Providing high-quality patient care while trimming costs is a major goal in the current health care reform environment. The Institute of Medicine has specifically called for the establishment of learning health systems (LHSs) to address this challenge. In an LHS, electronic health records (EHRs) drive research and personalized treatments based on data from patients with similar conditions and risk factors.
A recent pilot study by a team at Nationwide Children’s Hospital and Ohio State University in Columbus, Ohio, has demonstrated that with the implementation of a local LHS, clinical quality can be improved while simultaneously reducing health care costs. The study was published in Developmental Medicine and Child Neurology.
Current LHSs have been designed primarily around the integration of EHRs among multiple hospital systems. While progress has been made with this approach, the operational and technical barriers of bringing together diverse hospital systems led the Nationwide/Ohio State team to consider an alternative based on the concept of a local LHS.
Local systems start with the integration of research, clinical care, and quality improvement within a specific health service and then use the knowledge gained to systematically deliver quality improvements and cost savings. Those clinical improvements can be expanded to other programs within the hospital or across the health care network, according to the investigators.
The team developed and implemented a local LHS model of care involving the optimization of EHRs, with a care-coordination system at its core. The project was piloted with a group of 131 children treated through the Nationwide Children’s cerebral palsy program.
Children treated during the 12-month study period experienced a 43% reduction in total inpatient days; a 27% reduction in inpatient admissions; a 30% reduction in emergency department visits; and a 29% reduction in urgent care visits. Implementation of the local LHS model reduced health care costs by $1.36 million.
“Introducing electronic health record-supported care that integrated clinical care, quality improvement, and distinct, clinician-driven research resulted in large reductions in health care utilization, greatly reduced health care charges, and improved care coordination,” said lead author William E. Smoyer, MD.
The cost of implementing the pilot program, including care-coordination expenses, totaled approximately $225,000 during the first year. However, these costs were only 16% of the reduced total health-care expenditures realized during the first year of the program, representing a savings of approximately $6 for each $1 invested. In addition, the clinicians working in the cerebral palsy clinic reported that the approach simplified their documentation, enabling more patients to be seen during each session.
“There are numerous future challenges related to demonstrating the potential value of using local learning health systems to develop a national adaptable learning health system,” Smoyer said. “We still need to investigate whether local learning health systems can be successfully scaled across the wide variety of clinical programs that comprise the nation’s health care systems. However, these preliminary findings from implementing this disruptive innovation at a single center demonstrate that learning health systems are indeed able to be implemented and that their feasibility and effectiveness can be tested.”
Source: Nationwide Children’s Hospital; December 20, 2016.