Evolve: Bringing Data to Life for Healthier Communities

07 May 2014
The Data
In 2011, the California Health Care Foundation released a report of surgical rates of 13 procedures for selected hospital services areas (HSAs) across the state. The procedures, which are known to be “preference sensitive,” or “elective,” address conditions that could be treated with various interventions depending on the preference of the doctor and patient. At first glance, it can be difficult to understand what the four years of collected data mean at the local level. However, for longtime veterans of Humboldt County’s health care community Martin Love and Betsy Stapleton, the data revealed troubling information about the three HSAs in their region. The HSAs in Humboldt reported surgical rates more than 150 percent above the state average for six of the procedures.
Love, the CEO of the physician’s group Humboldt Del Norte IPA, and Stapleton, a former nurse practitioner, understand that variation in surgical rates impacts the individual’s experience of care, the health of the population, and the overall costs of the health care system in the community. Each surgery represents an expense to the individual and purchaser of care, time off from work, and a road to recovery. Deciding to take action, Love and Stapleton came up with the Surgical Rate Project.
Taking Action
The project was a joint effort between the Humboldt-Del Norte Independent Practice Association and Aligning Forces Humboldt at the California Center for Rural Policy, and was supported by the California Health Care Foundation. The initiative had three committees: community members, primary care physicians (PCPs), and surgeons and specialists directly associated with the procedures being studied.
“With some help and educational resources, the community group was able to understand and react to all of the clinical experts and data. It didn’t overwhelm them. Having separate meetings for each committee was vital. Although they were all provided with the same data and resources, each group had a unique process in digesting the information,” said Love.
The groups were all briefed on the data report and held separate brainstorming meetings. They focused their efforts on four of the six procedures: cardiac artery bypass graft, gallbladder surgery, hysterectomy, and carotid endarterectomy (for partially occluded vessels leading to stroke risk). At the project’s final meeting, the groups came together and proposed four recommendations:
1. Adopt a Shared Decision-Making Process
The decision to proceed with a particular procedure should be based on the patient’s informed preference, in consultation with the clinician.
2. Improve Communication Between Primary and Specialty Care
PCPS and specialists should adopt a clear process and nomenclature distinguishing the intent of a referral. In addition, patients should be fully informed about intent of the referral before seeing a specialist.
3. Processes for Evaluation and Treatment
Standards should be developed based on the most up-to-date treatment protocols available, and there should be a process where they are
kept current and providers are prompted to use them.
4. Accept Community-Wide Data
The data should be continuously monitored, updated, and made available to the public. Surgeons should make available their own
complication rates to help patients in their decision making concerning having a particular procedure.
Another Step Forward
Since the conclusion of the project, the group members have presented their recommendations to the local Board of Supervisors and St. Joseph Hospital’s Executive Management Team.
Humboldt’s local quality improvement collaborative, Primary Care Renewal (PCR), is focused on the concept of “Patient-Centered Medical Neighborhood” to improve care coordination across different areas of care. This year, PCR will involve hospitals, specialists, and group members from the project to move this idea forward. The recommendations from the Surgical Rate Project helped the planning team focus on care coordination and referral implementation. Additionally, the IPA Physician’s Group has spearheaded a shared decision-making project to improve patient engagement in the community.
“Many more subtle and equally important outcomes resulted from the project as well,” said Stapleton. “The Community Group has continued to act and present their findings to local government and organizations. The fact that the community as a whole is starting to have these conversations and coming together is a very profound transformation.”
Never Stop Growing
“A close examination of variation in surgical rates is useful in understanding how care is utilized and how our community may more effectively improve outcomes and lower costs. This project is a perfect example of how we can put the data to work to help transform and evolve our programming to create a healthier community,” said Melissa Jones, project director of AF4Q Humboldt. 
The group from the Surgical Rate Project continues to seek out avenues to implement the recommendations. The challenges the health care system faces demand long-term, adaptable, and ever-changing efforts.