Hundreds of solutions have been created, researched, tested, piloted, developed or adopted through OSF Innovation.
As OSF Innovation celebrates two years of operation, there have been many achievements benefiting OSF HealthCare patients and the communities it serves. Changes in healthcare are moving fast. As a result, it’s fair to say that hundreds of ideas, projects and solutions have been created, researched, tested, piloted, developed or adopted within OSF HealthCare to change healthcare for good. Working in collaborative environments has produced some big wins.
Identifying the Risk of Breast Cancer Sooner
Early detection of breast cancer influences a woman’s chance of survival. The traditional way this is done is through routine mammograms, which typically begin after the age of 40. While this method allows physicians to diagnose patients who have cancer now, it can’t help determine who may be at high risk for the disease in the future.
In 2015, the OSF Innovation Partnerships team collaborated with CancerIQ, a startup out of MATTER in Chicago, Illinois, to pilot its innovative, genetic screening tool that helps identify patients at high risk for breast cancer. CancerIQ is a five-minute online survey that flags vulnerable patients in real time based on a short personal and family history questionnaire. The application gives providers the information they need to quickly investigate the possibility of hereditary cancer for a patient.
The two-year pilot launched at OSF HealthCare Centers for Breast Health in Peoria resulted in the screening of more than 20,000 women—identifying over 5,000 women at high hereditary risk for cancer. The successful test led to the expansion of the CancerIQ screening tool to OSF HealthCare Saint Francis Medical Center in April 2017, where more than 14,000 patients were screened, and 3,300 of those were found to be high-risk. More than 400 of those patients met with a genetic specialist, and 25 tested positive for a genetic mutation that dramatically increases their chance of developing cancer.
Armed with this knowledge, patients facing a high risk for breast cancer are given multiple options moving forward. This includes increased screenings, the possibility of taking a medication that can prevent cancer from emerging, or referrals to a breast surgeon. In total, more than 300 patients in the Peoria area are getting the care they need to reduce and manage their cancer risk.
OSF HealthCare Saint Anthony Medical Center in Rockford, Illinois, is the most recent facility to offer CancerIQ, where more than 6,000 patients have been screened and 1,500 patients identified as high-risk. More than 320 patients have been seen by a genetic specialist; 24 patients tested positive for a genetic mutation; and 136 patients have had a change in their medical management to reduce their cancer risk.
Identifying Those At Risk for Hospital Readmissions
OSF HealthCare focuses on projects that will allow it to continue serving patients with the greatest care and love, as it has for more than 140 years. Among these important initiatives is keeping patients from being readmitted into the hospital within 30 days of discharge. This means clinicians not only have to determine who is most at risk for readmission, they also have to make sure these patients have the understanding, support and ability to care for themselves outside of the hospital.
To make it easier to identify those at risk for hospital readmissions, OSF HealthCare required nurses to assess patients using a questionnaire within their electronic health record (EHR). However, that approach was found to take a significant amount of nurse time. This led the Healthcare Analytics team at OSF HealthCare to develop an easier way to proactively identify patients needing help to reduce their risk of hospital readmissions. The group built a predictive model that uses many variables from data within the EHR and automatically identifies at-risk patients in four levels:
- Low risk: about 55 percent of discharges, with a readmission rate of about four percent;
- Medium-low risk: about 22 percent of discharges, with a readmission rate of about 11 percent;
- Medium-high risk: about 16 percent of discharges, with a readmission rate of about 18 percent;
- High risk: about seven percent of discharges, with a readmission rate of about 30 percent.
This made it easier for clinicians to provide case management resources to the most at-risk patients. As the utility and effectiveness of the model was proven, this data was incorporated into clinicians’ daily workflows, reducing the potential barrier to use.
Over the course of a year, this resulted in about 425 fewer readmissions than expected in medium-high and high-risk patients. The team also found it was able to reduce about 67 percent of nursing assessment activities and decrease the flow into case management by about 44 percent. These staff time reductions translate to a little more than $2 million per year that can be put back into direct patient care.
The model has been in active use for more than three years. While it started as a way to help direct case management activities inside the hospital, use of the model has expanded to provide work direction assistance to inpatient case management, ambulatory care management, follow-up phone calls, outpatient palliative care and homecare reporting/monitoring.
The Impact of Knowing a Patient’s Wishes
Patients face a variety of choices near the end of life, including preferences on pain control, whether to receive palliative care or life-prolonging treatment, and perhaps most importantly, choosing a surrogate to make care decisions. While these discussions are often difficult, making treatment preferences known to family and healthcare providers decreases the chance of unwanted interventions and increases the chance for a greater quality of life for patients.
OSF HealthCare launched OSF Care Decisions, an advance care planning (ACP) model that uses trained facilitators to help patients and their families have end-of-life care discussions. Jump Simulation, a part of OSF Innovation, helps train ACP facilitators, most of whom are nurses or social workers, to discuss these options—boosting their knowledge, confidence and competence to handle difficult conversations.
A Jump study published in the Journal of Palliative Medicine in 2017 found simulation training to be instrumental in positively shaping facilitators for ACP. More than 70 percent of learners felt the ACP simulation program met their expectations “to a great extent”—their knowledge scores increased from 83 percent to 92 percent. Following the training, facilitators who underwent simulation also averaged 3.87 ACPs per month, a 121-percent increase from FY 2014.
A collaborative Jump research study in late 2017 found that ACP leads to improved documentation of a patient’s end-of-life wishes, including choosing a health care power of attorney (HCPOA) and having a decision on file (POLST forms) that helps guide clinicians on resuscitative efforts.
Using Accountable Care Organization (ACO) data, 98.5 percent of patients who completed ACP chose a HCPOA, while only 75 percent of those without ACP made this designation. Meanwhile 53 percent of patients who went through ACP had POLST forms, while 45 percent of those without ACP completed the forms. The research also found that those who had ACP had fewer in-patient admissions and in-patient days. ACP was associated with overall costs that were $9,500 lower, and there was still a savings of more than $4,800 per patient after factoring in the costs of the program.
And More to Come…
This is just a small sample of what OSF Innovation has achieved in the last couple of years and there is still much more to come. OSF HealthCare recently became the first corporate partner with the University of Illinois System-led Discovery Partners Institute, an interdisciplinary public-private research institute in Chicago and hub of the Illinois Innovation Network.
As a partner, OSF HealthCare has located an OSF Innovation Lab at the University of Illinois Chicago (UIC) where students will work with the complex innovation solution team at OSF Innovation to create new methods, tools and technologies to care for the most vulnerable populations.
The OSF Innovation Lab will be an integral part of the ongoing efforts of OSF Innovation to pursue innovative solutions in the areas of removing barriers to healthcare for the most vulnerable individuals, giving older adults the ability to age gracefully at home, and fostering healthcare ideas beyond the hospital setting. iBi
Becky Buchen is senior vice president for OSF Innovation operations. To read more about OSF Innovation projects, visit osfinnovation.org.