Value Institute 2014 Annual Report

Integrating for Impact: Discovery and Dissemination

Value Institute 2014 Annual Report

CHRISTIANA CARE HEALTH SYSTEM | VALUE INSTITUTE

THE CHRISTIANA CARE WAY

We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value.

The Value Institute supports The Christiana Care Way by developing, delivering and evaluating innovative solutions impacting population health, patient experience, system performance and policy development.

FEDERAL GRANT FUNDING

PRIVATE GRANT FUNDING

INCLUDES:

INCLUDES:

Agency for Healthcare

AstraZeneca

Research and Quality

DAXOR Corporation

Centers for Disease Control

Gradian Health Systems

and Prevention Centers for Medicare and Medicaid Services Department of Defense National Institutes of Health – National Heart Lung and Blood Institute (NHLBI) – National Institute of General Medical Sciences (NIGMS)

Osler Fund Sanofi-Aventis

Combining Approaches to Address Challenges The Value Institute leverages the perspectives of its four centers and the Value Institute Academy to positively impact patient care and provider experience.

and methods including Lean Six Sigma approaches increasing value through efficiency, effectiveness and affordability in health care.

Experts partner on results-oriented projects and training strategically linked to institutional goals. They aim for high performance in vision and goal alignment; leadership; organizational structure and decision-making; people and teamwork; and work systems and process to create systems of care that improve overall performance.

Value Institute team of directors

THE CENTER FOR HEALTH CARE DELIVERY SCIENCE uses a pragmatic, implementation-based process to test the effects of clinical interventions on patient-centered outcomes. Our cross-disciplinary approach, applying principals from systems engineering, computer science, human factors and economics leads the way in improving population health, increasing health care efficiency and reducing harm to deliver the best health care possible.

THE CENTER FOR OUTCOMES RESEARCH investigates strategies for preventing, diagnosing, treating and monitoring medical conditions, conducting and evaluating large multi-center studies and disseminating discoveries through peer-reviewed academic conferences and journals.

Focusing on clinical and translational research, the center offers specific expertise in evaluating quality-of-life and cost-effectiveness endpoints.

THE CENTER FOR QUALITY AND PATIENT SAFETY provides the framework for our cultural transformation toward value. It aligns priority areas with the health system’s goals of enhancing the safety of patients and employees, increasing health care value, and developing efficient and affordable population-based models of care.

THE VALUE INSTITUTE ACADEMY is a destination for in-person and web-based education programs designed to empower providers and administrators with new knowledge and methods to innovate and lead change and drive scientifically based improvements in patient health and health care delivery.

THE CENTER FOR ORGANIZATIONAL EXCELLENCE offers expertise in change management and processimprovement tools, techniques

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From the Directors

2014

has been a year of remarkable

progress for the Value Institute. We celebrated the 3rd anniversary of establishing the Value Institute at our Spring Value Institute Symposium on May 22, 2014, during which we honored Dr. Bob Laskowski for his vision and leadership in founding the Value Institute.

The four center leaders updated the symposium audience on the progress and many accomplishments of their centers. Just a few weeks earlier, Dr. Bill Weintraub, director of CCOR, Christiana Care’s Center for Outcomes Research, led the Christiana Care team at the inaugural event for the NIH Clinical and Translational Research award, which has resulted in expansion of the biostatistical and data analytic capabilities in the Value Institute as well as enhancing our mentoring activities. Sharon Anderson’s Quality and Patient Safety team Dr. Timothy Gardner (right) and Dr. Eric Jackson, Jr. provide leadership across the Value Institute.

directed another successful and influential Focus on Excellence competition with more than 140 individual performance improvement projects submitted. In addition, the Value Institute Academy continued its successful educational programs and expanded its offerings.

Vernon Alders’ Organizational Excellence team continued their successful Green Belt projects in collaboration with the Juran Institute and added a Black Belt program for the first time this year.

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VALUE INSTITUTE :: ANNUAL REPORT 2014

In September, Dr. Eric Jackson and Seema Sonnad marked their second full years in the Value Institute.

Eric’s Health Care Delivery Science program has continued to expand and he recently welcomed four new senior investigators to his team. Seema led a

“These activities and accomplishments portend expanded transformative influence by the Value Institute teams on our Health Care System.”

group from the Value Institute to the AcademyHealth annual meeting in California, where more than a dozen presentations highlighted a subset of the many

and performance improvement efforts. What

collaborative pragmatic implementation projects that

characterizes this type of work is the application of

the Value Institute has partnered on in multiple settings

evaluative science principals from a variety of relevant

throughout Christiana Care.

disciplines to performance improvement efforts. All

These activities and accomplishments portend expanded transformative influence by the Value Institute team on our health system. The Value Institute is focused on supporting The Christiana Care Way by

of the Value Institute teams are working to improve care delivery — to increase the value of our care for our patients and this community — by providing the scientific evidence that supports clinical improvements.

achieving the goals of improved care for individual

We congratulate our center directors and their colleagues

patients, better health for our community and lower

for their efforts thus far. We also welcome our new team

costs: better patient outcomes with improved safety

members who bring new skills, energy and their diverse

and more efficient health care delivery. Current and

perspectives to our work of increasing value for our

future work in the Value Institute will concentrate on

patients and the community. We know that all of us in the

what many describe as pragmatic clinical research,

Value Institute accept the great challenge that has been

projects that address clinically relevant questions

given us along with the support and encouragement

that affect the quality and effectiveness of day-to-

from the entire Christiana Care community.

day health care delivery. These questions are at the interface of traditional health services research Tim Gardner, M.D. Executive Director, Value Institute

Eric Jackson, Jr., M.D., MBA Associate Director, Value Institute

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A Passion for Collaboration The Value Institute provides a nexus for connecting clinicians and researchers from a range of disciplines around the shared goal of making a measurable difference in the lives of patients and families in ways that they can appreciate and that society can afford.

The Value Institute initiates and participates in projects in a broad range of clinical areas. Many start with a clinician who sees an opportunity to improve patient care and asks for a consultation with the Value Institute. These opportunities often become collaborative projects with Value Institute researchers.

100

THE VALUE INSTITUTE FULFILLED MORE THAN 100 CONSULTATION REQUESTS THIS YEAR.

Research Areas

SURGERY

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VALUE INSTITUTE :: ANNUAL REPORT 2014

Aligning with National Priorities and The Christiana Care Way Value Institute projects span many clinical areas and approaches to answering questions aligned with Christiana Care goals and drawing on the Centers for Medicare & Medicaid Services National Quality Strategy Domains. We focus our work in areas most likely to produce discoveries that will positively impact patients and the community.

PROCESSES OF CARE

TECHNOLOGY ASSESSMENT

PATIENT ENGAGEMENT PREDICTIVE ANALYTICS (More on page 6)

EVIDENCE-BASED MEDICINE MEDICAL EDUCATION (More on page 9)

COMPARATIVE EFFECTIVENESS

RESEARCH INFRASTRUCTURE

POPULATION HEALTH (More on page 8)

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Saving Lives With Data-Driven Solutions DISCOVERING SEVERE INFECTION (SEPSIS) EARLY The Christiana Care sepsis team uses data and models to detect and intervene early when patients are at risk for life-threatening infections. The collaboration of analysts, clinicians and statisticians allows improvements throughout the process, from advancing

The sepsis team gets oriented in the clinical setting

data access at the bedside to discovering potential issues prior to implementation in the health system. These efforts have led to our external partners

DATA ACCESS IMPLEMENTATION

EXPLORATION

PREDICTIVE ANALYTICS DATA TRANSFORMATION

VALIDATION

MODELING

reconfiguring the data inputs for their product, to our current testing of the algorithm in real time, and to four national and international presentations of our discoveries.

PREDICTING AND PREVENTING OVERSEDATION | Narcotics are powerful medications that are used to treat pain. One of the effects of these medications, however, is that they depress the breathing centers of the brain.

Over-treatment of pain may lead to oversedation, respiratory depression and possibly death.

Existing methods for detecting potential oversedation in the hospital include time-intensive tasks such as manual chart review,

making implementation challenging.

Our team is using advanced analytics, leveraging computerized surveillance, to create an efficient prediction tool for oversedation.

REDUCING INPATIENT FALLS Using conservative estimates, there are more than 500,000 inpatient falls each year in U.S. hospitals, resulting in 150,000 injuries. Successful fall prevention requires the engagement of many individuals, including the multiple disciplines and teams involved in caring for the patient. An interdisciplinary team of clinicians and Value Institute researchers applied quality improvement and process engineering approaches, reducing inpatient falls by 52 percent on three Christiana Care units, discovering effective approaches for maintaining improvement, translating these research findings into sustainable improvements across the health system and actively disseminating this work through publications and presentations.

Combined Inpatient Fall Rate | Patient Care Units 6E, 5D and 6C DESIRED DIRECTION

FALL RATE PER 1,000 INPATIENT DAYS

8 7

52% REDUCTION

6 5 4 3 2 BENCHMARK

1 0

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY 13 14 13 13 13 13 14 14 13 12 13 12 13 12 13 14 14 12 13 12 13 12 13 12 12 12 12 12 12 FALL RATE = NUMBER OF INPATIENT FALLS PER 1,000 PATIENT DAYS

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VALUE INSTITUTE :: ANNUAL REPORT 2014

Integrating Clinical Practice and Research The Value Institute has continued to recruit across disciplines, building a team with skills enabling our mission.

Qualitative Research is important

Operations Research is a discipline that deals with the application of advanced analytical methods to help make better decisions. The terms management science and analytics sometimes are used as synonyms for operations research, which allows us to model processes of care to better understand how to improve them.

for including patient and family voices in health care decisions. The aim of qualitative research is to develop concepts that can help us understand the meanings, experiences and views of the participants, including patients, families, clinicians and administrators.

Lean Six Sigma is a widely used approach in the manufacturing industry that arose from a concept developed at Motorola in 1986 and was made a business strategy by General Electric in 1995.

Many hospitals are applying the approach to health care delivery to reduce waste and error. Focusing on defects including overproduction, under-utilized talent, transportation, inventory, motion, and extra-processing yields positive effects on efficiency, effectiveness and affordability by changing health care delivery systems and clinical practices.

Statistics are used to summarize and clarify complex information. Statistics allow us to identify and understand approaches that will effectively benefit both our community and Christiana Care.

Human Factors research examines the environmental, organizational and job factors of humans interacting with systems, as well as the physiological and psychological characteristics that influence the behavior of patients and clinicians in clinical care settings and their interaction with new systems and processes of care.

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Improving Population Health Value Institute researchers collaborate with clinicians and administrators throughout Christiana Care to bring evaluation methodology, statistical analysis, survey design skills and plans for disseminating discoveries beyond our walls to a range of efforts aimed at improving population health and care delivery, integrating the voice of the patient and the community into successful approaches to providing care. These efforts include: PROVIDING KNOWLEDGE IN THE COMMUNITY | The Christiana Care Blood Pressure (BP) Ambassador program educates volunteers to conduct BP screening for highrisk, underserved populations. BP screening is important because high blood pressure usually has no symptoms so it can’t be detected without being measured. The BP Ambassadors provide screening as well as connections to physicians and education on caring for high blood pressure, all in community settings, while Value Institute researchers provide measures of the impact of the program on patient engagement and knowledge.

IMPROVING SYSTEMS OF CARE FOR VULNERABLE POPULATIONS Christiana Care’s Medical Home Without Walls program asks whether intensive primary care outreach can decrease visits by patients who use the emergency room frequently.

We are evaluating how assigning a primary care provider and social worker to high-risk super users of the emergency department empowers patients to seek appropriate primary care before health concerns advance to a need for urgent care.

HARNESSING INFORMATION TECHNOLOGY AT THE POPULATION LEVEL | Bridging the Divides is one of only 107 projects selected from 3,000 applicants for funding by the Center for Medicare and Medicaid Innovation.

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VALUE INSTITUTE :: ANNUAL REPORT 2014

An engagement specialist counsels a patient in Project Engage. The program, led by Terry Horton, M.D., FACP, chief of the Division of Addiction Medicine and Value Institute Scholar, connects hospital patients with resources to help them overcome substance abuse.

The program is supported by an IT-infrastructure that facilitates the transitional and longitudinal care of patients with heart disease at Christiana Care, using data from inpatient and outpatient systems, and soon to include clinical information from the Delaware Health Information Network. We have observed improvements in transitional care and have maintained a high level of patient satisfaction with the process.

BRINGING A PEER-TO-PEER APPROACH TO ADDICTION TREATMENT | The involvement of Value Institute researchers is allowing Project Engage to quantitatively demonstrate its impact on saving lives and money by connecting patients with substance use disorders to peer-counselors who provide direction to treatment

and support services. This integrated approach is yielding inroads into a leading public health problem.

IMPROVING CARE BEYOND THE HOSPITAL STAY | Christiana Care is one of 15 hospitals selected from 132 eligible hospitals nationwide by the American College of Cardiology to participate in this new Patient Navigator Program, designed to keep patients healthy at home after discharge from the hospital.

With AstraZeneca as the founding sponsor, the Patient Navigator Program partners with patients to help them understand their health conditions, care plans and medications, and how to use community resources. The program supports a culture of patientcentered care at Christiana Care.

Integrating Education and Research

1,000

THIS YEAR THE VALUE INSTITUTE ACADEMY REACHED OVER 1,000 LEARNERS.

THE VALUE INSTITUTE ACADEMY Through a formalized approach to staff education and training, the Value Institute Academy facilitates changes in health care delivery that create innovative, effective, affordable systems of care that our neighbors value. The Value Institute Academy maximizes both individual and team abilities to innovate, lead change and drive scientifically based improvements in health care delivery, with programs designed to promote basic through advanced skill levels.

THE CHOOSING WISELY INITIATIVE results from health care provider organization produced lists of “Things Physicians and Providers Should Question” in recognition of the importance of conversations to improve care and eliminate unnecessary tests and procedures. Working with Christiana Care residency programs and Academic Affairs, the Value Institute is piloting a research- and education-based pilot to study the implementation of selected Choosing Wisely Initiatives in our clinical settings. These initiatives involve resident physicians in designing and implementing innovations that will limit low value care.

23 35 STUDENT INTERN PROGRAM Over the past year, the Value Institute has expanded its student internship programs to include biostatistics and MPH students

23 STUDENTS HAVE PARTICIPATED IN VALUE INSTITUTE RESEARCH SUPPORTING 35 PROJECTS.

from Drexel University, Medical Scholars from the University of Delaware and continued support of the Delaware INBRE student research program.

Choosing Wisely Here’s a breakdown of what services 26 specialty societies, that participated in the Choosing Wisely campaign, say are overused.

SOURCES |

17%

29%

PROCEDURES AND OTHER SERVICES

RADIOLOGY

DARTMOUTH INSTITUTE OF HEALTH POLICY & CLINICAL PRACTICE AND THE NEW ENGLAND JOURNAL OF MEDICINE

12%

21%

LAB TESTS AND PATHOLOGY

CARDIAC TESTING

21%

MEDICATIONS

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Including Patient and Family Voices

6,438

14

6,438 PATIENTS PROVIDED THEIR OPINIONS AND INSIGHTS TO 14 VALUE INSTITUTE STAFF AND SCHOLAR PROJECTS.

IMPROVING VALUE OF INFORMED CONSENT DOCUMENTS | Informed consent is meant to go beyond legal protection for providers. Ideally, the consent process allows shared decision-making, incorporating evidence with patient preferences.

In discussions with patients, our

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VALUE INSTITUTE :: ANNUAL REPORT 2014

Dashboard Displaying the Rate of Exclusive Breastfeeding DESIRED DIRECTION

60.00% 53.8%

TARGET > 50% 50.00% 44.1%

42.6% PERCENTAGE OF PATIENTS

CREATING A PROGRAM TO KEEP PATIENTS OUT OF ISOLATION To reduce infectious risks to other patients, standard practice is to place patients with a prior MRSA (methicillin-resistant Staphylococcus aureus) diagnosis in isolation when they return to the hospital. Value Institute researchers led the design and evaluation of a testing program to reduce isolation for patients who no longer have MRSA that produced savings of more than $100,000 per year across seven Christiana Care Units while preventing patient feelings of seclusion and perceptions of less attentive care described by patients in isolation.

40.00%

47.2%

46.5%

44.2%

45.3%

44.2%

50.7%

46.0%

48.7%

51.7%

51.2%

45.7%

45.3%

36.3% 36.2%

30.00%

20.00%

10.00%

0.00% JAN 13

FEB 13

MAR APR MAY JUN 13 13 13 13

JUL 13

AUG 13

SEP 13

OCT 13

NOV 13

DEC 13

JAN 14

FEB 14

MAR APR MAY 14 14 14

SOURCE | POWERINSIGHT, PERINATAL DISCHARGE SUMMARY

researchers learned that even those with high literacy and college educations felt overwhelmed by informed consent forms, having difficulty reading and remembering the important information. For lower literacy patients, it was rare that the forms even conveyed enough information to help them formulate specific questions for their doctor. Patients provided clear and actionable recommendations for formatting changes, content and additional sources that are informing a reevaluation of informed consent at Christiana Care.

ENGAGING PATIENTS IN IMPROVING SAFETY BY MAKING DATA VISIBLE | Both staff and patients appreciate dashboards displaying safety and outcome data in the units (see above). In a Value Institute led survey, 90 percent of patients and visitors said that data transparency would help them partner in the quality and safety of their care. However, patients prefer non-clinical language and currently understand non-clinical patient experience information better than clinical patient harm information. While more than twothirds of patients surveyed felt that public display is the best way to share data, this project revealed that simplicity and standardization are essential to ensure that data displays are meaningful to patients, families and staff.

Survival 22-22+6 WEEKS

RANGE: 2-9%

• Average 23-23+6 WEEKS

RANGE: 7-31%

• Average 24-24+6 WEEKS

RANGE: 21-65%

• Average 25-25+6 WEEKS

RANGE: 40-81%

• Average THINGS THAT ALTER SURVIVAL: GENDER | RACE | WEIGHT | MULTIPLES | STEROIDS

HELPING PARENTS MAKE DIFFICULT DECISIONS | Funded by a pilot grant from the Delaware-CTR ACCEL (clinical and translational infrastructure program), Value Institute Scholar Ursula Guillen, M.D. is conducting a six-hospital study of an original decision-making tool she and her research team created after more than five years of research and input from clinicians and parents of extremely premature babies. Said Dr. Guillen, “Parents facing such critical decisions need to be empowered to make fully informed decisions that reflect their values as well as all the pertinent information medical professionals have to offer.”

5

THE VALUE INSTITUTE PARTICIPATES IN 5 COLLABORATIVE GRANT PROGRAMS SUPPORTING CLINICAL AND TRANSLATIONAL RESEARCH.

Dr. Ursula Guillen uses cutting edge communication research to make data more accessible to patients.

© 2011 Cullen & Kirpalani. Childrens’s Hospital of Philadelphia

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Building Collaborations to Increase Impact Delaware Health Sciences Alliance With Value Institute leaders, staff and scholars playing important roles on multiple committees, the alliance supports collaboration to conduct cutting-edge research, improve health and health services, and educate the next generation of health care professionals. The Alliance’s broad-based partnership focuses on establishing innovative collaborations among experts in medical education and practice, health economics and policy, population sciences, public health, and biomedical sciences and engineering.

ACCEL program leaders include: Top row: Michael Rosenthal, M.D., Christiana Care; Thomas Buchanan, Ph.D., University of Delaware; Carolyn Jenkins, DrPH, RD, CDE, APRN, Medical University of South Carolina; Devona Williams, Ph.D., of ACCEL’s Community Advisory Committee; Sandra Hassink, M.D., Nemours; Jay Greenspan, M.D., Nemours; Omar Khan, M.D., MHS, FAAFP, Christiana Care; Stuart Binder-Macleod, Ph.D., PT, FAPTA, University of Delaware.

Front row: Julia Spencer Barthold, M.D., Nemours; William S. Weintraub, M.D., Christiana Care; Bettina Riveros, JD, Delaware Health Care Commission; Delaware Gov. Jack Markell; U.S. Representative John Carney; Timothy Gardner, M.D., Christiana Care.

Delaware-CTR ACCEL The NIH awarded this $20 million grant to Christiana Care and its partner institutions to support clinical and translational research, faculty development and infrastructure with the goal of transitioning groundbreaking research into practical clinical applications. William Weintraub, M.D., director of the Center for Outcomes Research at the Value Institute, serves on ACCEL’s executive committee and as the Christiana Care primary investigator.

Master of Health Care Delivery Science at Dartmouth The Value Institute sponsored a team of Christiana Care leaders to participate in the Master of Health Care Delivery Science program at Dartmouth. At the heart of the program is a commitment to the value-based improvement of health care delivery — achieving better outcomes for the same or lower costs — that is scientifically, ethically, and managerially sound — goals well aligned with The Christiana Care Way and the Value Institute’s mission.

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VALUE INSTITUTE :: ANNUAL REPORT 2014

Institute for Healthcare Improvement Sponsored by the Value Institute, Scholars Marci Drees, M.D., MS, FACP, DTMH, infection prevention officer for Christiana Care, and Kathryn Groner, M.D., of Emergency Medicine, participated in the Institute for Healthcare Improvement/Alliance of Independent Academic Medical Centers quality improvement program. They led internal quality improvement projects on reducing ventilator-associated events and applying case management in the Christiana Care Emergency Department.

This year Vijaya Surekha Bhamidpati, M.D., a hospitalist and Value Institute Scholar, will participate, broadening our cohort of leaders afforded the opportunity to deepen their knowledge of improvement methods, develop relationships with IHI leaders and faculty, and gain hands-on improvement experience.

Value Institute INBRE students present their work.

Delaware INBRE Delaware INBRE is supporting infrastructure development across a statewide network to grow research capacity for faculty and students in the areas of cancer, cardiovascular health and neurosciences, including research projects conducted by scholars and Value Institute involvement in key faculty roles and our direction of the didactic program for summer research students.

COLLABORATORS DELAWARE PARTNERS • AI DuPont/Nemours • Delaware Bioscience Association • Delaware Health Sciences Alliance • University of Delaware ACADEMIC PARTNERS Roger Kerzner, M.D., director of Electrophysiology Research (left), and William Weintraub, M.D., John H. Ammon Chair of Cardiology and director of the Center for Outcomes Research (right), talked about Bridging the Divides with Value Institute Symposium keynote speaker Patrick Conway, M.D., MSc, of the Centers for Medicare and Medicaid Services.

16 $20M

THIS WORK IS SUPPORTED BY 16 NEW AND ONGOING GRANTS REPRESENTING $20 MILLION DOLLARS.

Speakers and Visitors The Value Institute regularly hosts presentations and visits by local, regional and national experts in areas aligned with our scope of work. These opportunities allow collaboration and knowledge-sharing, while highlighting the need for value-based research in health care.

Shifting the focus to patients and their families — to the best ways to deliver high-quality, respectful, safe, efficient and equitable care — is the core mission of the Value Institute.

• Duke University • Harvard University • Johns Hopkins University • Medical University of South Carolina

Dissemination of Discoveries Value Institute staff and scholars made 116 poster and podium presentations at regional, national and international conferences. This included 13 posters presenting Christiana Care advances in improving patient outcomes, patient engagement, health information technology use and care transitions at the AcademyHealth Annual Research Meeting, the premiere conference for health services and policy research and the professionals who produce and use this work. Value Institute staff and scholars published 88 articles in 70 peer-reviewed journals between September 2013 and August 2014.

• Drexel University

• Northwestern University • Thomas Jefferson University • University of Michigan • University of Pennsylvania • University of Virginia • Wake Forest University • Weill Cornell Medical College At the fall 2013 Value Institute symposium, “End-of-Life Care in America: A Clinical and Public Policy Perspective,” national experts joined Christiana Care specialists in exploring the power of palliative care to deliver value to patients and families confronting serious, life-threatening illnesses.

The Value Institute spring symposium, “Bridging the Gap: Connecting Data to Decisions,” featured internal experts from across Christiana Care, providing an update on the first three years of progress toward fulfilling the Value Institute mission.

INDUSTRY PARTNERS • Booz Allen Hamilton, Inc. • ColdLight Solutions, LLC • Gradian Health Systems® • HealthCore, Inc. • Medecision® • Swets NATIONAL RESEARCH NETWORKS • HOMERUN (Hospital Medicine Re-engineering Network) • SHEA (Society for Healthcare Epidemiology of America)

During our fall 2014 Value Institute symposium, we were honored to have Patrick Conway, M.D., MSc, deputy administrator for Innovation and Quality and chief medical officer of the Centers for Medicare and Medicaid Services (CMS) as the keynote speaker. As the leader of the Center for Clinical Standards and Quality (CCSQ) and the Centers for Medicare and Medicaid Innovation (CMMI) at CMS, Dr. Conway provided key insights about developing innovations in health care and the transformation of health care systems.

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

Value Institute Leadership Team Timothy Gardner, M.D. Executive Director Eric Jackson, Jr., M.D., MBA Associate Director Vernon Alders, MHCDS, MBA, MSW Sharon Anderson, MS, BSN, RN Claudine Jurkovitz, M.D., MPH Paul Kolm, PhD Michael Rhodes, M.D. Herbert Scherrer Seema Sonnad, PhD William Weintraub, M.D.