBM SPSS Statistics Base.

In obstetrics, for example, Dr Cody Arnold at Texas Health Resources West (formerly Harris-Methodist Health System) determined how much of the variation in Caesarian-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."

Interested in using analytics to evaluate clinical outcomes and costs? Download the Texas Health Resources PDF here.

*IBM SPSS Statistics Base, formerly called SPSS® Statistics Base, is part of SPSS Inc.’s Predictive Analytics Software portfolio.

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