We’ve talked a lot about the importance of collaboration within OSF Innovation. It’s our belief it takes multidisciplinary teams working together to generate ideas that will transform health care for the benefit of the communities we serve. These teams can consist of anyone from Performance Improvement, Healthcare Analytics, Telehealth, Simulation & Education, Innovation Partnerships, OSF Ventures as well as those outside of OSF Innovation. They work together to transform care through the Complex Solution Innovation (CSI) division of OSF Innovation which developed a standard for how multidisciplinary teams will approach, collaborate and innovate around the toughest problems in health care.
Over the summer, we integrated college interns from various universities onto our teams. Many were shared from the Jump Simulation Engineering Internship program and one group was from the University of Illinois at Urbana-Champaign. We didn’t know what to expect from these young people considering they would only be with us for about a month and a half. However, the results they have achieved have been extraordinary with at least a couple of projects identified for further development.
What we found in working with our interns is that we can engage them much like our professionals and challenge them with difficult tasks with the help of subject matter experts. Here are a few of the projects our interns brought fresh ideas to over the summer.
Improving Our Predictive Models (Led by Chris Franciskovich, Manager of Advanced Analytics)
The Healthcare Analytics team developed and continues to advance a readmission model that helps OSF HealthCare predict which patients are at most-risk for hospital readmissions. Patients identified as high risk are assigned a case manager who does a thorough clinical review and looks at their social needs to line up interventions when they leave. The idea is to help the organization reduce the hospital readmissions rate Ministry-wide. We hope to build the ability into our model to target specific diseases.
The analytics team got the opportunity to bring on board three U of I interns to work on this project. One is a computer science major, one is working on a Master’s degree as a statistician and one is a Ph.D. engineering student. Their charge was to find a way for the model to be applied specifically to the heart failure population.
The intern team developed a model that matches the results of the OSF program. This challenge showed that we need to have additional iterations to meet the solution we envision. But it’s something the analytics team will continue to work on. We found the interns to be valuable to our work and welcome the opportunity to bring other students onto our teams. The U of I has one of the top five Computer Science Graduate programs in the United States.
Access to Care (Led by Roopa Foulger, Vice President of Data Delivery)
Performance Improvement (Ministry and Saint Francis), Healthcare Analytics, Finance, OSF HealthCare Saint Francis Medical Center Logistics and others collaborated with summer interns to focus on capacity management issues at acute care sites throughout OSF. The goal is to ensure all of our patients can access emergency care where and when they need it.
The three interns came from Arizona State University (Justin Bloomer, biomedical engineering), Bradley University (Steven Gallagher, computer science) and the University of Illinois College of Medicine (Matthew Schaeffer, M2). Using system data, the three interns helped the overall team find three different business opportunities in the span of about one-and-a-half months.
One set of data around different types of surgeries found that procedures were starting about 14 minutes after the scheduled time, impacting operations for the rest of day. The team also looked at how many procedures were canceled on the day they were supposed to occur. They found that certain specialists had higher rates of cancellations than others. Both of these issues need to be explored further to determine why this is happening and how it impacts our patients’ experience.
Another deep dive into system-wide data found that nearly 300 patients who were transferred to OSF HealthCare Saint Francis Medical Center from other smaller OSF facilities didn’t need to be. This resulted in 388 other patients being denied access to the Peoria site. 60% of those denied were then transferred outside of OSF for treatment. This particular project also led to the development of a database for the improved collection of transfer and denial data. Saint Francis was initially using spreadsheets to gather this information. Purchasing a similar type commercial product had the potential cost of $250,000 to the hospital.
Much of the data collected by our interns will be used to build business cases around what the future design looks like for capacity management. Being able to lay out the complexity of this data helps paint a picture of why certain solutions will need to take place.
More for Those with Less (Led by Sarah de Ramirez, MD, Vice President of Transformation Innovation)
An ongoing issue for health care systems around the nation is hospital readmissions. A major contributor to patients having to revisit the hospital soon after discharge is their living circumstances. Maybe they can’t pay for medication; maybe they don’t have access to transportation for follow-up doctor’s visits, or maybe they just don’t have the ability to take care of themselves.
The Mobile Integrated Health program launched in March at Saint Francis Medical Center, in partnership with Advanced Medical Transport and the East Peoria Fire Department, aims to address some of these unmet needs through in-home visits over the course of a month and connection to social service agencies. It specifically targets patients who are at greatest risk for hospital readmission but don’t qualify for in-home services. Our intern project through OSF Innovation found a way to expand it even further to serve more patients.
The MIH program is currently offered to inpatients at Saint Francis, but the program hasn’t picked up much steam with only 35 patients being referred since March. That’s out of 443 who were eligible. The interns two of whom are in medical school (Sean Patel and Michelle Williams, U of I College of Medicine) and the third applying for entry (Ryan Nierstedt, University of Pittsburgh) worked with leaders of the program to develop a process map for the referral process and found multiple areas for improvement.
The group then investigated other MIH programs across the country to determine their strategies and operations and found that many were successful by not only reducing inpatient readmissions but also decreasing inappropriate Emergency Department utilization. Many patients who frequent the ED are Medicare/Medicaid/self-pay patients and usually have conditions that can be better handled outside of the hospital, but factors such as socioeconomic status, education and access impact whether these patients can get the help they need.
Knowing Saint Francis did not incorporate frequent ED utilizers in their program, the intern group went back to the leadership of the current program, ED physicians and ED case managers for approval to determine whether adding these patients to the model was feasible. Further research identified 438 high-risk patients who used the emergency department at Saint Francis at least five times or more in a year for non-emergent reasons and could have benefitted from the MIH program.
The interns then worked with Performance Improvement to develop a process map for ED referrals in order to avoid the problems noted on the inpatient side. Working with ED case managers, the team identified 57 frequent ED utilizers, considered high-risk, who would be ideal candidates for the MIH program.
By using data from the interns’ investigation into other MIH programs, they determined that these ventures have the potential to reduce ED visits by roughly 50%. Assuming 70% of the 57 Saint Francis patients accepted MIH services, the hospital would likely be able to open more space to individuals who need emergency care and save money.
The success of the interns’ findings led them to explore the feasibility of expanding the MIH program across the OSF organization. They found multiple locations where it could be implemented with potential success.
The next step is to finalize a business case and determine how the program fits into the larger OSF strategy. In the meantime, this intern project demonstrated the way OSF Innovation wants to continue to work in the future. We will continue to enable multidisciplinary teams where they focus on a specific problem for a sprint discovery. The work completed by the interns is a prime example of how much we can accomplish when we provide focused effort.
Learn more about other projects OSF Innovation is working on by visiting our website at osfinnovation.org.