Froedtert & the Medical College of Wisconsin Collaborative for Healthcare Delivery Science (CHDS) Projects

Overview

We are evaluating a the ADOP model to determine its impact on A1c compared to patients not under this model. We are assessing the marginal impact of each component of the program to better tailor diabetes care while also determining its impact on healthcare utilization.

Key Learnings & Impact

• ADOP patients maintained a significant A1c reduction over time compared to the change in the non-ADOP group
• ADOP users show a persistent, significant reduction in both acute and ambulatory care utilization compared to the change in utilization in non-users over time
• ADOP patients who engaged with Glooko had a 23% decrease in A1c compared to 15% decrease for non-Glooko users after 6 months in the program relative to A1c levels 1 month prior to program start

Results Dissemination & Next Steps

• Accepted poster at the 2022 AcademyHealth Annual Research Meeting
• Manuscript preparation underway
• Continuing analysis to determine diminishing returns of program and assess its ROI

In Partnership with F & MCW Office of Population Health

CHDS Lead

Yilu ‘Bill’ Dong, PhD
Pediatrics-Emergency Medicine
CHDS Economist

Project Team
Ryan Hanson, MS
Annie Penlesky, MPH
Mark Lodes, MD
Caitlin Dunn, MHA
Rachel Drury, PharmD
Melissa Emanuel, BA
Nick Olson, PharmD
Jordan Spillane, PharmD

Overview

We randomized implementation of a SNF utilization review (UR) model among 20 local SNFs with the intent of reducing SNF length of stay (LOS) for patients managed under the F & MCW clinically integrated network (CIN).

Anticipated Key Learnings

• Patients managed under the UR model are more likely to meet condition-specific milestones than those not in the UR model
• Patients managed under the UR model will have more coordinated care, promoting more clinically appropriate SNF discharge
• Reduction in the average SNF LOS for CIN patients
• No change in hospital re-admission for UR managed patients

Results Dissemination & Next Steps

• Analysis currently underway
  
  

In Partnership with F & MCW Office of Population Health

CHDS Lead 

Yilu ‘Bill’ Dong, PhD
Pediatrics-Emergency Medicine
CHDS Economist

Project Team
Kathlyn Fletcher, MD, MA
Muska Nataliansyah, PhD, MD, MPH
Liliana Pezzin, PhD, JD
Sid Singh, MD, MS, MBA
Ryan Hanson, MS
Annie Penlesky, MPH
Mark Lodes, MD
Caitlin Dunn, MHA
Diane Ehn, MA
Melissa Emanuel, BA
Anna Riordon, MSW

Overview

The National Institute for Health and Care Excellence evidence-based, multicomponent intervention program outlines 9 best practices for delirium prevention. After deploying all 9 best practice interventions in a stepped-wedge fashion, we seek to understand the marginal and cumulative impact of such interventions on the incidence of delirium as well as the financial impact of delirium reduction.

Key Learnings & Impact

• Each component of the prevention bundle may have varying effects on incidence of delirium
• Delirium prevention may be more impactful dependent upon diagnosis or reason for hospitalization
• Anticipating an overall decreased length of stay when delirium is prevented and/or identified early & decreased cost of care associated with delirium prevention

Next Steps

• Implementation of the multicomponent intervention occurring in a stepped wedge design; once fully implemented, the analysis will begin.

CHDS Lead

Liliana Pezzin, PhD, JD
Institute for Health & Equity
CHDS Economist

Key Clinical Partner

Tom Heinrich, MD
Psychiatry and Behavioral Medicine

Project Team
Yilu ‘Bill’ Dong, PhD
Ryan Hanson, MS
Annie Penlesky, MPH
Debbie Kania
Sandy Glapa

Overview

ECP was established as a comprehensive program to support GIM patients with complex healthcare needs. Recognizing the importance of addressing social determinants of health that often contribute to ongoing health challenges, ECP offered a broad suite of services.

Key Learnings & Impact

• Two variants – intensivist and primary care provider – were compared to each other and to a “control” group to determine the program’s impact on hospital utilization measures
• Our team provided a retrospective record review of the interventions compared to usual care

CHDS Lead

Liliana Pezzin, PhD, JD
Institute for Health & Equity
CHDS Economist

Project Team
Ann Nattinger, MD, MPH
Emily McGinley, MS, MPH
Jeanne Tyszka, MA
Julie Mitchell, MD, MS
Brian Hilgeman, MD
Ted MacKinney, MD
Jeana Holt, DNP, MSN
Mandy Kastner, MPH
Greg Stadter, MPH
Nick Wagner, Data Analyst

Overview

Froedtert Hospital has experienced a higher-than-expected incidence of C. diff infection over the past 5 years, sparking the need for increased surveillance. Our analysis estimates dynamic transmission model parameters to characterize variation in C. diff epidemiology and generate new insights about transmission. We also analyzed how proximity to waste/pollution-generating businesses impacts colonization and infection.

Key Learnings & Impact

• Many patients come into our hospital colonized from home; residential proximity to livestock farms increases likelihood of a positive C. diff test result
• Hospital transmission patterns differ from unit to unit
• Froedtert Hospital changed isolation practices to prevent spread of C. diff; changed testing practices to detect true infection; achieved national #1 rank in patient safety

Results Dissemination

• Results presented at European Congress of Clinical Microbiology & Infectious Diseases in Amsterdam (April 2019)
• Findings published JAMA Network Open, January 2020

View publication

CHDS Lead

Liliana Pezzin, PhD, JD
Institute for Health & Equity
CHDS Economist

Key Clinical Partner
Silvia Munoz-Price, MD, PhD
Medicine-Infectious Disease

Project Team
Ann Nattinger, MD, MPH
Sid Singh, MD, MS
Ryan Hanson, MS
Emily McGinley, MS, MPH
Annie Penlesky, MPH
Kirsten Beyer, PhD, MPH
Sima Namin, PhD
Yang Song, PhD
University of Utah - Dept of Internal Medicine
Informatics, Decision-Enhancement, and Analytics Sciences (IDEAS) Center - VA Salt Lake City Health Care System

Overview

The intent of an early warning system (EWS) is to facilitate early detection of patient deterioration. A commercially available EWS was implemented across Froedtert Health in June 2018. Our team assessed its utility in preventing in-hospital mortality and other indicators of patient deterioration. We analyzed the impact of the EWS on key patient outcomes six months after it was implemented and compared them to the same time period one year prior. Completed concurrently with qualitative assessment – see Inception Health projects.

Key Learnings & Impact

• EWS implementation did not lead to any changes in mortality, rapid response team activation, or Code-4 calls
• Many providers do not find the EWS helpful in their management of patients
• Eliminating the EWS from F & MCW would result in a yearly cost avoidance of over half a million dollars

Results Dissemination

• Presentation at the Vizient Connections Education Summit (September 2020)
• Poster presentation at the International Forum on Quality & Safety in Healthcare in Copenhagen (November 2020)
• Results submitted for publication

CHDS Lead

Sid Singh, MD, MS, MBA
Chief Quality Officer, F & MCW

Key Clinical Partner

Rahul Nanchal, MD, MS
Medicine-Critical Care Medicine

Project Team
Brad Crotty, MD, MPH
Kathlyn Fletcher, MD, MA
Prakash Laud, PhD
Ryan Hanson, MS
Annie Penlesky, MPH
Michael Stadler, MD - Chief Medical Officer
Emilie Braun – MD 2022

Overview

We deployed a centralized, digital outreach strategy utilizing EMR messaging to alert digitally-enabled patients of their eligibility for an AWV. We compared this to AWV completion rates in previous years when only phone outreach was available, also accounting for potential impact on important care disparities.

Key Learnings & Impact

• Patients who received and read the electronic outreach message had a 48% relative increase in scheduling an AWV
• There are many differences between patients who are likely to read the message and who are not likely to read the message
• 10% increase in AWV scheduling during the intervention period compared to previous years
• 300% increase in AWV scheduling for patients of Black race than in previous years; this increase far surpassed that of white patients

Results Dissemination & Next Steps

• Presented at the Vizient Connections Summit in 2022
• Results submitted for publication

In Partnership with F & MCW Office of Population Health

CHDS Lead

Melek Somai, MD, MPH
Principal, Digital Development
Inception Health

Project Team
Brad Crotty, MD, MPH, FACP
Prakash Laud, PhD
Sid Singh, MD, MS, MBA
Ryan Hanson, MS
Annie Penlesky, MPH
Mark Lodes, MD
Caitlin Dunn, MHA
Melissa Emanuel, BA
Ivan Pasillas, MD