Embracing predictive analytics.
PinnacleHealth initiated a pilot study, taking three years’ worth of data on 225 patients with chronic obstructive pulmonary disease (COPD) and creating a model to predict their admissions using a range of clinical factors.
“The pilot study was a success: our SPSS model predicts readmissions for COPD patients with 85 percent accuracy – a rate that will improve as we refine the model,” explains Dr. Beauregard. “We used this pilot to build a business case showing the potential financial savings and improvements in patient outcomes if we target the patients who are most likely to be readmitted. With the cost per readmission for a patient with COPD around USD 6,200 and the possibility of extending similar analytical techniques to a variety of other chronic conditions, our CEO immediately saw the potential. We assembled a multidisciplinary team and started the work.”
The solution automatically delivers a report to physicians at the point of care when a patient with COPD is admitted to one of PinnacleHealth’s hospitals. This report predicts the likelihood of readmission within a range of time periods and the probable time until an exacerbation of the patient’s condition is likely to occur, alongside details such as comorbidities and other medications. The report is built on data from the organization’s core clinical and financial systems, as well as vital signs and lab results recorded during the patient’s hospital stay.
Dr. Beauregard says: “The insights we glean from the IBM solution help encourage our physicians and care coordinators to step back and look at the entire health continuum for those patients who are most at risk of readmission. As a result, we can initiate a set of interventions where they are most needed.
“For example, we can check whether a patient can easily access their medication and understands how to take it; we can ensure that they are adequately engaged in self-care; we can arrange a home visit by our community paramedicine team, or a follow-up appointment with a pulmonologist; we can even offer counseling to help patients quit smoking while they are still in the hospital.”
By revealing aspects of the patient that were invisible before, the solution helps PinnacleHealth make decisions that offer patients the maximum benefit over the long term, reducing the rate of readmissions. Dr. Beauregard adds: “As soon as the intervention activities are hardwired into our care delivery process, we expect to realize the benefits for patient health and cost efficiency provided by the IBM solution.”
“Reducing the number of readmissions for patients with COPD is just the beginning. We already plan to build predictive models to help retard the progression of chronic kidney disease, cardiovascular disease and others. We’re early in this process and many lessons have already emerged. With IBM solutions and Waypoint Consulting, we are revolutionizing our approach to healthcare delivery across the board.”
- Dr. George Beauregard