US Health Care: Half Right. Thomas L. Garthwaite, MD Director and Chief Medical Officer Department of Health Services County of Los Angeles USC Health.

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Presentation transcript:

US Health Care: Half Right. Thomas L. Garthwaite, MD Director and Chief Medical Officer Department of Health Services County of Los Angeles USC Health Collaborative Retreat October 19, 2005

Reducing Variation: From Evidence to Practice… Patient With Need Patient Need Met Possess Knowledge Operationalize Knowledge Pneumococcal Pneumonia Vaccination Indications Performance Measurement & Accountability + Supporting Technologies Computerized Health Information System  System Changes Closing the Quality Chasm

Vaccine Cuts Pneumonia Risk in High-Risk Patients Archives of Internal Medicine 1999;159: Dr. Kristin Nichol, VAMC / Minneapolis  50% of elderly Americans / high-risk individuals have not received the pneumococcal vaccine.  VAMC study of 1,900 elderly patients with chronic lung disease ; 2/3 vaccinated against pneumonia.  Pneumococcal vaccination:  43% reduction in hospitalizations for pneumonia and influenza  29% reduction in the risk of death.  Pneumonia and Influenza vaccination:  72% reduction in hospitalizations for these two diseases  82% reduction in deaths from all causes.  Pneumococcal vaccination saved an average of $294 per vaccine recipient over the 2-year period.

Pneumonia: Acute Inpatient DRG89-90; Unadjusted for Pt. Population (up 20%, FY99-01) Improving Efficiency by Reducing Excess Health Care Utilization 9,500 fewer bed days 8,000 fewer discharges Effective, Efficient

Pneumococcal Vaccination Rates Iowa: Petersen, Med Care 1999;37: >65/ch dz HHS: National Health Interview Survey, >64

Performance Measurement Setting the U.S. Benchmark for 18 Comparable Indicators Clinical IndicatorVA 2003Medicare 03Best Not VA or Medicare Advised Tobacco Cessation (VA x3, others x1) (NCQA 2002) Beta Blocker after MI (NCQA 2002) Breast Cancer Screening (NCQA 2002) Cervical Cancer Screening (NCQA 2002) Cholesterol Screening (all pts)91NA73 (BRFSS 2001) Cholesterol Screening (post MI) (NCQA 2002) LDL Cholesterol <130 post MI (NCQA 2002) Colorectal Cancer Screening67NA49 (BRFSS 2002) Diabetes Hgb A1c checked past year (NCQA 2002) Diabetes Hgb A1c > 9.5 (lower is better)15NA34 (NCQA 2002) Diabetes LDL Measured (NCQA 2002) Diabetes LDL < (NCQA 2002) Diabetes Eye Exam (NCQA 2002) Diabetes Kidney Function (NCQA 2002) Hypertension: BP < 140/ (NCQA 2002) Influenza Immunization76P68 (BRFSS 2002) Pneumocooccal Immunization90P63 (BRFSS 2002) Mental Health F/U 30 D post D/C (NCQA 2002)

Home-Telehealth Technologies

Low-Tech Hi Tech  Single Dialogues  HTN, COPD, DM, CHF, Cancer Care, Depression, Chronic pain, HIV, Hep C, Anticoagulation, Bi-polar Disorder  Dual Dialogues  HTN/COPD  DM/CHF  DM/HTN  CAD/Angina  HTN/Hyperlipidemia (Spanish)  CHF/Hyperlipidemia (Spanish)  Trialogue  HTN/CHF/DM

Improved Utilization ServicesCare Coordination Usual care Clinic visits+30%+15% ER visits-36%+11% Admissions-46%+7% BDOC-61%+8% Ext Admissions-47%+65% BDOC-81%+68%

Move to Los Angeles  800,000 patients  Billion $$$ deficits  Multiple languages  Acute infections & public health  King/Drew  Press  No incentives  Personnel, union, etc.

Percent who received an LDL cholesterol test in the past 12 months among adult diabetic patients with three or more outpatient visits in the past year 25% Improvement

Percent of asthmatic children with at least three outpatient or ED visits and a subsequent DHS admission for asthma 19% Improvement

Percent of asthmatic children with at least three outpatient or ED visits and a subsequent DHS ED visit for asthma 22% Improvement

Percent with documentation of site verification in chart among OR patients receiving left-right specific surgery 27% Improvement

Percent of approved Medicare accounts that are unbilled over 150 days from outpatient services 24% Improvement

Draft 10/14/2004

* Note: Fourth quarter data for MLK/Drew is preliminary.

Draft 10/14/2004

Reducing Variation: From Evidence to Practice… Patient With Need Patient Need Met Possess Knowledge Operationalize Knowledge Pneumococcal Pneumonia Vaccination Indications Performance Measurement & Accountability + Supporting Technologies Computerized Health Information System  System Changes Closing the Quality Chasm