“Excellence” Model at UH Expanding to Managing Chronic Conditions

UH Clinical Update | July 2023

Centers of Excellence are a UH success story. Our five centers devoted to hip and knee replacement, atrial fibrillation, cochlear implant, bariatric surgery and cervical and lumbar spine create high-value, integrated care programs that embrace a patient-centered approach, promote best practice guidelines and eliminate unnecessary treatments and procedures. The results speak for themselves: Among patients who have joint replacement, for example, the length of stay in the Center of Excellence was 1.08 days, compared with 3.15 days in an Ohio peer group. Readmission rates also showed significant differences, with a readmission rate of 0.65 percent in a Center of Excellence compared with 3.67 percent in an Ohio peer group.

Patrick Runnels, MD, MBA

“We optimize everything, from the diagnosis right through to recovery for every aspect,” says Patrick J. Runnels, MD, MBA, Chief Medical Officer for Population Health at UH. “It’s deeply designed and deeply thought about in terms of getting the best outcome for the lowest cost.”

Now, Dr. Runnels and his Population Health colleagues are piloting a similar systematic approach in managing the care of patients with chronic conditions. The “Systems of Excellence” initiative aims to reduce unnecessary variation in care, standardizing and optimizing care for UH patients with chronic kidney disease, heart failure, diabetes, COPD and hypertension.

How it Works

Dyads of primary care providers and specialists are working together with the Population Health staff to develop clinical practice guidelines for optimizing care for these conditions, to be approved by a UH advisory board.

“There are rules, checklists, algorithms and processes whereby the treatment for the chronic disease is optimized at every level,” Dr. Runnels says.

Patient outreach is also key.

“Our data analysts are also supporting this activity to help identify people whose care we can optimize,” says Callie Bahner, MSN, RN, CCM, Manager of Care Management in Population Health.

“Often there are people in a primary care practice who don't show up, and they fall off the practice’s radar,” Dr. Runnels adds. “Systems of Excellence is designed so that the entire group of patients a provider is responsible is evident. All of this is visualized, and we can go about the work of making sure that those who are being seen are getting the right care, and those who aren't coming in are brought in as appropriate.”

Providing Clarity

One big benefit of this initiative, Dr. Runnels says, is providing more clarity to providers about when a patient with a chronic condition can be managed in primary care – and when a trip to a specialist is warranted.

Dr. Runnels says he’s excited to get the Systems of Excellence project up and running as soon as possible.

“Our goal is to have these piloted by the fall and widely distributed throughout the system by the end of the year,” he says. “Then we'll be able to start looking at the results and harnessing the data. Our hope is that we can provide some evidence to show that creating these kinds of standardized processes can really impact outcomes in a positive way, such as reduced readmissions, reduced ER visits, less need for specialty care and less progression of disease. By the same token, we also want to make sure the process works. If it does, then our goal is to expand to potentially other chronic disease states.”

Obesity is one likely target, as are patients who have more than one of the five original chronic conditions targeted in the initiative.

“Rarely does someone show up with just diabetes, for example,” says Valerie M. Reese, M. ED, Director of Clinical Services for Population Health. “Of our chronic disease states that we're working with, somebody might have one to all five of them. As this takes shapes and matures, we're going to start looking at which ones go hand in hand. We’re try to figure out how to streamline and group what makes sense to do. The opportunities are endless.”

So far, the team says, feedback from UH providers is positive.

“The passion that I'm seeing in the providers who are working on this project is impressive,” Callie Bahner says. “I always walk away saying, ‘That was really cool.’ There are those challenges, certainly, especially working between two disparate systems of primary care and specialty care. But we're figuring out ways to overcome it, and that's exciting.”

For more information about the Systems of Excellence initiative, please email Patrick.Runnels@UHhospitals.org.