Ascension Health Research Articles

Abstract PO4-09-07: Overall Survival According to Race and Socioeconomic Status Among Women Treated for BreastCancer at Ascension Health Hospitals in Metropolitan Detroit

Abstract Background: Despite increasing public awareness and education regarding racial inequality, African American (AA) patients continue to carry higher likelihood of death from breast cancer due to both cancer phenotype and remediable factors of access to care and socioeconomic status. Patients and Methods: We identified 3,241 patients treated for breast cancer between 2006 and 2015 at Ascension St John Hospital (Detroit MI), Ascension Macomb Oakland Hospital (Warren MI) and Ascension Providence Hospital (Southfield MI). Of these, 2530 (78.1%) were categorized as White (W), 658 (20.3%) as African American (AA), and 53 (1.6%) as Other. We considered known risk factors of race and zip code as well as marital status and having any Medicaid insurance (7.4%). 58.55% of patients were married, 15.88% never married, 13.9% widowed, and 11.6% divorced or separated. There were 632 (19.5%) cases represented from the 50 most affluent zip codes in Michigan (median income $83,125 to $140,372), 400 (12.3%) from the 50 least affluent zip codes (median income $14,909 to $33,500), 2199 (67.8%) from the intermediate zip codes, and 10 (0.31%) unknown or out of state. Tumors subtypes were 62% Luminal A (HR+/HER2-), 9.5% Basal (HR-/HER2-), 3.74% Her2 Enriched (HR-/HER2+), and 8% Triple Positive (HR+/HER2+). There were 279 Stage T0 Receptor positive DCIS and 64 Receptor Negative DCIS. 57.3% had lumpectomy or partial mastectomy as the first course of surgery, 27.9% had some form of mastectomy and 14.7 percent mastectomy with reconstruction. SAS for Windows 9.4, Cary, NC and Tableau 2023.1 was used for descriptive and crude analysis. Results: As expected overall survival was highly statistically associated (p< 0.0001) with the variables: age, race, subtype, node positivity and AJCC pathologic stage. Socioeconomic risk factors including zip code (p< 0.0001), marital status (p=0.0006), and carrying Medicaid insurance (p< 0.0001) statistically influenced overall survival. When considering the 50 most affluent zip codes, just 3.79% were African American (AA), with a greater proportion diagnosed at Stage I (49.85%) as compared to the 50 least affluent zip codes (81.97% AA; 37.74% Stage I, p= 0.022). Conclusions: As expected, breast cancer survival was influenced by race, tumor, and patient characteristics. This analysis allows for evaluation of the relative influence of biologic factors (e.g.tumor subtype and cancer stage) and socioeconomic indicators including zip code (stratified by median income) and insurance status. Citation Format: Shaveena Sivapalan, Khalid Berdi, Ali Shamsa, Maria Vlachaki, Aye Thet, Jeffrey Falk, Carrie Dul, Paul Chuba. Overall Survival According to Race and Socioeconomic Status Among Women Treated for BreastCancer at Ascension Health Hospitals in Metropolitan Detroit [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-07.

Abstract 34: Social Risks, Glycemic Control and Elevated Blood Pressure Among Patients With Diabetes in the Ascension Health System

Background: Calls to address social risks have stimulated interest in integrating screening measures into the electronic medical record (EMR) - particularly, self-reported individual level social risks - to improve care for chronic diseases like diabetes (DM). Objective: Examine associations between individual-level social risks and glycemic control and elevated blood pressure (BP) among patients with DM in the Ascension Health System. Methods: A 10-item EMR-embedded survey [access to care, resources, transportation, employment] was collected in Ascension primary care clinics in 12 U.S. states. Neighborhood-level risk was characterized with the CDC Social Vulnerability index (SVI) by census tract of patients’ residences. Associations between social risk (individual/composite) and uncontrolled DM (HbA1c >9%) and elevated BP (>120/80) adjusting for age, sex, race/ethnicity, SVI, region, and chronic conditions were examined. Results: Among 75,848 patients with DM and social risk data available [median age 62, 53% female, 22% Black, 7.5% Hispanic]. 20% had poor glycemic control; 27% had elevated BP; 20% lived in a high SVI census tract. Patients identifying any social risk were more likely to have poor glycemic or elevated BP. Patients with the highest social risk scores had higher odds of uncontrolled glycemia (OR 1.72, 95% CI 1.60-1.85) and elevated BP (OR 1.18, 95% CI 1.10-1.26). Conclusion: Examination of a large sample of primary care patients in a large multi-region health system determined that individual-level social risks were correlated with glycemic and BP control. These data highlight the need to simultaneously address social risks and medical conditions to impact population health.

Implant efficiency and clinical performance of Aveir™ VR and Micra™ VR leadless pacemaker: A multicenter comparative analysis of 67 patients.

Leadless pacemaker (LP) is a novel pacemaker that has been proven to be effective and safe; however, the majority of LPs in previous reports were the Medtronic Micra™ VR LP. We aim to evaluate the implant efficiency and clinical performance of the Aveir™ VR LP compared to the Micra™ VR LP. We performed a retrospective analysis in two healthcare systems (Sparrow Hospital and Ascension Health System, Michigan) in patients implanted with LPs between January 1, 2018, and April 1, 2022. The parameters were collected at implantation, 3 months and 6 months. A total of 67 patients were included in the study. The Micra™ VR group had shorter time in the electrophysiology lab (41±12 vs. 55±11.5 min, p=.008) and shorter fluoroscopic time (6.5±2.2 vs. 11.5±4.5 min, p<.001) compared to the Aveir™ VR group. The Aveir™ VR group had a significantly higher implant pacing threshold compared to the Micra™ VR group (0.74±0.34mA vs. 0.5±0.18mA at pulse width 0.4ms, p<.001), but no difference was found at 3 months and 6 months. There was no significant difference in the R-wave sensing and impedance and pacing percentage at implantation, 3 months, and 6 months. Complications of the procedure were rare. The mean projected longevity of the Aveir™ VR group was longer than the Micra™ VR group (18.8±4.3 vs. 7.7±0.75 years, p<.001). Implantation of the Aveir™ VR required longer laboratory and fluoroscopic time, but showed longer longevity at 6 months follow-up, compare to the Micra™ VR. Complications and lead dislodgement are rare.

Hydrocortisone vs. Vasopressin for the Management of Adults Patients with Septic Shock Refractory to Norepinephrine: A Multicenter Retrospective Study.

Significant practice variation exists when selecting between hydrocortisone and vasopressin as second line agents in patients with septic shock in need of escalating doses of norepinephrine. The goal of this study was to assess differences in clinical outcomes between these two agents. This was a multicenter, retrospective, observational study conducted across ten hospitals within Ascension Health. Adult patients with presumed septic shock receiving norepinephrine prior to initiation of hydrocortisone or vasopressin between December 2015 and August 2021 were assessed for inclusion. The primary outcome, mortality within 28 days of study drug initiation, was assessed using multivariable logistic regression and propensity score matching performed with a 1:1 ratio. A total of 768 patients were included with a median (interquartile range) SOFA score of 10 (8-13), norepinephrine dose of 0.3 mcg/kg/min (0.1-0.5 mcg/kg/min), and lactate of 3.8 mmol/L (2.4-7.0 mmol/L) at initiation of the study drug. A significant difference in 28-day mortality was noted favoring hydrocortisone as an adjunct to norepinephrine after controlling for potential confounding factors (OR 0.46 [95% CI, 0.32-0.66]); similar results were seen following propensity score matching. Compared to vasopressin, hydrocortisone initiation was also associated with a higher rate of hemodynamic responsiveness (91.9% vs. 68.2%, p<0.01), improved resolution of shock (68.8% vs. 31.5%, p<0.01), and reduced recurrence of shock within 72 hours (8.7% vs. 20.7%, p<0.01). Addition of hydrocortisone to norepinephrine was associated with a lower 28-day mortality in patients with septic shock, compared to the addition of vasopressin.

PO-05-017 IMPLANT EFFICIENCY AND CLINICAL PERFORMANCE OF AVEIR VR AND MICRA VR LEADLESS PACEMAKER: A MULTICENTER COMPARATIVE ANALYSIS OF 67 PATIENTS

Leadless pacemaker (LP) is a novel pacemaker that has been proven to be effective and safe in many real-world studies; however, the majority of LPs in previous reports were the Medtronic Micra leadless system. We aim to evaluate the efficiency and clinical performance of the Aveir leadless system, a newer LP model, compared to the Micra leadless system. We performed a retrospective analysis of patients in two health care systems (Sparrow Hospital and Ascension Health System, Michigan) who were implanted with LPs between January 1, 2018, and April 1, 2022. Patient characteristics including age, sex, and BMI were collected. The LPs parameters were collected at implantation, 3 months, and 6 months. Wilcoxon rank sum test and Fisher's exact test were used to analyze the data. A total of 67 patients were included in the study, with 41 patients received Micra VR implantation and 26 patients received Aveir VR implantation. All patients completed their 6 months follow up. The mean age was 77 years (SD = 11.6) in the Micra group and 65.7 years (SD = 11.8) in the Aveir group. The mean time in the electrophysiology lab was 41 minutes (SD = 12) in the Micra group and 55 minutes (SD = 11.5) in the Aveir group, with a p-value of 0.008. The mean fluoroscopic time was 6.5 minutes (SD = 2.2) in the Micra group and 11.5 minutes (SD = 4.5) in the Aveir group, with a p-value of < 0.001. The Aveir group had a significantly higher implant pacing threshold compared to the Micra group (0.74 ± 0.34 mA. at pulse width 0.4, 0.5±0.18 mA. at pulse width 0.4, p<0.001), but no difference was found at 3 months and 6 months afterward. There was no significant difference in the R-wave sensing and impedance and pacing percentage at implantation, 3 months, and 6 months follow up. Complication of the procedure include vascular hematoma required surgical intervention in one patient of each group and no lead dislodgement was noted in either group at 6 months. The mean longevity of the Aveir group was significantly longer than the Micra group (18.8 ± 4.3 years versus 7.7 ± 0.75 years, p<0.001). Implantation of Aveir VR requires significantly longer laboratory and fluoroscopic time than in Micra VR , however, Micra VR has much shorter longevity than Aveir VR at 6 months follow up even though pacing percentage are not significantly different. Complications and lead dislodgement are rare. Larger study is necessary to confirm these findings

Randomized Trials Fit for the 21st Century: A Joint Opinion From the European Society of Cardiology, American Heart Association, American College of Cardiology, and the World Heart Federation.

Randomized Trials Fit for the 21st Century: A Joint Opinion From the European Society of Cardiology, American Heart Association, American College of Cardiology, and the World Heart Federation.

Abstract 11930: Ascension Health System Experience With Extended Ambulatory Electrocardiographic Monitoring: Implementation of a Novel Integrated Approach to Better Characterize Disparities in Healthcare

Introduction: Atrial fibrillation (AF) is an established risk factor for stroke, hospitalization and mortality. Whether AF differs by race has not been well characterized in the real world setting due to inherent challenges in linking large datasets across multiple databases. Methods: Extended ambulatory electrocardiographic (AECG) monitoring with Zio XT allows for continuous recording of cardiac rhythm data for up to 14 days in indicated patients. A preliminary dataset from the Ascension Health System electronic health records (EHR) archive on patients prescribed the Zio XT patch was retrospectively analyzed. The study population consisted of 6,293 patients treated at 34 Ascension centers in 6 states between January 2020 and April 2022. Patient EHR data were linked to proprietary device-specific rhythm reports for analyses. Results: Among 6,293 patients in whom EHR data were matched to Zio XT findings, the median (IQR) age was 63 (47, 73) years, 3,816 (60.6%) were female, and 1,038 (16.5%) were non-Caucasian. Median device wear time was 7.2 (5.0, 13.9) days. AF was detected in 749 (11.9%) patients, including 326 (5.2%) with 100% AF. Median AF burden was 37.0% (3.4%, 100%). Older white males had the highest risk of AF events, whereas younger non-white females had the lowest risk (Figure 1). Non-white subgroups demonstrated greater freedom from AF compared to whites. Conclusions: In these preliminary findings, the use of Zio XT for extended AECG monitoring in the Ascension Health System is in predominantly older patients. Patients were racially and geographically diverse, and females were well represented. More than 10% of patients had AF detected during the monitoring period. Despite small sample sizes, differences in AF detection by subgroups demonstrate that a tailored approach to managing AF remains a critically important research question. Linkage of patient EHR data with device-specific outcomes can be a useful approach to address this important unmet need.

Effect of Text Message Reminders and Vaccine Reservations on Adherence to a Health System COVID-19 Vaccination Policy

Many organizations implemented COVID-19 vaccination requirements during the pandemic, but the best way to increase adherence to these policies is unknown. To evaluate if behavioral nudges delivered through text messages could accelerate adherence to a health system's COVID-19 vaccination policy. This randomized clinical trial was conducted within Ascension health system from October 11 to November 8, 2021. Participants included health system employees in the Midwest or South US who were not adherent with the vaccination policy 1 month before its deadline. Data were analyzed from November 17, 2021, to February 25, 2022. Participants were randomly assigned to control or to receive a text message intervention that stated a vaccine had been reserved for the participant, with a scheduled date for vaccination within a 2-week period. Participants could reschedule to a different date within the period or upload a copy of their vaccination card. Follow-up text message reminders were sent the day before and the day of the appointment. The primary outcome was adherence to the health system's vaccination policy during the 2-week intervention. Secondary outcomes included time to vaccination during a 4-week follow-up period. The sample included 2000 participants (mean [SD] age, 36.4 [12.3] years; 1724 [86.2%] women), with 1000 participants randomized to the control group and 1000 participants randomized to the intervention group. Overall, there were 164 Hispanic participants (8.2%), 46 non-Hispanic Asian participants (2.3%), 202 non-Hispanic Black participants (10.1%), and 1418 non-Hispanic White participants (70.9%). By the end of the 2-week intervention, 363 participants in the text message nudge group (36.3%) and 318 participants in the control group (31.8%) were adherent with the vaccination policy, representing a significant increase of 4.9 (95% CI, 0.8 to 9.1) percentage points in adjusted analyses comparing the nudge group with the control group (P = .02). Among participants who became adherent by the end of the 4-week follow-up period, the text message nudge significantly reduced time to adherence by a mean of 2.4 (95% CI, 2.1 to 4.7) days (P < .001) and a median of 5.0 (95% CI, 2.5 to 7.7) days (P < .001) compared with the control group. At 4 weeks, overall vaccination adherence was no longer different between groups (control: 477 participants [47.7%]; intervention: 472 participants [47.2%]). This randomized clinical trial found that a behavioral nudge delivered through text messages accelerated adherence to a health system's COVID-19 vaccination policy but did change overall adherence by the time of the policy deadline. ClinicalTrials.gov Identifier: NCT05037201.

The changing face of spiritual care: current developments in telechaplaincy.

In recent years, and particularly since the Covid-19 pandemic, telehealth has been rapidly introduced into U.S. healthcare institutions. While preliminary data and best practices are beginning to emerge, it remains unclear how chaplains are responding to this development in practice. Consequently, professional organizations have tended to lag behind the changing demands of increasingly digital professional environments. This article addresses this gap by presenting three case studies of U.S. healthcare settings where chaplains have become an integral component of telehealth infrastructure: the Mercy system, Ascension Health, and the Veteran's Health Administration of the U.S. Department of Veteran Affairs. Based on interviews with chaplains and directors of chaplaincy departments, it shows how the ‘telechaplains’ at these institutions have adapted to the introduction of telehealth across the continuum of care, and discusses the legal, economic, practical and theological challenges and hopes reported in each case.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

1210 Implementation of Stress Ulcer Prophylaxis Appropriate Use Criteria in a Community Hospital

INTRODUCTION: Upper gastrointestinal stress ulcer formation is a potential risk for critically ill hospitalized patients. Due to this, SUP is an important preventative measure for at risk patients. Stress ulcer medications such as PPIs and H2 blockers do come with potential side effects.1,2 A widely accepted guideline was written by the American Society of Health System Pharmacists which along with similar variations continue to be used today.3,4 One such guideline has been implemented within the Ascension Health System (Figure 1). Despite guidelines, inappropriate administration continues to be a common problem. Studies show rates of inappropriate administration anywhere from 20 to 70 percent.5–9 A discrepancy in knowledge from providers leads to inappropriate prescribing of SUP medications. Administration of these laminated cards will improve appropriate administration of the medications. METHODS: Laminated cards were dispersed to fit on ID badges of IM and FP residents which following the Ascension SUP guidelines. Data was collected on all patients admitted under the core faculty of an IM or FP attending between 7/1/18–9/30/18 and 11/1/18–1/31/19. 10/1/19-10/31/19 constituted the run-in period. Patients were excluded if they had active diagnoses of GERD, PUD, H. Pylori. Eligible patients' charts were reviewed at random by using an online number generator. The A&amp;P section of the H&amp;P note was reviewed to determine if SUP was was appropriately administered, appropriately held, inappropriately administered, or inappropriately held. Any discrepancies were reviewed by the principal investigator. A t-test was performed to determine if statistical significance was achieved. RESULTS: There were 124 and 115 patients in the pre and post-intervention period respectively. There was an overall improvement of 5.64% (P = 0.21) after distribution of cards (Figure 1). Inappropriately given SUP use improved by 5.01% (P = 0.22). Inappropriately held SUP use improved by 0.61% (P = 0.78). CONCLUSION: Administration of cards improved appropriate prescribing. The cards provided a resource to aid in enhancing knowledge and on-the-go decision making. The availability of implementing these guidelines or similar such protocols using EMR may be more effective in reaching a wider audience of physicians and provide a consistent effect on prescribing habits.

Build It and They Will Come: Outcomes of Developing a Palliative Care Identification and Machine Learning Algorithm (FR403)

•Discuss how development of a software tool can drive development of inpatient and outpatient palliative care programs.•Discuss Algorithms 101.•Discuss ‘lessons learned’ and results of going live with a Palliative Care Algorithm in the acute care setting. One of the largest barriers for seriously ill patients, is timely identification of Palliative Care needs. In the acute care setting, many admitting and consulting physicians struggle with identification of appropriate patients. Intermountain Healthcare and Ascension Health, in collaboration with an electronic medical record company, developed an electronic Palliative Care identification algorithm, or trigger, which leverages historical and near real-time data to identify patients that would benefit from Palliative Care services. This project allowed several iterations of the algorithm, which ran in ‘silent mode’ in the electronic medical record. Over time, accuracy has improved with a current positive predictive value of 80%. It has identified nearly 26% of this 310 bed hospital’s adult population as appropriate for Palliative Care services. This algorithm led to accurate data for program development and resource allocation at Intermountain Healthcare. Ascension’s St. John Providence Hospital has utilized this same Palliative Care identification algorithm in a live clinical setting since April 2017. Many lessons were learned at both the algorithm development and the deployment state which can benefit others hoping to utilize similar methods. Due to the high volume of patients and staffing capacity of most palliative care programs, risk stratification for identified patients will be necessary. Therefore, development is underway for a machine learning algorithm to help assign a risk score to each patient identified as appropriate for palliative care services. This stratification will allow for appropriate resource allocation, identification and education about primary Palliative Care, and further adjustments to the electronic solution to help embed Palliative Care throughout the healthcare continuum. This presentation reviews the current state of an ongoing collaborative project between a major electronic medical record company and multiple large healthcare systems, as well as the lessons learned in the technology and healthcare delivery industries.

Patient and family/carer experiences of their involvement in a regional quality improvement collaborative utilizing the SSKIN care bundle

Introduction: In Ireland, a regional quality improvement collaborative was established within the Health Service Executive (HSE) entitled ‘Pressure Ulcers to Zero’, utilizing the SSKIN care bundle1. As the involvement of patient and family/carer is a central component of health care delivery, this study set out to explore the patient and family/carer experiences and involvement within the collaborative including use of the SSKIN care bundle. Methods: A qualitative descriptive approach was adopted. Three main healthcare settings were involved in the collaborative (acute /specialist, residential and primary care). One unit from each of these settings was purposively selected to participate. Following ethical approval and written informed consent, data were collected over a 6 week period using semi-structured, one to one interviews with patients, and focus group interviews with family members/carers. Twenty-five persons agreed to participate; 16 patients, with varying levels of dependency, and 9 family members/carers. Results: Data were analysed using Colaizzi’s Framework2, 5 main themes with corresponding subthemes emerged from the analysis: awareness, patient and family/carer involvement, ‘prevention is better than cure’, ‘communication is key’ and resources in prevention. Discussions: Both patients and family/carer had limited involvement in PU prevention within the collaborative. Further, a general lack of awareness of the SSKIN care bundle was identified. Participants expressed the desire to be more involved in PU prevention, henceforth, empowering patients and family/carers through education and communication may increase their level of involvement. Conclusion: Educating patients and families/carers on PU prevention through utilization of the SSKIN care bundle may facilitate a greater willingness of the patient and family/carer to participate in PU prevention. Lessons Learned: The unique findings of this research study have significant meaning for future collaboratives, where collaborative techniques adopted such as acronyms and activities, require a patient as well as a professional focus. Limitations: The data obtained reflects the perceptions of a small number of representatives across 3 sites within the regional collaborative, where overall there were 21 participating sites. Furthermore, there was some confusion among study participants surrounding the acronym ‘SSKIN’ which necessitated the interview question scheduling to be adapted to allow for a discussion on each element of ‘SSKIN’. Suggestions for Future Research: Exploring health care professionals experiences of the collaborative may determine their perceptions of involving patients and family/carers in PU prevention. Also, with much confusion surrounding the acronym ‘SSKIN’, there is a need to explore patients and family/carers understanding and preferences on the use of an acronym compared to a word process care bundle. Performing research on the appropriate timing of providing PU information to patients and family/carers could prove beneficial in earlier, timely PU prevention interventions.

Now or Never: Making the Commitment to Value-Based Reimbursement

THE MARKET HAS spoken. Healthcare is too fragmented, inconsistent, redundant, and expensive. With a slew of value-based reimbursement reforms marching across the healthcare landscape, a fundamental shift is beginning to take hold. In their feature article, Henkel and Maryland point out that Ascension Health in St. Louis, Missouri, realized that a payment inflection point was bearing down faster than anticipated, stimulating them to make a bold commitment to building a value-based system. Similarly, Kuhn and Lehn relate how Banner Health Network (BHN), in Phoenix, Arizona, seized the initiative by volunteering for the Pioneer accountable care organization (ACO) program. Understanding the magnitude of the undertaking, both organizations realized that a significant investment was needed to transform the management of patient communities. Taking action ahead of competitors is risky, as any early adopter can attest, and it is not without setbacks and lessons learned. However, the accelerating pace of change is demanding action as payment innovations, which are beginning to yield cost and quality results, redefine the revenue model. Although the levels of these payments are currently marginal, the rise of consumerism brought about by exchanges and narrow networks is spurring a redesign of the care model. A tipping point will come when the bulk of revenue shifts from volume to value, as we discovered at Carroll Hospital Center in Westminster, Maryland, when we volunteered to participate in an experimental payment program.Many executives are struggling with the question of how legacy healthcare organizations should reinvent themselves to thrive under value-based reimbursement. Without question, underlying quality incentives-avoidable readmissions, process-of-care improvements, and disease management outcomes-are objectives that hospitals and healthcare systems should already be pursuing. Strategists and planners are grappling with the future business model even as current volume-based revenue continues to be the driver in most markets. Under diagnosis-related group case rates, hospitals have been fairly successful in driving down unit costs. Yet, the major gains will come from utilization management. This is the tricky strategic question: how and when to embrace a shrinking inpatient enterprise?The feature articles in this issue describe two organizations that anticipated the future and created it, often at great peril to existing business models. Unlike volumebased payment systems that fail to reward high-quality, low-cost providers, value-based reimbursement fosters real competition. Kuhn and Lehn describe how BHN stepped forward as a Pioneer ACO and garnered success in a program that has not proven to be a panacea for all, in light of the fact that about one-third of original members have dropped out. Sensing the impending impact of valuebased reimbursement, Henkel and Maryland describe how Ascension redirected resources to building MissionPoint Health Partners, a provider-sponsored organization that identifies high utilizers and develops focused care management for patients with chronic disease. Both organizations understood that the forces driving change were not only inevitable but welcome, because change would encourage and reward improvements in health and enhancement of patient experience at a reasonable cost.Inherent in these case studies are key success principles in value-based reimbursement: making the infrastructure commitment, transforming the cost structure, and collaborating across the healthcare delivery spectrum.MAKING THE VALUE COMMITMENTFor Carroll Hospital Center, the opportunity to make the value commitment came early, even before passage of the Affordable Care Act. In 2009, the state of Maryland rolled out a value-based reimbursement system that focused on potentially preventable conditions, core measures, and patient experience of care. Owing to its unique payment system, Maryland has become a hotbed of innovation. …

The effect of bivalirudin and closure device on bleeding outcomes after percutaneous coronary interventions.

IntroductionStudies have demonstrated bivalirudin efficacy in some patients at increased risk of bleeding. The aim of this study was to determine the extent to which bleeding reduction is achieved among all patients using bivalirudin as compared with a heparin with or without 2B3A inhibitor strategy.MethodsThis is a real-world, large-scale retrospective study utilising the American College of Cardiology (ACC) data from a 37-hospital Ascension Health System. The registry represents routine clinical practice between 1 June 2009 and 30 June 2012. End points included major bleeding, major adverse cardiac events and death. Multivariate regression analysis modelled on predictors of end points.ResultsThis study included 58 862 PCI procedures. Major bleeding rates were lowest for bivalirudin plus closure device overall (OR=0.53, CI 0.21 to 0.84, p=0.001). The use of a device for access closure contributed to the greatest declines in major bleeding. Compared with heparin with device, bivalirudin with device had a significantly lower rate of bleeding (OR=0.37, CI 0.18 to 0.74, p=0.005). The use of device had a greater effect on decreasing bleeding among patients receiving bivalirudin compared with heparin, especially among women (p=0.001). After adjustment for 2B3A use, this advantage was no longer significant in ST segment elevation myocardial infarction patients (OR=1.8, CI 0.5 to 6.0, p=0.34).ConclusionsAll risk groups in this real world database representing current clinical practice benefited from the use of bivalirudin and device closure with lower risk groups benefiting the most. This robust analysis of real-world clinical data supports a combined treatment strategy of bivalirudin and closure device.

Evaluation of Process Improvements Achieved with “Partnership for Patients” to Reduce Healthcare Associated Infections in 71 Hospitals

Hospitals can better focus their efforts to prevent healthcare-associated infections (HAIs) if they identify specific areas for improvement. Ascension Health (AH), a system of more than 100 hospitals, is one of 26 Hospital Engagement Networks that led quality improvement efforts to reduce (HAIs) through Partnership for Patients. We evaluated the effect of work in 71 of its hospitals.

Ascension Health’s Demonstration Of Full Disclosure Protocol For Unexpected Events During Labor And Delivery Shows Promise

Communicating openly and honestly with patients and families about unexpected medical events-a policy known as full disclosure-improves outcomes for patients and providers. Although many certification and licensing organizations have declared full disclosure to be imperative, the adoption of and adherence to a full disclosure protocol is not common practice in most clinical settings. We conducted a case study of Ascension Health's implementation of a full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221percent. Practitioners saw insurers' acceptance of the full disclosure protocol, consistent and ongoing leadership by local practitioners and hospitals, the establishment of a well-trained local investigation and disclosure team, and disclosure training for practitioners as key catalysts for change. Lessons learned from this multisite initiative can inform liability insurers and guide providers who are committed to ensuring that full disclosure becomes the only response to unexpected medical events.

Improved Safety, Eliminating Errors Top Policy Agenda

Improved Safety, Eliminating Errors Top Policy Agenda

Viewing Ascension Health From A Design Thinking Perspective

In this commentary, I discuss how the design thinking concepts of empathy, related worlds, prototyping, ethnography, and story could enhance Ascension Health’s organizational design and ultimately its delivery of healthcare services. When organization design integrates a design thinking lens, more meaningful and innovative processes are developed both internally among organizational actors and externally with end users.

Organizing Healthcare For Changing Markets: The Case of Ascension Health

This case describes a Ministry Positioning process that will enable the management of Ascension Health to enact designs suitable for the rapidly changing healthcare industry. Ascension Health is the largest not-for-profit healthcare system in the United States with $21 billion in annual revenues and a presence in 24 states and the District of Columbia. Because the design of a large organization for a fast-moving environment is too complex and ambiguous to be fully planned in advance, the focus of the case is on the processes of learning while designing—that is, learning how to learn from designing organizations. The main lessons drawn from the Ministry Positioning process are discussed.