The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


Maternity Care the Ideal Setting for Evidence-Based Practice and PCP/Specialty Collaboration

By Truven Staff
Michael R. Udwin imageThe recent Crain’s New York Business article “Birthing biz booms for hospitals,” captures the complex dynamic of balancing hospital service lines to support revenue, manage costs, and ensure the well-being of a community – in this case mothers and babies. Successfully managing these three objectives requires strong leadership and evolving business intelligence resources. As negotiated reimbursement rates shift from volume to value, it won’t be enough to merely focus on high-margin procedures. 

The best hospitals and health systems recognize the importance of integrating clinical pathways that invite evidence-based practice from both primary care and specialty providers. Maternity care is an ideal setting for such collaboration, since the stakes are so high. Rapid identification of high-risk mothers can not only ensure the health of the mother, but also the well-being of the newborn, with a reduced likelihood of needing to use neonatal intensive care resources.

Effective care coordination for any service line depends on timely, accurate and actionable data across the care continuum. Accomplished leaders leverage such intelligence to identify gaps in care, quality below expectations and costs attributable to inefficiencies. As negotiated reimbursement rates shrink, penalties for avoidable events expand and transparency to consumers evolves, healthcare data will be the medium by which we not just measure our achievements, but ensure the health and well-being of our collective mothers, babies, and families.

Michael R. Udwin, MD, FACOG
National Medical Director

Recent NCQA Report Highlights Need for More Use of Evidence-Based Guidelines

By Truven Staff
Mike Taylor imageMost upper respiratory illnesses (colds, sinus infections and acute bronchitis) are caused by viruses. Typical antibiotics will not be helpful in curing these infections. In fact, overuse of antibiotics leads to bacterial resistance, a situation in which antibiotics lose their ability to kill bacteria. Antibiotic resistant infections have been estimated to cause 23,000 deaths annually.

To improve this situation, guidelines have been published around inappropriate antibiotic use. But as a nation, the US is not complying with these guidelines. A recent report from the NCQA showed that compliance with these guidelines has decreased, falling from 29% in 2009 to 24% in 2012. The report did show improvement in levels of compliance with guidelines for childhood obesity screening and pediatric immunizations.

Why do physicians follow guidelines at such a low level? There are several reasons:

  • Some guidelines are overly complex – LDL cholesterol -lowering guidelines come to mind.
  • In the example of antibiotics, some physicians don’t have the time to ‘negotiate’ with patients about the advisability of antibiotics in certain situations.
  • Physicians have an incentive to keep patient satisfaction scores high, which may lead to ordering tests or treatments because patients want them, even if not needed.
  • Clinical situations exist where guidelines do not apply.

As a nation, are we doing any better with other screening recommendations?  Nation-wide, breast cancer screening rates (as of 2010) are 72%, cervical cancer screening rates are 83% and colon cancer screening rates are only 59% of those who are eligible.

It is hoped that changes in the Affordable Care Act (ACA) to cover these screening procedures with no out of pocket charges will improve compliance with the guidelines. But we cannot expect 100% coverage to solve the problem. Many employers have offered these services at 100% coverage for some time, and yet their employees’ screening rates are often quite low.

There are several reasons for non-compliance with screening recommendations: 
 Fear of learning one has cancer
  •  Lack of knowledge about the test.
  • Fear of the test causing pain or discomfort.
  • Perception of cost.
  • Not wanting to take the time to have the test.
  • No personal  primary care physician.
  • Personal physician neglected to recommend the test.
  • Perception that guidelines change often and may not be correct, as has been the case with breast and cervical cancer screening.

To improve compliance with guidelines, each of these factors should be considered.  Educational materials need to be personalized and as specific as possible, and information about price transparency is a must.
Guidelines and templates for clinical care have the potential to improve the quality of medical care delivered, and better implementation of guidelines requires both patient and physician education and acceptance.

Michael L. Taylor, MD FACP
Chief Medical Officer

Hospitals Need Analytics to Focus Interventions, Prevent Readmissions

By Truven Staff
Michael R. Udwin imageAs suggested in the New York Times article of March 29th, hospitals are confronting expanded readmissions penalties without clear direction on which interventions are likely to yield the greatest impact relative to their unique circumstances. To paraphrase Occam’s Razor, often the simplest explanation is best.

How does this apply to readmissions? Over the years, Truven Health has helped its CareDiscovery customers connect the dots; linking patient populations across the spectrum of care from outpatient setting to hospital to post-discharge facility, and testing the impact of both process and practice on outcome. By following the patient path through risk-adjusted models, we can test and quantify the results of competing readmission theories.

As you might expect, it is often the simplest theory that prevails. Of course, such analytics not only validate the theory but serve to identify the drivers behind the higher than expected readmissions. Only at this point can one be assured that the application of evidence-based protocols can optimally address the highlighted opportunity. With diminished reimbursements and expanded disease burden, now more than ever hospitals must harness true and proven analytics to ensure a thriving population and future.  

Michael R Udwin, MD, FACOG
Medical Director