As more tools for data collection become available, physicians are adopting them in creative but simple ways to improve outcomes for patients. One physician explains how his hospital is leveraging these tools and other sources of data analysis for patient care.
Reducing readmissions with the LACE index
Access to large amounts of data could allow physicians to get to specific actionable needs and gaps, said David Bates, MD, officer and chief of internal medicine and primary care at Brigham and Women’s Hospital in Boston. “We ought to be able to use sources of data to figure out … what’s relevant for individual patients.”
At Brigham and Women’s Hospital, Dr. Bates and his colleagues use a tool based on the LACE index to identify patients that are at risk for readmission or death within 30 days of discharge:
L: Length of stay
A: Acuity of admission
C: Co-morbidities
E: Emergency department visits in last six months
“We take claims data from the last 12 months—there are clinical conditions from a list of about 30 that are categorized high, moderate or low-acuity—then take combinations of conditions from each category to figure out how clinically complex the patient is.”
By using this approach and having a care manager work with these patients, Brigham and Women’s Hospital has been able to decrease their inpatient discharge rate over time, “which is exactly what you’d want to see,” he said.
Tools and data sources to take care one step further
In one trial, Brigham and Women’s Hospital used a device that measures pulse, respiratory rate and how much the patient was moving and decreased the number of subsequent intensive care unit days by 47 percent. “This is the kind of thing that can improve value,” Dr. Bates said.
“Tools are now available to monitor patients, and that’s especially important outside of intensive care units, where we monitor patients fairly aggressively for a long period of time,” he said. “In intensive care units, it will be especially valuable to take all the data that we have and put it together and look for trends.”
Clinical data are now ubiquitous in the U.S. “We have them in over 80 percent of hospitals and also in the outpatient setting,” Dr. Bates said. “Yet most organizations haven’t yet figured out how to best leverage this data, and they don’t have robust plans for doing that.”
Making sure hospitals and practices have the appropriate resources and payment models available will be key. “Every organization will need to invest,” he said. “If there are incentives that pay people for value, they’ll have resources to do that.”
“If you want to look from the bigger picture,” he said, “what is going to help the most at the margin in terms of doing better with these predictions—I think it will be novel sources like social data and mobile data, which will enable us to identify many things that we can’t today.”
For more on data use in practice, find out why one surgeon says medicine needs a cloud, or read how a practice in Minnesota is using patient data to enroll patients in diabetes prevention programs.
