Lessons from a Top-Performing Health System on Lowering Mortality Rates

Key takeaways:

• Bon Secours Mercy Health (BSMH) embarked on a strategic system-wide standardization effort to reduce unwarranted clinical variation to lower mortality rates and improve care quality.
• The health system utilized PINC AI™ CareScience analytics to delve into their data and identify areas for mortality improvement.
• BSMH was able to improve their mortality O/E ratio as well as reduce length-of-stay (LOS) and cost of care with the support of PINC AI™ analytics technology.

Bon Secours Mercy Health (BSMH), the fifth-largest Catholic health system in the U.S., has a history of achievement. In fact, the Cincinnati-based health system recently earned Premier’s “Top Performer” title. “Overall top performer groups within Premier’s analytics capability solution, PINC AI™ QualityAdvisor, must perform well in multiple outcomes and not just the one in which they are a top performer,” said Tasha Lackey, Senior Product Director for the PINC AI™ Quality Enterprise. “Not only is BSMH a top performer in mortality, but they are an overall top performer across all outcomes at Premier which is a notable accomplishment.”

While the health system recognizes this achievement, BSMH isn't about to slow down any time soon. “To be recognized among the best of the best really does demonstrate our commitment to high-quality patient care,” said Thomas Flynn, System Director of Safety and Reliability at BSMH. The organization is continually striving to improve healthcare quality while safely reducing costs and tackling community-wide healthcare challenges. As part of this effort, in 2022, BSMH established a strategic initiative to improve inpatient mortality rates in four key areas: telemetry monitoring, glycemic management, bilevel positive airway pressure (“BiPAP”) use and sepsis care. Below is an overview of the three-pronged approach BSMH utilized to achieve mortality improvement.

Uncover Data Opportunities

BSMH needed a solution that would enable accurate analysis of mortality observed versus expected (O/E) ratio across all their facilities to effectively identify opportunities for improvement. Observed mortality is the actual number of inpatient fatalities that take place in the hospital over a given period of time, whereas expected mortality is the number of hospital deaths that are anticipated based on the severity of the patients' illnesses. The health system turned to PINC AI™, Premier’s technology and services platform, to implement new processes for accessing and analyzing high-quality mortality data.

BSMH used PINC AI™ CareScience analytics to delve into their data and pinpoint specific clinical data that contributed to each patient's risk adjustment. Risk adjustment allows hospitals to account for the severity of their patients’ conditions and refers to methods of determining if a patient’s characteristics might warrant greater use of medical services. The PINC AI™ CareScience risk model is driven by the PINC AI™ Quality Enterprise analytics technology which gains visibility into data insights and benchmark capabilities.

“Using Premier's QualityAdvisor™ database was extremely useful for us both in terms of target setting within each of the four categories (telemetry monitoring, glycemic management, BiPAP and sepsis care) but equally important is Premier’s risk adjustment methodology since it allowed us to have a different conversation about normalizing the data,” said Flynn. The health system was able to identify areas for improvement by using PINC AI™ CareScience analytics to compare clinical cohorts and internal performance as well as assess performance against external benchmarks.

Reduce Unwarranted Clinical Variation

One of a healthcare organization’s greatest obstacles in outcomes improvement is unwarranted clinical variation. Suboptimal results, including increased mortality rates, are caused by unwarranted clinical variation. With this in mind, it can be especially difficult for a large health system to get different facilities on the same page. “For a large organization like ours with a variety of populations, it was critical to ensure that all clinical leaders and subject matter experts were fully engaged, involved and had a voice in our journey to improve mortality,” said Dr. Marcus Blackstone, Chief Medical Officer for Acute Services at BSMH.

To improve mortality, BSMH needed to identify the causes of unwarranted clinical variation in outcomes and develop ways to manage them. The belief that standardization is the solution to overcoming unwarranted clinical variation is common in health systems. However, this isn’t always the case and healthcare organizations should exercise caution when implementing standardization. A cookie cutter standardization strategy risks the overlook of differences in facilities, patients and resources.

“We centralize as much as we can in terms of what the organization expects and shared resources provided but then we decentralize the improvement work at the local level so that each facility can work at their own pace based on their own unique factors to implement the change,” said Andrea Mazzoccoli, Chief Nursing and Quality Officer at BSMH. “It’s important that the improvement work is happening as close to the bedside as possible so direct care providers see the impact firsthand.”

Encourage Clinician Engagement

Improvement initiatives that include a strong physician leader gain momentum and clinical support when there is a champion. Physician leaders spread the word about the project and articulate its advantages in a way that resonates with clinicians. “You need to have somebody who's doing the work on an everyday basis, who understands the pain points for physicians and who can speak for them,” said Dr. Taryn Kennedy, Chief Quality Officer at BSMH. “Physicians usually respond best to their colleagues, so it's important to have an advocate who can convince clinicians to embrace new procedures and clearly communicate the significance of mortality improvement.” Staff at BSMH participate in routine education training sessions on how to reduce mortality, including reliable strategies and processes to mitigate unintended outcomes.

Outcomes

The effort to understand the factors that influence mortality rates has helped BSMH successfully convert complex mortality data into usable information for clinical teams. The healthcare organization stated that they saw improved mortality O/E ratio leading to better quality care provided to patients. In addition to mortality improvement, BSMH stated they saw a reduction in lengths-of-stay and cost of care. “This journey wasn't singularly about reducing mortality. It was about reducing mortality and optimizing patient care, and the patient experience. We saw improvement in quality, efficiency and cost,” said Flynn.

The health system remains committed to further reducing mortality rates and plans to expand its mortality improvement initiative to focus on early recognition and treatment of patients with potentially serious illnesses such as sepsis. “When we realized how well we were doing, we decided we could do even better. This year we're looking at our sepsis mortality, and we’re using it as sort of our KPI for looking at our race and ethnicity piece as well. We want to ensure that we don't have disparity in care, or at least we can start digging into the data to see if we do have any disparities,” said Kennedy.

Ultimately, with data-driven mortality improvement BSMH was able to enhance the consistency of care provided to its patients. “It isn’t a simple process, but better data and analytics have made it possible for us to make sure that the picture we paint of our patients reflects the exceptional care we offer,” said Kennedy.

• Learn more about quality improvement with PINC AI™.
• Register for Breakthroughs 23 to hear more about BSMH's data-driven improvement journey.

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