Health care organizations are putting forth plans for standardizing patient care, demonstrating the value of monitoring adherence to protocols.
Health care organizations (HCOs) around the country have been establishing protocols for treating certain symptoms and conditions in an attempt to expand and improve treatment, and at the same time, standardize patient care. These initiatives, some of which are gaining national attention, have been demonstrating the value in monitoring adherence to protocols.
New Jersey has been taking the lead in some areas, including state hospitals’ latest efforts to standardize care for stroke patients, and St. Joseph’s Medical Center’s approach to reducing opioid use and abuse.
Standardizing Stroke Care
HCOs in New Jersey have historically been leaders in stroke care, so it’s no surprise that health care advocates there have been trying to modernize the current system, proposing legislation that would result in updated guidelines, regular outside reviews, and standardization of diagnosis and treatment protocols. As it is, 67 of New Jersey’s 70 acute-care hospitals already are designated to care for stroke patients.
New Jersey was the first state to designate two levels of stroke-care facilities back in 2004, with primary care facilities providing basic services such as stabilizing, caring for, and transferring stroke patients. Next-level facilities, which were designed to handle more complex cases, also provide rehab services and are equipped and staffed accordingly.
The new legislation would introduce a third level of stroke care, referred to as an “acute stroke-ready hospital” — a facility designated to treat the least complex cases. Patients would be triaged there and then transferred to the appropriate facility, depending on their needs.
All three levels would meet national standards under the legislation and would employ standardized diagnosis and treatment protocols for all emergency providers. All facilities would also be required to submit quarterly data to demonstrate they meet certain metrics. Bill advocates argue that by meeting national standards and submitting to assessments from outside accreditation agencies, the facilities that care for stroke patients can further improve outcomes.
Reducing Opioid Prescriptions
Emergency department (ED) visits due to suspected opioid overdoses increased nearly 30 percent from 2016 to 2017. And, a recent CDC report shows a 27.7 percent increase in opioid overdose deaths in 2015-2016.
So, what are HCOs doing about reducing opioid use and improving access to treatment? Initiatives in several states have been garnering national attention, for instance, Washington state is trying to flag patients at risk for misuse or overdose by integrating electronic health records (EHRs) with a prescription drug-monitoring program (PDMP). In Rhode Island, EDs are partnering with community organizations and state public health agencies to extend support after discharge, and assist in recovery by distributing naloxone kits that include overdose prevention education, treatment referrals, counseling resources, and more.
In New Jersey, the Emergency Department at St. Joseph’s University Medical Center in Patterson has developed the Alternatives to Opioids (ALTO) program in an effort to prevent opioid prescribing in acute pain management. The program was launched in 2016 and has treated hundreds of patients without the use of opioids. ALTO has also been successful in Colorado, where 10 EDs are reported to have reduced overall opioid prescribing by an average of 36 percent.
In March, Dr. Mark Rosenberg, chairman of Emergency Medicine and chief innovation officer at St. Joseph’s, testified before Congress about a new bill he co-authored based on his program, the Alternatives to Opioids (ALTO) in the Emergency Department Act. If approved, the bill will designate funds for expanding the ALTO program nationwide.
Another bill, Preventing Overdoses While in Emergency Rooms Act of 2018, would establish the Medication-Assisted Treatment (MAT) protocol, which would also include certain follow-up procedures after a patient is discharged from the ED.
Saving Lives and Improving Outcomes Through Data Analysis
Proving that the right tools can bridge gaps among health care providers while gathering and analyzing data for insights, St. Joseph’s University Medical Center uses d2i as the data engine to track patients and their treatment under ALTO. Data analytics can be used to address the opioid crisis by pinpointing prescription misuse and educating both patients and prescribers.
Using data analytics to target protocol change means obtaining and working with timely and relevant information, and determining and monitoring patterns. Analytics tools allow transparent monitoring of physicians and site compliance, and can help identify practice patterns and variations. d2i has clinical protocol compliance analytics tools that can help HCOs monitor protocol compliance.
d2i combines data from all sources into a single platform and allows filtering based on any of the data fields without relying on an EHR vendor or IT department. By using the right data analytics tools, health care providers can track compliance with clinical protocols, identify physician practice variations, and see the results in the effectiveness of patient treatment.