Accountable Care Highlights the Value of CLG
Clinical Looking Glass (CLG) is a breakthrough approach to improving outcomes, cost, and care coordination. CLG has helped identify the 58% of diabetics who were not being successfully controlled, leading to targeted outreach activities which reduced the percentage of uncontrolled diabetics by over 1/3. Selected clinicians using CLG to get at blood pressure control have achieved a 15% greater control for blood pressure patients than the average for the organization. CLG confirmed that using Hospitalists was effective in reducing lengths of stay without adversely impacting readmission rates or mortality. Most dramatically, using CLG to reduce health disparities and close gaps in care in a population where almost half the children seen live in poverty and many of the adult patients are uninsured, clinicians have been able to surpass Healthy People 2010 targets.
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An internist with a kidney failure patient, upon learning that a patient’s hematocrit is dangerously high and examining the treatment plan, concludes that the patient has been getting too much erythropoietin, an expensive drug used to treat anemia in kidney failure dialysis patients. The physician knows that large doses of erythropoietin to achieve “normal blood counts” increase mortality and that other, less expensive, drug treatment plans are available. CLG easily allows this physician to identify which other patients may also be getting too much erythropoetin and need to be more carefully monitored for high hematocrit levels.
The result: A large population of patients has their mortality risk reduced.
Aligning Patients with the Right PCP
Primary Care Providers (PCP's) at Montefiore are ultimately responsible for each patient’s care. It is therefore critical to care quality that PCP’s and their panel (list of patients for whom each provider serves as their PCP) be accurate. A panel that is accurately reflected helps to define and equitably distribute the work of the practice, improving access, efficiency and continuity. Proper alignment also allows rational transfer of patients from one PCP to another when a provider enters or leaves a practice.
A Montefiore physician-executive created a CLG study himself - with no need for Analyst or IT assistance - and determined that at a large clinic in the network only 60% of all patients for primary care were in fact aligned with the PCP of record in the EMR, that many patients were assigned to physicians who had left the practice, and that many PCP’s were over-paneled (they had more patients than they could manage) while others were under-paneled.
The result: A patient PCP-reassignment process is initiated in the EMR to insure that patients are assigned to the physicians they are actually seeing and that patient panels are more balanced across providers.
Recent studies from the New England Journal of Medicine have suggested that the use of Avandia may be associated with increased risk of stroke, Acute Myocardial Infarction, and Congestive Heart Failure in patients older than 65.
Using CLG, Montefiore researchers sought to replicate these studies and assess the effect of this medication on the population of patients in the Bronx. The researchers first created two cohorts, one of patients using Avandia over a three year period, the other using a control diabetes medication, Actos, which has not been associated with these co-morbidities, over the same time period.
Using CLG’s Time to Outcome analytic, Montefiore patients in the two groups were found to have no significant difference in subsequent incidence of stroke, AMI, or CHF. This was also true for the composite Time to Event Analysis for all three events. However, the CLG analysis suggested that patients 65 years or older on Avandia did have a higher risk of death.
The Result: In a matter of a few hours, researchers were able to test the validity of recent journal findings for patients in the Bronx. Sharing this information with the academic medical community at large contributes to knowledge of this emerging issue and serves as the basis of remediation programs.