Think “patient care” and you might think of a doctor or nurse’s bedside manner, their years of experience or their professional expertise. What’s unlikely to spring to mind, however, is process improvement and analytics.
Yet this is exactly where Lalit Bajaj, MD, MPH, focuses his attention. Dr. Bajaj is medical director of clinical effectiveness at Children’s Hospital Colorado (CHCO) and for the child-health practice in the University of Colorado School of Medicine. For the last 10 years of his career, he’s been researching ways to measure and ensure effective care.
The key, he believes, is to think critically about how we care for patients and to continually question whether we are achieving the desired results.
“In order to make sure we’re doing the right thing for the right patient, we need to measure all the activity of physicians and hospital staff in a reliable way,” he said. “We have to measure things in real time and then allow clinicians access to that information in real time.”
Dr. Bajaj explains that the current CHCO reporting system is intermittent and spread out across different locations and departments. “For asthma, one of the most common diseases, there are about 50 different reports, all going out to different units,” he said. “For the asthma continuum of care we are creating a dashboard where clinicians can view the effectiveness of their initiatives and adapt their behavior accordingly, to ensure they are providing the most effective care.”
Bringing all the data together in a concise and accessible way is one of Dr. Bajaj’s key goals, and he aims to create reliable reporting mechanisms for the needs of various CHCO care teams. “We want to have all the data on hand so that clinicians can see the preferred method of treatment and the clinical outcomes for a given situation,” he said.
However, the analysis of clinical practices doesn’t just affect the type of care a patient receives; it also affects how much they pay for care, a topic Dr. Bajaj holds dear. “We need to think about creating systems of reimbursement that are care-effective and cost-effective,” he said. “It’s time to change the way we pay for healthcare from procedure-based to value-based reimbursement.”
Value-based models, Dr. Bajaj explains, are gaining popularity, as highlighted in the publication of a recent article in the New Yorker, which called to eliminate unnecessary care and replace it with only necessary, effective care.
“Currently, physician reimbursement is based on what tests you order for a patient,” Dr. Bajaj explains. “A new payment model could involve a bundled cost for the diagnosis, more like a per-case rate. A good example of this is the move to reduce the number of CT scans performed to diagnose appendicitis. I think everyone is now realizing that we can’t keep paying for episodic healthcare.” (See related NSQIP article, in this issue)
To achieve his goals of revitalizing patient care, Dr. Bajaj is building a team of clinical experts, process improvement specialists and data and analytic professionals with whom clinicians can partner to improve the quality and effectiveness of their care.
It is this sort of collaboration that Dr. Bajaj hopes will change the landscape of patient care. “For perhaps the first time, we’re forming a partnership between the clinicians, the data folks and the finance department,” he said. “Previously the delivery of care was always separate from the financing of care. Now that we have opened up the conversation, it’s a very different discussion.”
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