US Health Care: Half Right.

1. Thomas L. Garthwaite, MD Director and Chief Medical Officer Department of Health Services County of Los Angeles US Health Care:Half Right. USC Health Collaborative Retreat October 19, 2005

4. Closing the Quality Chasm Reducing Variation: From Evidence to Practice… Operationalize Knowledge Possess Knowledge Patient Need Met Patient With Need Pneumococcal Pneumonia Vaccination Indications Performance Measurement & Accountability + Supporting Technologies Computerized Health Information System  System Changes

5. Vaccine Cuts Pneumonia Risk in High-Risk PatientsArchives of Internal Medicine 1999;159:2437-2442Dr. Kristin Nichol, VAMC / Minneapolis • 50% of elderly Americans / high-risk individuals have not received the pneumococcal vaccine. • VAMC study of 1,900 elderly patients with chronic lung disease; 2/3vaccinated against pneumonia. • Pneumococcal vaccination: • 43% reduction in hospitalizations for pneumonia and influenza • 29% reduction in the risk of death. • Pneumonia and Influenza vaccination: • 72% reduction in hospitalizations for these two diseases • 82% reduction in deaths from all causes. • Pneumococcal vaccinationsaved an average of $294 per vaccine recipient over the 2-year period.

6. Pneumonia: Acute InpatientDRG89-90; Unadjusted for Pt. Population (up 20%, FY99-01)Improving Efficiency by Reducing Excess Health Care Utilization 9,500 fewer bed days 8,000 fewer discharges • Effective, Efficient

7. Pneumococcal Vaccination Rates • Iowa: Petersen, Med Care 1999;37:502-9. >65/ch dz • HHS: National Health Interview Survey, >64

8. Performance MeasurementSetting the U.S. Benchmark for 18 Comparable Indicators

9. Home-Telehealth Technologies

10. Low-Tech Hi Tech • Single Dialogues • HTN, COPD, DM, CHF, Cancer Care, Depression, Chronic pain, HIV, Hep C, Anticoagulation, Bi-polar Disorder • Dual Dialogues • HTN/COPD • DM/CHF • DM/HTN • CAD/Angina • HTN/Hyperlipidemia (Spanish) • CHF/Hyperlipidemia (Spanish) • Trialogue • HTN/CHF/DM

12. Improved Utilization

13. Move to Los Angeles • 800,000 patients • Billion $$$ deficits • Multiple languages • Acute infections & public health • King/Drew • Press • No incentives • Personnel, union, etc.

14. Percent who received an LDL cholesterol test in the past 12 months among adult diabetic patients with three or more outpatient visits in the past year 25% Improvement

15. Percent of asthmatic children with at least three outpatient or ED visits and a subsequent DHS admission for asthma 19% Improvement

16. Percent of asthmatic children with at least three outpatient or ED visits and a subsequent DHS ED visit for asthma 22% Improvement

17. Percent with documentation of site verification in chart among OR patients receiving left-right specific surgery 27% Improvement

18. Percent of approved Medicare accounts that are unbilled over 150 days from outpatient services 24% Improvement

19. Draft 10/14/2004

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22. * Note: Fourth quarter data for MLK/Drew is preliminary. Draft 10/14/2004

23. Draft 10/14/2004

24. Closing the Quality Chasm Reducing Variation: From Evidence to Practice… Operationalize Knowledge Possess Knowledge Patient Need Met Patient With Need Pneumococcal Pneumonia Vaccination Indications Performance Measurement & Accountability + Supporting Technologies Computerized Health Information System  System Changes