Changing Landscape of Quality – Implications for Pediatric Specialties and Data Systems

Ramesh Sachdeva, MD, PhD, JD, FAAP, FCCMChief Scientific Officer, VPS

Professor of Pediatrics, Critical CareMEDICAL COLLEGE OF WISCONSIN

Associate Executive Director

Medical Director, Quality InitiativesDirector, Department of Subspecialty Pediatrics

AMERICAN ACADEMY OF PEDIATRICS

Achieving Change to Improve Quality and Enhance OutcomesEight Steps of Change

Increase Urgency

Build the Guiding Team

Get the Right Vision

Communicate for Buy-In

Empower Action

Create Short-term Wins

Don’t Let Up

Make it StickCreating a climate for change

Engaging and enabling the whole

organization

Implementing and sustaining

change

Kotter, John P. and Cohen, Dan S. The Heart of Change. Boston: Harvard Business School Press, 2002.

The DNA of Continuous Learning for QIKnowledge Management

Level 1:Standardized

Infrastructure for Knowledge Sharing

Level 3:Top-Down Retention

Measurement

Level 5:Organizational

Knowledgebase

Level 7:Continual Process

Improvement

Level 2:Top-down Quality-Assured Information Flow

Level 4:Organizational Learning

Level 6:Process-Driven Knowledge Sharing

Level 8:Organizational Self-Actualization

In: http://wisdomsource.com/k3m_overview.html

Role of the Intensivist

Improving care for the child in the PICU

Role of the Intensivist

Leadership at the hospital and system level

Role of the Intensivist

Impacting child health outcomes

Contemporary View for Data Systems

DATA

Quality Improvement

INFORMATION

ACTION

Clinical Usability

Reliability

EHR – Best Practices

Validity

Risk Adjustment

*(Sachdeva et al., Pediatrics 1999 – HRQOL)

Long Term Outcomes*

Whole System Measures

Emerging View for Data System Integration

PICU

30% of kids <2Y admitted to PICU for respiratory diseases

were preemies(Gunville et al., J Peds

2010)

NICU

Prenatal – weight adjusted survival

PICU – risk adjusted survival

Community

6 Months – significant morbidity (Jones et al.,

Pediatrics 2006)

VPS

STS/NSQIP

VON

PHIS

Future Direction for Data Systems- BIG Data

MARCH 16, 2015 BY LAURA LANDRON

Pediatric ICU Quality Measures

• Children's Health Insurance Program Reauthorization Act (CHIPRA) – Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Measures Program (PQMP)

• Project Management Center of Excellence (PMCoE) – Pediatric Intensive Care Unit (PICU) Quality Measures

• WAVE 1 Measures – (1) Incidence of Pressure Ulcer-standalone, (2) Risk Assessment for Pressure Ulcer, (3) Screening for Nutritional Status, (4) Red Cell Transfusion

• WAVE 2 Measures – (1) Composite Measure on Preventable Harm, (2) Incidence of Pressure Ulcer-component, (3) Composite Measure on Patient Comfort, (4) & (5) Pain Management-2components, (6) & (7) Sedation Management-2components, (8) & (9) Iatrogenic Withdrawal Mananagement-2 components

Learning from Specialty NetworksResearch – Knowledge Management - Practice

Primary Care

Pediatricians

Pediatric

Subspecialists

Practice

Transformation

Technology

Payment Reform

Team Based

Care

Surgery

NSQIP

Oncology

POND4Kids

NICU

VON

GI-IBD

ImproveCareNow

CCMVPS

If not us, then who?If not now, then when?

Dr. M artin Luther King, Jr.

Discussion Questions • What changes are needed in the VPS to meet the current needs of

hospitals and health systems?

• SOI models – next generation?

• Subspecialty modules – PICU?

• How can quality measures be embedded into VPS to effectively inform public reporting and payment policies?

• What are solutions to technical barriers to specialty data system integration?

• Should the VPS become a registry?

• Role of VPS in informing strategies for integrated delivery systems and ACOs to improve child health population outcomes?