Integrated healthcare system consisting of 15 hospitals
Prioritize early disease identification
In September 2019, interventionalists at Ascension Michigan realized that many of their patients were having second and third DVT and PE events due to incomplete work ups and inadequate medication. CV service line leadership realized this cohort needed more attention around this disease, and wanted to reduce fragmented care across different specialties. Data on poor VTE outcomes prompted the physician leadership to adopt a new approach designed to identify patients earlier and reduce the fragmentation of VTE across different specialties within the system.
To ensure that VTE patients received prompt diagnosis and treatment, Ascension did rounds at different hospitals to speak with and educate a wide array of specialists so that patients would be triaged and referred appropriately. They also leveraged community partnerships to ensure that patient education was done as well.
Define care pathways and cross continuum care
Prior to the start of Ascension’s efforts, the full work-up for a VTE patient could take up to six months to ensure all appropriate care steps were completed, where this process should typically take either 1 or 2 visits. Under the new framework, after the VTE patient is identified, they receive an appointment for an initial visit focused on ensuring the patient receives care from all appropriate specialties. Imaging is generally performed prior to this visit to ensure that all care needs can be appropriately evaluated.
The nurse practitioner staffed acts as the VTE coordinator and serves as a resource for identifying best treatment practices for each patient. Additionally, together all the staff at the advanced VTE clinic hold quarterly and monthly meetings evaluate each patient seen in the clinic and identify potential challenges each patient confronts.
Strengthen staff coordination
Ascension decided to create a multidisciplinary clinic staffed with a vascular specialist, hematologist, and an extended provider (NP) who would serve as a VTE coordinator and a liaison between patients and providers. There is a rotation between providers, all of whom have the same algorithms for how to treat patients. The goal of this clinic is to provide a comprehensive work-up of each VTE patient’s needs, so that the patient can receive imaging and all necessary care in one room over the course of one or two visits.
Ascension has found that keeping PCP informed about their patients’ individualized treatment is most important to ensure care continuity, and this in turn leads to further downstream referrals. Poor communication between PCPs and specialists, as well as the inability of PCPs to access hospital records for patients with VTE needs led to consistent fragmentation of VTE care. With limited guidance and structure for care continuity, many patients either received delayed care, insufficient care, or were lost to follow-up.
With the advent of the advanced VTE clinic, follow-up with PCPs is now continuous, with pre- and post-appointment communication hardwired into the care pathway.
Leverage data to prove quality
As the clinic gains traction across the health system, collecting and analyzing data is an on-going process. Currently, patients are given a 20-question survey so that the nurse practitioner can track their progress from visit to visit. These metrics include quality of life/pain scale, circumference of legs, success for procedures, staging of disease, ulcer state, and more.
Data collection is in its early stages, but they are using anecdotal trends to prove value to leadership. The limitations in the data currently are that the pain scale is subjective and may be harder to compare across patients.