Garnet Health, formerly Greater Hudson Valley Health System, is a not-for-profit organization headquartered in Middletown, New York. Together with two member hospitals — Orange Regional Medical Center and Catskill Regional Medical Center — Garnet employs more than 4,100 professionals and 850 medical staff members.
“To reach clinical performance goals and maintain our quality-focused Det Norske Veritas accreditation, our leaders recognized the need to have a single source of truth for credible and accurately attributed data and analytics, seeking one place to develop queries and present uniform information,” said Rose Baczewski, chief clinical officer for Garnet. Leaders believed having this centralized data access would help providers improve patient outcomes by reducing readmission rates and approaching a goal of zero harm incidents — both of which also improve financial performance.
In 2012, Garnet adopted the advanced data and analytics capabilities of Axiom Clinical Analytics to support inpatient performance improvement goals and compare their organization’s performance against thousands of benchmarks at the national, all-payer, state, and hospital levels. According to Baczewski, “We selected Axiom to get a handle on things that reach the patient — our highest priority.”
Robust analytics were among the capabilities key to adoption. “Axiom offers the ability to perform query-based calculations and risk-stratified analysis,” Baczewski said. “With the evolution of pay-for-performance programs across all payers and an increasingly complex patient population, we need these risk-stratified measures to accurately capture performance in real time.”
The health system assesses the impact of care variation on the bottom line as well and uses the financial reporting in Axiom Clinical Analytics to determine how clinical quality impacts cost. “Axiom lets us track both good performance (eligible for bonuses or incremental payment) as well as sub-optimal performance (e.g., performance that may trigger readmission penalties),” Baczewski said. “Analytics and reporting around potentially Preventable Readmissions, a quality-of-care measure required by the Centers for Medicare & Medicaid Services, are also invaluable.”
Created an Award-Winning Harm Index
Leveraging data from Axiom Clinical Analytics and other sources, leaders at Garnet created a Harm Index that tracks adverse incidents among patients in its care and helps the health system reduce such incidents.
“We take a top-down approach to patient safety,” Baczewski said. “Our Harm Index is a board-level tool that monitors 16 quality measures and compares performance against expected mortalities. Using a detailed template of the Patient Safety Indicators report, we have documented significant improvement at both of our facilities, with 54% and 48% reduction in harm incidents from 2015 to 2017 at two facilities.”
“Our health system leaders recognized the need for a single source of truth for credible and accurately attributed data.”
The Harm Index is a key part of the Garnet Health compliance management system, which received the 2018 Partners in Performance Excellence (PiPEX) Process Recognition Award from the U.S. Commerce Department’s National Institute of Standards and Technology. The highly coveted award is based on the Malcolm Baldrige Performance Excellence Framework, established by Congress in 1987. Further, Garnet received system-wide recognition, achieving Gold- Level Malcolm Baldrige status.
Figure 1: Harm Index Improvement at the Orange Regional Medical Center & Catskill Regional Medical Center, 2015-2018
Reduced Readmission Rates
The most extensive use of Axiom Clinical Analytics at Garnet has been to support a system-wide goal of reducing readmission rates. “Comparing benchmarks from the hospital to national level lets us identify improvement opportunities,” Baczewski said. “We then use Axiom capabilities such as the Frequent Readmissions Report to drill down for a better picture of underlying causes that can be addressed.” Since the system began employing these tools, readmission rates in our two facilities have dropped 1% and 1.5%, respectively.”
This year, health system leaders are laser-focused on further reducing readmissions. Axiom Clinical Analytics offers Garnet department-level scorecards to drill into related performance areas, providing reports that include length of stay analysis, readmissions, risk-stratified mortalities, and Axiom Physician Practice Evaluation reporting.
Streamlined and Enhanced Quality Reporting
Early in the implementation process, Garnet integrated various information sources with the Axiom system. By combining data such as electronic medical records, patient satisfaction data, and external statistics from the Agency for Healthcare Research and Quality, leaders streamlined quarterly reporting. “Axiom has become our single source of truth for developing queries and producing uniform reporting,” Baczewski said.
One report type of particular value to the health system is Axiom Clinical Analytics standard scorecard for physician departments, providing high-level, departmental, and physician-level metrics that allow leaders to identify care variation and hone in on performance opportunities. For example, the physician service details section offers physicianlevel reporting aggregated at the chargemaster level, with the ability to drill down to physician preference trends by individual physician. Likewise, the pharmacy analytics section focuses on medication utilization and practice trends across service lines as well as by individual physician.
A Partnership for Health and Safety
“Axiom Clinical Analytics and reporting, supported by the team at Syntellis Performance Solutions, have been a key component in developing our Harm Index and supporting our improvements in patient outcomes and hospital readmissions,” Baczewski said.
Looking forward, system leaders are beginning to examine orthopedics and emergency department analytics to identify additional improvement opportunities. “We are making forward progress in our focus on the most important number: zero harm,” Baczewski said.