Any quality improvement project requires data, but getting enough of the right data and using it in the right capacity can be a challenge for any hospital, health system or provider group.
Pediatrix Medical Group, has been using its EHR, called BabySteps, and collecting data since 1996. Pediatrix, a division of MEDNAX National Medical Group, was founded in 1979 and is the nation's leading provider of maternal-fetal, newborn and pediatric subspecialty physician services. It, along with its affiliated professional corporations, employs more than 1,650 neonatal, maternal-fetal and pediatric physician subspecialists in 34 states and Puerto Rico.
Nearly two decades' worth of data collected about neonatal patients across the nation is all housed in the Pediatrix Clinical Data Warehouse, which became operational in the early 2000s. Now, on a daily basis, 563 potential data points about each patient are extracted from the EHR into the CDW. It now has information — all de-identified and HIPAA-compliant — on more than 1 million neonates. Pediatrix physicians care for more than 20 percent of neonatal patients in the country through their hospital partners.
"The amount of data we have is really unparalleled," says Alan Spitzer, MD, senior vice president and director of The Center for Research and Education for Pediatrix. Dr. Spitzer, a practicing neonatologist for more than 25 years, has collaborated on more than 250-peer-reviewed research articles and textbook chapters and is co-author of Fetal & Neonatal Secrets, Editions 1, 2 and 3. He joined Pediatrix in 2004 with the goal of helping the group "change the practice of neonatal medicine."
"MEDNAX is a physician-run, patient-focused, outcomes-driven company that makes an investment in collecting quality data and putting it to use at the bedside, not only for neonates, but also for surgical patients receiving care through our American Anesthesiology Division," notes Dr. Spitzer. There they use clinical quality initiatives and data-driven metrics to help hospital partners achieve safer and more efficient operating rooms.
And with Dr. Spitzer’s leadership, Pediatrix has been and continues to be committed to using big data to improve the quality of neonatal care by publishing findings for a national audience and leading physicians to collaboratively drive quality improvement.
Internal comparison
Through the CDW, Pediatrix clinicians in locations across the country can compare how their patients are faring to other similar patients, or how their practice's outcomes compare to other practices of similar size and patient makeup.
"If [they] have a patient population or a specific patient they have questions or concerns about, they can use the CDW to see methods of treatment and expected outcomes," Dr. Spitzer says. "They can gain valuable insights by just looking at the data contained within."
According to Dr. Spitzer, most physicians have an "innate competitive drive" and desire to do well by their patients, both of which help this approach to quality improvement. The CDW has demonstrated meaningful quality metrics so far, including a decrease of more than 80 percent in severe retinopathy of prematurity, a 40 percent reduction in necrotizing enterocolitis and an 80 percent drop in catheter-related bloodstream infection rates.
"We achieved the significantly improved outcomes by focusing on providing high-quality care and giving physicians information back so they can see immediately if there are ways to do something better," he says.
Publishing findings
"Our CDW is a wealth of information, and we recognized early on that it needed to be shared," Dr. Spitzer says. "It's our guiding principle that if we extract information, it needs to be published. It can have an impact beyond our own patients and improve outcomes for neonates everywhere." Investigators from noted academic institutions have also published studies that share findings and best practices gleaned from the CDW.
According to Dr. Spitzer, one major finding from the CDW was published in a 2010 paper that generated a new intrauterine growth curve. The prior intrauterine growth curve came from data gathered from a limited number of babies in the Denver area, when, at the time, there were few surviving infants under 30 weeks' gestation. "The earlier study was valuable and contributed a great deal, but I think there was a general recognition it could be improved upon. Our data was more extensive and diverse because of the CDW and its capabilities," Dr. Spitzer explains.
So, using information gathered from the CDW, researchers from Pediatrix and the University of Pennsylvania were able to generate a whole new growth curve, which was adopted by the American Academy of Pediatrics and is now the national standard intrauterine growth curve.
Another example of the CDW contributing to a major change in care involved treatment for possible septicemia in newborns. Two antibiotics were commonly used and thought to be equivalent approaches. However, upon looking at data in the CDW, researchers found mortality rates for one of the antibiotics were twice as high compared to the other, which led to a change in approach for neonatal physicians.
National meetings
Beyond allowing physicians to compare outcomes against one another and publish studies to drive quality improvement nationwide, Pediatrix also hosts Clinical Quality Summits three times a year. The summits are focused on giving clinicians the principles of quality improvement, training them in the process of quality improvement and helping them troubleshoot any challenges they may have in their NICUs.
According to Dr. Spitzer, the Clinical Quality Summits not only train and educate Pediatrix physicians, but they also bring these physicians together from practices across the country to share experiences, learn from each other and get a sense of community that they would not have if they practiced as a single entity.
"One of the biggest benefits I see to joining MEDNAX is this community we have created among our physicians. It's invaluable for them to have access to experiences and data on a national scale that they can take back and improve outcomes in each of their communities."