Rethinking quality and safety in the age of COVID

Rethinking quality and safety in the age of COVID

Early in the pandemic, CMS suspended quality reporting during the first two quarters of 2020. That will create a gap in data that would normally be available to assess trends in the industry and to spur process improvements.

CMS “is committed to supporting clinicians during this unprecedented pandemic so they can focus on what’s most important—caring for their patients and communities across the country,” an agency spokesperson said.

Hospitals and other health systems have since invented new ways of utilizing patient data.

“Currently, we’re looking at all nationally reported metrics: readmissions, infections, our complications and patient experience data,” said Tami Minnier, chief quality officer of UPMC, affiliated with the University of Pittsburgh Schools of the Health Sciences. UPMC uses a wide variety of internal and external data, including its extensive internal clinical data warehouse, Press Ganey patient surveys, surgical registries for specific specialties, CMS and others.

UPMC is placing a specific focus on quality outcomes related to racial disparities, Minnier continued, saying, “I think this will change our data and analytics going forward. We have looked at every measure we report to our board and have started to overlay a diversity lens on those, to figure out better opportunities to drive clinical outcomes for diverse populations.”

Those challenges are going to live long into the future, beyond COVID, she noted.

Some providers have fine-tuned technology platforms to enhance data collection on COVID patients. NYC Health + Hospitals started to track patients in February 2020, harmonizing its process and making it more granular to create a range of dashboards that provide daily reports with key information on COVID patients system-wide. During the initial COVID-19 surge, the dashboards helped to organize information and allow administrators to make educated, data-based decisions on patient care.

The health system generates real-time data about available beds and ventilators, how much oxygen support patients need at each hospital, and illness acuity.

HCA Healthcare has been repurposing its NATE—Next-Gen Analytics for Treatment and Efficiency—platform to monitor patients at the bedside. NATE uses an algorithmic method based on a patient’s clinical data to assess that person’s needs throughout the day. HCA clinicians can evaluate vitals in real time to assess whether a patient needs a ventilator, proning or more oxygen flow.

This has impacted the treatment of COVID patients in big ways, said Dr. Jonathan Perlin, president of the clinical services group and chief medical officer of the Nashville-based health system.

A COVID patient’s respiratory system is fragile, he emphasized. “The challenge of caring for patients on ventilators is following the patient’s pressure, volume and position to make sure they have optimal care.”

HCA used NATE to track how to best limit COVID exposure in both patients and providers, and advance learning about the disease. These efforts improved survival rates by a third, from the early days of COVID to today. Perlin sees NATE’s uses expanding beyond the pandemic.

“Once we can put COVID behind us, this platform will be phenomenal for optimizing care for every patient on a ventilator,” he said.

HCA is also looking outward, taking steps to mine its large repository of COVID data in the realm of clinical research. To date, it’s captured data from more than 111,000 suspected and positive patients who sought inpatient care in 2020 from its network of 187 hospitals.

A consortium that includes HCA, the federal Agency for Healthcare Research and Quality and academic healthcare organizations will be tapping into the data to advance retrospective clinical trials.

“Not only is this a new paradigm for research, we’re really excited about the tremendous partnership with a number of academic institutions to accelerate learning about COVID and other diseases,” Perlin said.

The consortium plans to explore delirium in COVID ICU patients, COVID outcomes as they relate to age and frailty, resource utilization trends in older and younger patients, gender differences, inflammatory response in children and adults, and risk of blood clots. Other investigations include protecting and improving lung function without using ventilators, and social determinants of health and outcomes on populations of color who experience COVID.

Cleveland Clinic, a 6,026-bed health system in three U.S. states and locations in Abu Dhabi, London and Toronto, has utilized a COVID patient registry to improve care for patients suffering from long-term health effects of the disease.

“We have always been a data-driven organization,” said Dr. Raed Dweik, chairman of the Cleveland Clinic Respiratory Institute. The health system was an early adopter of a registry at the pandemic’s outset, keeping track of all patients admitted with the disease.

Recently, in addition to hospital and ICU patients, the focus has been on patients with “long COVID,” Dweik said. “We’re discovering things with these patients; people having persistent symptoms, muscle aches, fatigue and a variety of multisystem problems.”

Cleveland Clinic, similar to other health systems across the country, has since built a recovery clinic to care for these so-called long-haulers.

“We’ve established a multidisciplinary team of infectious-disease, primary-care physicians, lung, heart, neurology and other specialists to come together” to recognize the undiscovered pieces of long-term COVID recovery, Dweik said. Clinical and research efforts are underway to better understand these patients.

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Marie Maynes
Marie Maynes is a Sports enthusiast and writes for the Sports section of ANH.