Updates on UHQCN media coverage and related news.
University Hospitals Wins Top Award from American Hospital Association
AHA, July 2022
"The American Hospital Association Quest for Quality Prize is presented annually to honor health care leadership and innovation in achieving high-quality health care and advancing health in communities. The 2022 award recognizes hospitals and health systems that are committed to and are making significant progress in providing access to exceptional quality, safe, patient- and family-centered affordable care that is improving the health of their communities. The award showcases successful innovative models of care, services and collaboration to provide seamless care and to address health care disparities. The prize is directed and staffed by the American Hospital Association’s Office of the Secretary. The award winner and finalists were recognized in July at the AHA Leadership Summit.."
University Hospitals Quality Care Network Joins the Population Health Alliance
Pittsburgh Post-Gazette, August 14, 2020
"Population Health Alliance (PHA), the industry's only multi-stakeholder professional and trade association solely focused on population health, today announced that University Hospitals Quality Care Network (uhqcn.org) has joined the organization as a member. UH Quality Care Network was established in 2016 to lead and transform the practice of healthcare through evidence-based medicine. The vision of UH Quality Care Network is to lead a clinically integrated network of providers to improve the quality, experience, and cost of healthcare. The UH Quality Care Network hosts a publicly accessible database of Adult Clinical Practice Guidelines & Toolkits. Developed by a multi-disciplinary team, these toolkits provide easy to use guidelines that aide providers in their pursuit of successful value-based care...."
Publications and articles where our team members have been key contributors or authors
Decreasing Dissonant and Increasing Resonant Leadership Behaviors to Transform Health Care
Team contributors: Patrick Runnels MD, MBA, Peter J. Pronovost MD, PhD, Mark E. Schario, MS, RN
Published: April, 2023
"Highly effective transformational leadership is grounded in the establishment of resonance. Resonant leaders become attuned to individuals' values and establish an environment of open dialogue, mutual trust, and respect. They then articulate a compelling vision of the future and proactively work to achieve that vision by supporting and developing staff, encouraging them to be creative, and doggedly facilitating collaboration. In this article, the authors highlight 5 common leadership behaviors identified - through direct observations and in conversations and collaborations with others around the country - that impede the work of transformation, while contrasting them with more successful resonant behaviors..."
Eliminating Defects in Value: Turnaround of an MSSP ACO
Team contributors: Peter J. Pronovost MD, PhD, Patrick Runnels MD, MBA, Mark E. Schario, MS, RN, Tomasina Green MPH, Kelsey A. Fuller MS, Heather M. Byrne MPA-HSA, CNMT, Valerie Reese MEd, Tyler D. Barnett MHSA, Kaitlin Mabin BA, George Topalsky, MD
Published: March, 2023
"Study findings estimate that defects in value—the practices or systems that worsen quality or patient experience and increase costs without benefit—account for one-third of health care expenditures (or $1.4 trillion) in the United States. Federal policy makers have implemented programs to address these defects. The Medicare Shared Savings Program (MSSP) rewards provider organizations with shared savings when they reduce the annual cost per Medicare beneficiary and improve overall quality. However, payment policies, such as MSSP, alone have had limited impact on improving value across the United States. To realize larger gains in value, health systems and providers must redesign their care models and implement strategies to achieve their value improvement goals. Our health system took this journey, aligning the health system around a common purpose to maximize value by designing and implementing a framework to eliminate its defects with 3 frames: believing, belonging, and building..."
Achieving Large-Scale Quality Improvement in Primary Care Annual Wellness Visits and Hierarchical Condition Coding
Team contributors: Todd M. Zeiger MD, Esther K. Thatcher PhD, RN, Sona Kirpekar MD, George Topalsky, MD, Mary Jane D. Zarach MBA, Mark E. Schario MS,RN,FACHE, Kelsey A. Fuller MS, Tomasina Green, MPH, and Peter Pronovost, MD, PhD
Published: January, 2022
"Completion of Medicare Annual Wellness Visits (AWV) and documentation of Hierarchical Condition Categories (HCC) are important metrics in accountable care organizations (ACO) with quality and financial implications. To improve performance in large healthcare organizations, quality improvement (QI) efforts need to be scaled up in a way that is feasible within available system-wide resources. We describe a 3-year effort using a multifaceted QI framework called the fractal management system for AWV and HCC performance. Pre-post evaluation of a multi-level, health system–wide QI management system intervention between 2018 and 2020. The system provided project management, coaching, communications, feedback of performance, and health informatics..."
Chatbot-Assisted Care Management
Team contributors: Mark E. Schario, MS, RN, FACHE - Vice President of UH Population Health & President of UHQCN, Carol A. Bahner, BSN, RN, CCM - Manager of the Care Management in UH Population Health, Theresa V. Widenhofer, ADN, RN, CCM - UH Population Health Case Manager, Joan I. Rajaballey, BSN, RN, CCM - UH Population Health Case Manager, and Esther J. Thatcher, PhD, RN - UH Population Health Nurse Scientist
Published: November, 2021
"Abstract: Chatbots are automated conversation pathways that users can access through text message or email on smartphones or other connected devices. In care management, they can be used to monitor patients’ health conditions or recovery from procedures. This article describes nurse care managers’ experiences using chatbots in patient care, illustrated through two patient case reviews. Considerations for planning and implementing chatbot technology in care management settings are discussed. This care management service is part of an accountable care organization that serves 582,000 patients in University Hospitals of Cleveland, Ohio. Care management focuses on patients with chronic conditions, recent hospital discharges, and other needs. Care managers comprise a centralized team as well as embedded staff in select primary care practices..."
Stratifying for Value: An Updated Population Health Risk Stratification Approach
Contributors: Justin J. Coran, PhD, MPH, Mark E. Schario, MS, RN, FACHE - Vice President of UH Population Health & President of UHQCN and Peter J. Pronovost, MD, PhD - UH Chief Clinical Transformation & Quality Officer
Published: August, 2021
"Abstract: Most risk stratification approaches attempt to predict clinical outcomes rather than value. For a provider organization or health system to have financial success in value-based contracting, future risk models must analyze costs as well as disease burden. The purpose of this study was to create a customized risk stratification algorithm that considered a patient’s medical spend alongside disease burden while delivering a scoring system that improves the efficiency of a care coordination program. The authors focused on University Hospitals (UH) Health System’s Accountable Care Organization population of 554,805 because this patient cohort is engaged with UH’s primary care network and has the most robust data. The 5-category risk algorithm was found to be meaningful and impactful after integrating the foundation of the Minnesota Tiering system with an expanded comorbidity list and weighting the result by the previous 12 months of medical spend. This new technique can identify patients in need of intensive care coordination. The complex risk tier of the stratification system reduces the number of patients from 551,045 to 27,552, or 5% of the patient population, and accounts for 67.9% ($1,107,822,887) of total annual medical spend. Expanding care coordination efforts to patients in the top 2 tiers would account for 15% of the patients and 83.2% ($1,357,545,872) of annual medical spend. The novelty of the new approach allows clinical teams to focus intense resources on a smaller sample of the patient population and to identify chronic conditions contributing to costs, and feel confident that they have greater explanatory power regarding value."
EMBA Alum Leverages Design Thinking, Applies Course Project to Real-World Solutions in Healthcare Industry
Case Western Reserve: Weatherhead School of Management
Published: June, 2021
"What started as the desire to “get some letters” while pursuing his Executive MBA (EMBA) from the Weatherhead School of Management quickly turned into “the single most gratifying learning experience I’ve had in my life.”
Patrick Runnels, MD, (MGT ‘18), Chief Medical Officer of Population Health for University Hospital, was looking for a way to maintain his managerial position and potentially open doors down the road. The EMBA program seemed like the right fit. After completing the program, Runnels quickly realized the tremendous impact it would have on his life—professionally and personally..."
Making a Dent in the Trillion-Dollar Problem: Toward Zero Defects
Team contributors: Peter Pronovost, MD, PhD - UH Chief Clinical Transformation & Quality Officer, Justin J. Coran, PhD, MPH, Mark E. Schario, MS, RN, FACHE - Vice President of UH Population Health & President of UHQCN, Patrick Runnels, MD, MBA - UH Population Health-Behavioral Health Chief Medical Officer, Todd Zeiger, MD - Vice President of UH Primary Care Institute, and Sandeep Palakodeti, MD, MPH - UH Population Health Chief Medical Officer
Published: December, 2020
"Health care harms too many patients, costs too much, and improves too slowly. Progress in improving value has been slow. Most efforts to eliminate defects in value have been piecemeal rather than systematic. In this article, the authors describe a framework for identifying defects in value and provide estimates for cost savings if these defects were to be eliminated. The authors then provide a framework for how health systems may work to systematically eliminate these defects in value. Finally, they provide an example of one academic health system that embarked on a journey to implement this framework and the initial results and lessons learned..."
Utilizing a Dashboard to Promote System-Wide Value in Behavioral Health
Team contributors: Patrick Runnels, MD - UH Population Health-Behavioral Health Chief Medical Officer, Justin J. Coran, PhD, MPH, and Peter Pronovost, MD, PhD - UH Chief Clinical Transformation & Quality Officer
Published: October, 2020
"Introduction: The past 10 years have seen significant growth and evolution in value-based payment models, many ushered in by initiatives contained in the Affordable Care Act and expanded on by subsequent legislation and policy at the federal and state levels. Performance success in these models relies heavily on having a mature data infrastructure and valid measures that track key metrics across a range of health conditions, such as hemoglobin A1c levels are monitored for individuals with diabetes. When system-level data are available and distributed to providers, gaps in care become visible, fueling the quality improvement initiatives necessary to deliver increased value..."
A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics
Team contributor: Esther J. Thatcher, PhD, RN - UH Population Health Nurse Scientist
Published: October, 2020
"Abstract: Purpose. To explore system/staff‐ and patient‐level opportunities to improve colorectal cancer (CRC) screening within an 11‐clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%‐30%. Methods. Using a convergent parallel mixed‐methods design, staff (n = 26) and patients (n = 60, age 50‐75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC‐related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive‐deductive approach.... "
Neighborhood Food Environment and Health Outcomes in U.S. Low-Socioeconomic Status, Racial/Ethnic Minority, and Rural Populations: A Systematic Review
Team contributor: Esther J. Thatcher, PhD, RN - UH Population Health Nurse Scientist
Published: August, 2020
"Abstract: Introduction. This review examined associations between the neighborhood food environment and health outcomes in populations with the highest obesity rates in the United States: people of low-socioeconomic status (SES), racial/ethnic minorities, and rural residents. Methods. We searched multiple databases using preselected search terms through June 2017. Forty-three sources met criteria of peer-reviewed U.S. studies that tested food environment-health associations (e.g. obesity, diabetes) in the populations of interest..."