Leveraging Real-world Evidence to Influence Care Coordination and Patient Identification

Care coordination and patient identification represent two of the greatest challenges in health care. Finding the right patients and providing a catalyst for change in their behavior and how they are treated has an incredible amount of potential.

Finding high-risk patient types in particular has been historically challenging, but with the evolution of cloud-based technology and the development of multi-variable algorithms – including those for Covid-19 – it’s possible to identify patients in real time. New resources such as provider tools, customized education, and real-time alerts make it easier to influence coordination of care in alignment with the latest evidence and to enable the collection of patient-reported outcomes.

An example of one such program undertaken by Premier Inc., a health care improvement company, dealt with Clostridioides difficile infection (C. diff). In collaboration with a life sciences organization, the Premier Applied Sciences team sought to co-develop and test solutions to help improve patient care. This population health improvement program included a cloud-based application, provider education, and process and outcomes measures to help reduce the recurrence of C. diff by improving follow-up management. It was tested across multiple provider sites, and the intervention has been found to improve readmission rates for C. diff as well as the use of guideline-adherent treatments.

Another example that sits in the patient identification space involved using MedConcert to help support the diagnosis and disease management of post-fracture patients who may be appropriate candidates for an osteoporosis disease management program. This solution aimed to better understand how to identify patients with fragility fractures who visit emergency departments or are hospitalized; provide education and resources to clinicians on osteoporosis management; assist in care coordination; and assess specified outcome measures to support improvement in care. Furthermore, bone mineral density screening and osteoporosis treatment ordering rates improved with the use of the application.

The health care community is on the precipice of being able to understand which patients and conditions can be most impacted by these new technologies, and which can be most useful for patient education and care coordination. These interventions can focus on highly specific conditions where education, tools, resources and performance measurement are not widely available at present.

Many life sciences organizations find themselves struggling to build awareness of evidence-based care practices that ensure high-quality, cost-effective care for all patients they touch. Premier works with life sciences companies and health system providers to identify and disseminate effective interventions; change processes to drive better, efficient care; and measurably improve patient outcomes.

The Premier Applied Sciences team partners with leading subject matter experts from the professional community, including academic medical centers, to design studies in disease areas that matter to our members – a network of more than 4,100 U.S. hospitals and health systems and approximately 200,000 other providers and organizations – and are of interest to our life science partners. Often, the first step of this work is a retrospective analysis utilizing the Premier Healthcare Database, which contains data from 25 percent of U.S. hospital discharges with a volume of 1 billion patient encounters.

Learn more about how you can get involved in these efforts.

This article was originally published in STAT on November 10, 2020.