UC Davis Medical Center in Sacramento, Calif., participates in the Delivery System Reform Incentive Program, a five-year pay-for-performance initiative in which California public hospital systems aim to meet benchmarks related to healthcare access, quality and safety outcomes. The program is part of the Section 1115 Medicaid Waiver in California, an initiative that began in November 2010 to help the state's public hospital systems prepare for and implement health reform in 2014. Allan D. Siefkin, MD, CMO of UC Davis Medical Center, describes three of the 14 projects the hospital is implementing under DSRIP.
1. Patient-centered medical home. UC Davis has been developing a patient-centered medical home for about three years. The hospital focuses on transfers of care, chronic disease management and coordination of care practices. To create a PCMH, the hospital has also extended its electronic health records to its physician groups so all providers are connected and can easily access patients' information. The hospital is currently approximately 96 percent paperless, according to Dr. Siefkin. He says the EHRs facilitate not only communication, but also standardization because the EHRs include standardized order sets and direct electronic communication between patients and their team of providers. "The ability to communicate and to share information [electronically] has empowered the quality and safety process," he says.
2. Disease registries. UC Davis is also building disease registries, which include outcome measures such as the number of readmissions and the rate of complications. The disease registries focus on vulnerable populations, such as those with diabetes, as a strategy to help manage population health.
3. Sepsis improvement. UC Davis is in its second year of an initiative to reduce mortality from sepsis. The hospital built into its EHR the ability to screen patients' vital signs, such as pulse, blood pressure and heart rate, for signs of sepsis. If a vital sign indicates the patient is at risk for sepsis, the EHR automatically sends an inquiry to the nurse responsible for the patient. If the patient has no other reason for the abnormal vital sign, the nurse conducts a pre-septic workup, draws a blood lactate level, communicates with the physician and applies a sepsis resuscitation bundle.
Using this method, UC Davis has already reduced all sepsis mortality from 17 percent to 11 percent and has reduced severe sepsis mortality from 30 percent to 23 percent, according to Dr. Siefkin. One of the reasons for the initiative's success is because UC Davis used the EHR not only to gather and file information, but also to apply the information in real situations. "This is one example of how we use the EHR to improve care. Having information doesn't do any good if you don't turn around and use it," he says.
1. Patient-centered medical home. UC Davis has been developing a patient-centered medical home for about three years. The hospital focuses on transfers of care, chronic disease management and coordination of care practices. To create a PCMH, the hospital has also extended its electronic health records to its physician groups so all providers are connected and can easily access patients' information. The hospital is currently approximately 96 percent paperless, according to Dr. Siefkin. He says the EHRs facilitate not only communication, but also standardization because the EHRs include standardized order sets and direct electronic communication between patients and their team of providers. "The ability to communicate and to share information [electronically] has empowered the quality and safety process," he says.
2. Disease registries. UC Davis is also building disease registries, which include outcome measures such as the number of readmissions and the rate of complications. The disease registries focus on vulnerable populations, such as those with diabetes, as a strategy to help manage population health.
3. Sepsis improvement. UC Davis is in its second year of an initiative to reduce mortality from sepsis. The hospital built into its EHR the ability to screen patients' vital signs, such as pulse, blood pressure and heart rate, for signs of sepsis. If a vital sign indicates the patient is at risk for sepsis, the EHR automatically sends an inquiry to the nurse responsible for the patient. If the patient has no other reason for the abnormal vital sign, the nurse conducts a pre-septic workup, draws a blood lactate level, communicates with the physician and applies a sepsis resuscitation bundle.
Using this method, UC Davis has already reduced all sepsis mortality from 17 percent to 11 percent and has reduced severe sepsis mortality from 30 percent to 23 percent, according to Dr. Siefkin. One of the reasons for the initiative's success is because UC Davis used the EHR not only to gather and file information, but also to apply the information in real situations. "This is one example of how we use the EHR to improve care. Having information doesn't do any good if you don't turn around and use it," he says.
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