What Value Really Means: An Overview of the Value Institute by ChristianaCare

Value Institute Christiana Care Health System John H. Ammon Medical Education Building 2nd Floor, Suite 2E55 4755 Ogletown-Stanton Road Newark, Delaware 19718 302-733-4380 | Phone 302-733-5884 | Fax TheValueInstitute@ChristianaCare.org www.ChristianaCare.org/ValueInstitute

What Value Really Means

christiana care health system | Value Institute

Jennifer Goldsack, MChem, MA (Oxon), MS, Research Associate, Value Institute

by the experts in the field as incremental changes.” come from the grass roots; it’s too complicated. Instead it must be driven “Health care reform must be the social revolution of our time. But it can’t

Value “Value is service and care that make a measurable difference in people’s lives in ways they appreciate and society can afford. It reflects concerns about quality, safety, cost, accessibility, affordability and efficiency with the patient’s perception featured prominently.” Robert Laskowski, M.D., MBA, President and CEO, Christiana Care Health System

Value Institute Leadership Team Timothy Gardner, M.D. Executive Director Eric Jackson, Jr., M.D., MBA Associate Director

Dr. Robert Laskowski

Vernon Alders, MBA, MSW Sharon Anderson, RN, MS Claudine Jurkovitz, M.D., MPH Michael Rhodes, M.D. Herbert Scherrer Seema Sonnad, PhD William Weintraub, M.D.

Research leadership by a multi-disciplinary team of experts is a fundamental part of the Value Institute.

What Does Value Really Mean? Patients perceive value as access to high-

health-related outcomes, increase access and

quality care that they can afford. For physicians,

lower costs.

value is practicing medicine that benefits patients, while for health care systems, policymakers and payers, value exists in an efficient and sustainable system of care. The deep seated issues in health care in the United States center on value.

The Value Institute comprises communities of researchers, project managers, biostatisticians and data analysts, all working together to develop the best models of evidence-based care for our patients. A team with diverse expertise – medicine, public health, sociology, law, economics

Christiana Care created the Value Institute in 2011

and mathematics – provides a unique range of

recognizing both the need for answers to health

perspectives needed to confront today’s problems.

care challenges and their unique ability to address that need. The Value Institute unites the Center for Outcomes Research, already known for clinical trials, epidemiological and cost effectiveness research; the Center for Operational Excellence; and the Center for Quality and Patient Safety; and adds a new, critical component – the Center for Health Care Delivery Science, a team focused on applying scientific approaches to create and analyze system-based processes to improve

The Value Institute seeks answers to questions that are complex yet basic. Will patient-centered approaches improve health and reduce costs? Can technology be used to direct resources to those needing them most? What can be done to prevent life-threatening infections? The Value Institute applies research methods to provide clinicians and administrators with data to support optimal decisions about patient care. That is what value really means. 01

Visits by social workers and nurses provide patientcentered care outside the clinical setting.

, Centering Care on Patients Needs When she heard from clinicians about a

helping patients address hunger, homelessness

program for hospital “super-users,” Sharon

and even unemployment.

Anderson, RN, MS, director of the Value Institute’s Center for Quality and Patient Safety, knew the approach would dovetail with Christiana Care’s mission to provide services that community members not only need but also want and value.

Without Walls to transform lives, Value Institute Scholar Heather Bittner Fagan, M.D., MPH collaborated with the Center for Health Care Delivery Science. The resulting multidisciplinary team designed a randomized trial to compare

Less than a year later, Medical Home Without

the outcomes of program participants with

Walls began reaching out to super-users, those

other super-users.

patients who use hospital services more often than average.

Early results indicate that participants’ health has improved while costs have gone down. The team

A nurse and social worker in the program visit

expects to publish numerous papers on the

patients in the community to link participants

project, giving other organizations a blueprint to

with physicians, then help them keep medical

improve health and lower costs while providing

appointments and follow treatment plans. The

patients with services they value.

team also serves as a conduit to social services,

Recognizing the potential of Medical Home

Confronting Challenges from All Sides The Value Institute unites Christiana Care’s educational programs, more than two dozen clinicians, researchers, biostatisticians, data analysts and project managers and four centers:

Center for Health Care Delivery Science Creating and analyzing system-based processes across the full patient experience to improve outcomes, increase access and lower costs.

Center for Operational Excellence Redesigning services to improve safety and efficiency.

“We’re really focused on creating

Center for Outcomes Research

safe and effective health care

Focusing on clinical and translational research to measure the effectiveness and efficiency of health services.

programs that our community

Center for Quality & Patient Safety Developing nationally recognized programs to increase the quality and safety of health care.

values. We do this through pragmatic, innovative research.” Timothy Gardner, M.D., Executive Director, Value Institute 03

Making MakingData DataManageable Manageable “Reform has placed a whole new perspective on patient care and patient-centeredness. The institute was designed to meet the challenges of health care changes in ways the patient appreciates. That’s our core focus.” Susan Smola, JD, MBA, Research Investigator, Value Institute

Research shows that following evidencebased guidelines helps heart patients stay healthy. But the real world often gets in the way, and the massive amount of information needed for effective and efficient case management has been a barrier. Until now. William Weintraub, M.D., director of the Center for Outcomes Research, and Value Institute Scholar Daniel Elliott, M.D., MSCE, lead a team that has overcome multiple challenges to devise a technologically sophisticated system alerting case managers when heart patients need care. The project, Bridging the Divides, restructured an existing software program to use algorithms developed at Christiana Care to identify heart patients most at risk for complications and flag those needing attention from the case management team. The Bridges team created a unique system, Neuron, to manage data from multiple sources to improve patient care.

This improved software merges real-time information about patients from cardiac practices, hospitals, labs and pharmacies. Adapting commercially available software will enable hospitals across the country to replicate the program. The project will answer a question at the crux of health care reform: Can new systems of care for cardiac patients improve health while lowering costs? If so, the Value Instituteâ&#x20AC;&#x2122;s research will give

Counted Among the Best

hospitals large and small a technological advancement that provides real value.

The Center for Medicare and Medicaid Innovation chose the Value Instituteâ&#x20AC;&#x2122;s Bridging the Divides as one of 107 projects out of 3,000 submitted to receive a first-round, $10 million innovation grant. In its first 18 months, the Value Institute received funding from 38 sources.

Novel applications of existing technologies can create innovative solutions to persistent health care problems.

Harnessing Technology to Save Lives Sepsis kills 300,000 Americans annually,

algorithm to search electronic medical records

costing the U.S. health care system $17 billion.

for lab results and vital signs, looking for a

Could hospitals stem the tide by harnessing

combination of clues indicating emerging sepsis.

technology to identify patients most at risk, then begin aggressive treatment immediately? Eric Jackson, Jr., M.D., MBA, director of the Value Instituteâ&#x20AC;&#x2122;s Center for Health Care Delivery Science, says yes. With the reduction of sepsis being a major goal of virtually every hospital in the country, Dr. Jackson, his team at the Center for Health Care Delivery Science and colleagues from throughout Christiana Care attack the challenge in an innovative way â&#x20AC;&#x201C; using the Global Trigger Tool, a technique normally employed

to commercially available software that has machine learning and natural language processing capabilities to determine the effectiveness of each. The study also addresses a second issue: Given variations in medical teams, when is the best time to start an intervention? Dr. Jackson and his team are investigating the efficiency of alternate protocols in providing the most effective and timely treatment.

retrospectively to identify adverse events.

The number of deaths from sepsis increases

The team chose almost two dozen triggers,

year after year. The Value Institute combines

or clues, that could indicate early stages of

technology with implementation science to

sepsis. Clinical investigators, statisticians and

save lives.

programming experts then designed an 06

The study compares the instituteâ&#x20AC;&#x2122;s algorithm

Collaborating Across Departments The research created and supported by the Value Institute unites a wide range of disciplines and departments, each adding a unique and valuable perspective. The sepsis project involves researchers, data specialists and administrators from the institute's centers of Health Care Delivery Science and Patient Quality & Safety as well as nurses, respiratory therapists, pharmacists and physicians. The project includes staff from numerous departments, including surgery, medicine and IT, and from both hospitals in the Christiana Care Health System.

“Having the core competencies under one roof in the Value Institute allows us to have team-based learning and enhanced horizontal networking, so we’re more effective in addressing problems. We maximize resources.” Eric Jackson, Jr., M.D., MBA, Director, Center for Health Care Delivery Science and Associate Director, Value Institute 07

The Value Institute believes that research education is essential to empowering our front-line practitioners and future clinicians.

Empowering Professionals with Education â&#x20AC;&#x153;In the modern world, we need to be committed to measuring, quantifying and proving that the things we do bring value to our community.â&#x20AC;? Seema Sonnad, PhD, Director of Health Services Research, Value Institute

The passion that Christiana Care’s clinicians

Less formal education occurs via mentoring

feel about providing the best care for patients

during consultations that team clinicians with

inevitably leads them to ask questions: Would

Value Institute researchers and biostatisticians.

care improve by making one small change?

Both formal and informal meetings allow Value

Would costs decrease if we combined steps?

Institute Scholars to share new ideas with their

Would patients benefit from a different

peers, present initial results and receive feedback

approach? Through education and mentoring,

on projects and manuscripts. Clinicians and

the Value Institute equips clinicians with

administrators throughout Christiana Care

the tools to discover answers with pragmatic

benefit from “lunch-and-learn” workshops

research.

featuring internal and external experts.

In 2012, Christiana Care formed the Value

Through education across many levels, the Value

Institute Academy by consolidating existing

Institute empowers everyone at Christiana Care

educational offerings and bolstering those in

to find solutions to the nation’s most vexing

research, improvement science and patient

health care problems.

safety. “We are using our unique capabilities to develop educational offerings equivalent to those of a university-based medical center without the constraints,” said Carol Moore,

The Value Institute Academy offers a wide range of courses, including a curriculum dedicated to research methods.

MS, RN, education specialist at the Value

Research Methods

Formal offerings range from the nuts and bolts of clinical trials to research design and statistics.

advanced

Institute Academy.

In a course that Christiana Care helped the

Research Fellowship Core Lecture Series for Fellows: Epidemiology and Statistics Lectures Translational Research

Robert Wood Johnson Foundation pioneer, health

Health Care Delivery Science Research

to analyzing and solving problems complete with

Statistics 2: General and Generalized Linear Models

data collection. Tracks on improvement science and patient safety round out the offerings. In addition to offerings through the Value

intermediate

care professionals learn a systematic approach

Current Issues in Research Series

Institute Academy, the Value Institute

Research Fundamentals: Introduction to Research Design and Statistics

co-sponsors a large, federally-funded, summer internship program. Undergraduate and

Biomedical Human Subjects Research Training (CITI Training)

graduate students from around the country have made significant contributions to more than 50

Historical Perspectives on Human Subjects Research

individual instruction on clinical and health services research to this next generation of researchers.

basic

projects. In addition to research experience, the Value Institute provided classroom and

Research Seminar Series: Value Institute

Conducting a Literature Search: Finding the Evidence Institutional Review Board (IRB) Processes and Regulations 09

Collaborations with Christiana Care clinicians on the front lines of health care are fundamental to Value Institute success.

Creating a Research Culture â&#x20AC;&#x153;To establish something like the Value Institute, you have to have a truly committed leadership that understands we have no choice in this day and age but to prove the efficacy of the care we offer.â&#x20AC;? William Weintraub, M.D., Director, Center for Outcomes Research, Value Institute

Reaching Into Every Area Anesthesia

The Cancer Center

Cardiology

Emergency Medicine

Family & Community Medicine

Genetic Counseling

Infectious Disease

Internal Medicine

Laboratory Science

Neurology

Nursing Sciences

Obstetrics and Gynecology

Oral & Maxillofacial Surgery

Orthopedics

Pediatrics

Pharmacy

Psychology

Pulmonology

Radiology

Surgery

Trauma

The Value Institute partners with departments and specialties across the Christiana Care Health System.

Attracted to the startup environment at the

and received a mentored research grant that

Value Institute, Seema Sonnad, PhD, director

included funding for a Value Institute research

of Health Services Research, joined the

associate and a student intern. The project is

organization to expand the culture of research

using research to confirm Dr. Satti’s clinical

at Christiana Care.

belief that national recommendations against

The Value Institute works with departments and individuals to develop research programs. This includes establishing the value of publication, instituting long term grant planning and

surgery for brain aneurysms smaller than 7 millimeters lead to unnecessary ruptures. The study has the potential to change national guidelines – saving lives.

integrating related efforts so that research can

Dr. Satti’s project is one example of the many

play a continual and growing role in answering

ideas arising in surgery, nursing, emergency

important clinical questions. Sudhakar Satti,

medicine and other areas that have blossomed

M.D., a neuro-interventional surgeon, posed one

into rigorous research through mentoring and

such question.

collaboration provided by the Value Institute.

Dr. Satti came to Dr. Sonnad with several

An institution that helps turn clinical

research ideas. They decided to tackle his list

observations into innovations and uses hard

starting with the project most important to Dr.

data to guide decisions – that is value.

Satti’s clinical work. Together they applied for

Join Us on Our Journey The Value Institute is built on a model of high-level, successful collaboration. The team is committed to fostering relationships with patients, clinicians, sponsors and other partners with the common goal of using high-quality, high-impact research as a vehicle to advance population health, patient experience, system performance and health policy. Please contact the Value Institute to join us on our journey. TheValueInstitute@ChristianaCare.org

Advancing Projects System Wide The Value Institute’s influence includes smaller studies with the potential for significant impact.

Value Institute experts from medicine and informatics collaborated to develop an automated screening tool, AUDIT-PC, to predict alcohol withdrawal in recently admitted patients.

The Value Institute guided staff from Christiana Care’s clinical laboratory in sharing research with colleagues across the country through the unit’s first peer-reviewed study. It focused on improving patient outcomes by improving communication between the lab and the Emergency Department.

Health professionals from Obstetrics and Gynecology working with the Value Institute have significantly decreased admissions to the Neonatal Intensive Care Unit by establishing a policy limiting elective delivery before 39 weeks.

Health professionals working with the Value Institute collaborated with colleagues in the Intensive Care Unit to integrate telemedicine monitoring with sedation management. Their innovation decreased drug costs and improved outcomes.

The Value Institute joined a multidisciplinary team of clinicians to determine the root cause of inpatient falls and identify interventions.