The Utility of Clinical Milestones Pathway in a Cardiovascular ICU

NCT02864238 | Completed

• 1 other identifier: IRB #151566
• Study Type: observational
• Target: 2,401
• Locations: 0 countries
• Sites: N/A

Brief Summary

The economic burden of health care is becoming a greater burden from year to year. Medicare spending, which represented 20 percent of national health spending in 2013, grew 3.4 percent to $585.7 billion, a slowdown from growth of 4.0 percent in 2012. This slowdown was attributed largely to slower enrollment growth and impacts of the Affordable Care Act (ACA) and sequestration. Per-enrollee spending in 2013 grew at about the same rate as 2012. The push to create Accountable Care Organizations (ACO) has taken these initiatives a step further. The goal would be to move away from a fee for service system and base reimbursement on quality of care. Clinical metrics, re-admissions, and patient satisfaction in categories of acute myocardial infarction, congestive heart failure, pneumonia, surgeries and healthcare associated infections will be the foci for 2013. Centers for Medicare and Medicaid Services (CMS) has also initiated a valve bundled payment system that encompasses total patient care for 90 days, including readmissions. Leapfrog and the ACO movement along with the nonprofit group Institute for Health Care Improvement have placed quality and cost effectiveness into the spotlight for clinicians in the ICU and beyond. While clinicians have always been focused on evidence based therapies with little concern for cost, in the new era of healthcare understanding cost, value and effectiveness of therapies will be key for improved patient outcomes and institutional solvency in trying economic times. Vanderbilt elected to enroll in the CMS valve bundle trial. The Leadership team in the heart and vascular institute identified the importance of an electronic medical record that includes display and utilization of key drivers of quality and success across the continuum of care (Preoperative assessment to discharge up to 90 days) in the bundled payment model of care. A multidisciplinary team was developed in conjunction with nurses, midlevel providers, multi-specialty physicians, case managers, informatics specialists, and performance improvement representatives to develop an electronic pathway of care using evidence based and best practices for cardiac surgery.

Conditions

Cardiac Surgery

Keywords

electronic milestone pathway; cardiac valve surgery

Outcome Measures

Primary Outcomes (1)

• mortality

  mortality rate for patients during index hospitalization

  Post operative day 0 to post operative day 7

Secondary Outcomes (8)

• Re-intubation rate within 48 hours

  48 hours of index procedure

• Acute Kidney Injury as defined by KDIGO (Kidney Disease Improving Global Outcomes) guidelines

  All time points occurring between post operative day 0 and Post operative day 7

• Delirium

  All time points occurring between post operative day 0 and Post operative day 7

• major adverse cardiac events

  All time points occurring between post operative day 0 and Post operative day 7

• Infection rates

  All time points occurring between post operative day 0 and Post operative day 7

Study Arms (2)

Pre intervention

This cohort consists of patients who underwent cardiac valve surgery during calender year 2013 prior to the institution of the electronic milestone pathway

post intervention

This cohort consists of patients who underwent cardiac valve surgery during calender year 2014 after the electronic milestone pathway had been instituted

Other: electronic milestone pathway

Interventions

electronic milestone pathway OTHER

an electronic based, clinical milestone driven pathway developed to guide the care of cardiac valve surgery patients.

post intervention

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All patients who underwent cardiac valve surgery at vanderbilt university medical center between 1/1/2013 and 12/31/2014

You may qualify if:

• Underwent cardiac valve surgery at vanderbilt university medical center between 1/1/2013 and 12/31/2014

You may not qualify if:

• none

Sponsors & Collaborators

• Vanderbilt University: lead

Study Officials

• Lee Parmley, MD, JD

  Vanderbilt University Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: July 13, 2016
• First Posted: August 11, 2016
• Study Start: January 1, 2013
• Primary Completion: December 1, 2014
• Study Completion: December 1, 2014
• Last Updated: August 12, 2016

Record last verified: 2016-08

Data Sharing

• IPD Sharing: Will not share