Deploying POKE Within Intermountain Healthcare
Study Details
Study Description
Brief Summary
To assess the impact of POKE on babies, the investigators will longitudinally track outcomes before and after implementation at Intermountain Healthcare's five NICUs. Process outcomes will include the number of total POKEs per baby and the number of painful POKEs per baby, each measured at both the patient-level and NICU-level. Clinical outcomes will include hospital acquired infections, length of stay, and mortality. Financial outcomes will include total variable costs and backfill rate. The effect of POKE on each of these outcomes will be measured using multivariable regression analysis with appropriate distributional families and interaction terms.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
POKE was developed and implemented at Dixie Regional Medical Center's Neonatal Intensive Care Unit (NICU) over the past 10 years to eliminate waste and reduce harm in healthcare. POKE is a combination of a unique culture and process, with a supporting database, that is designed to guide and inform care decisions while minimizing POKEs. The program utilizes an implementation framework, educational materials, electronic health records (EHR), and decision support analytics. POKE's initial deployment showed extremely promising results for Intermountain, which included: (1) eliminating 11,000 POKEs per year (a 50% reduction in overall POKEs), (2) realizing $940,000 per year in cost savings (a 28% reduction of overall cost), (3) reducing length of stay by 2 weeks per average stay (a 21% reduction in length of stay), and (4) eliminating Hospital Acquired Infections (i.e., Central-line Associated Bloodstream Infection and Ventilator-associated Pneumonia), translating into 10 lives saved and a $5.2M savings over a decade. POKE will now be deployed and routinized within all Intermountain Healthcare NICUs and be developed as a commercial product for external customers. To assess the impact of POKE on babies, the investigators will longitudinally track several outcomes before and after implementation at Intermountain NICUs. Process outcomes will include the number of total POKEs per baby and the number of painful POKEs per baby, each measured at both the patient-level and NICU-level. Clinical outcomes will include hospital acquired infections, length of stay, and mortality. Financial outcomes will include total variable costs and backfill rate.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| POKE All babies in NICU at Intermountain Healthcare hospitals |
Procedure: There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.
There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.
|
Outcome Measures
Primary Outcome Measures
- Number of POKEs per baby [1 October 2018 - 31 May 2019]
The primary outcomes will be the number of total POKEs per baby and the number of painful POKEs per baby. We will assess the impact of POKE on each of these outcomes modeled as counts (ie, generalized Poisson distributions) using multivariable regression adjusting for potential confounders including age, gestational age, interaction terms, and nominal indicators of NICU (to account for baseline heterogeneity across sites).
Secondary Outcome Measures
- Infection Rate [1 October 2018 - 31 May 2019]
Also using multivariable regression, the secondary outcomes will be patient-level indicators, including hospital acquired infection (logistic regression)
- Length of Stay [1 October 2018 - 31 May 2019]
Length of stay (scaled beta regression)
- Mortality [1 October 2018 - 31 May 2019]
Mortality (logistic regression)
- Total Variable Cost [1 October 2018 - 31 May 2019]
Total variable costs (log-linear regression)
- Aggregate Backfill Rate [1 October 2018 - 31 May 2019]
aggregated backfill rate (quasibinomial regression)
Eligibility Criteria
Criteria
Inclusion Criteria:
- All babies in Intermountain Healthcare NICU
Exclusion Criteria:
- None
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Dixie Regional Medical Center, Intermountain Healthcare | Saint George | Utah | United States | 84770 |
Sponsors and Collaborators
- Intermountain Health Care, Inc.
Investigators
- Principal Investigator: R. Erick Ridout, MD, Intermountain Health Care, Inc.
- Study Director: Terri Kane, RN, MBA, Intermountain Health Care, Inc.
- Study Director: Brad Isaacson, PhD, MBA, MSF, Intermountain Health Care, Inc.
Study Documents (Full-Text)
None provided.More Information
Publications
- Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012 Apr 11;307(14):1513-6. doi: 10.1001/jama.2012.362. Epub 2012 Mar 14.
- Committee on the Learning Health Care System in America, Institute of Medicine; Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington (DC): National Academies Press (US); 2013 May 10.
- Critical Care Statistics. Retrieved from http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx
- Ebell MH, Sokol R, Lee A, Simons C, Early J. How good is the evidence to support primary care practice? Evid Based Med. 2017 Jun;22(3):88-92. doi: 10.1136/ebmed-2017-110704. Epub 2017 May 29.
- Harrison W, Goodman D. Epidemiologic Trends in Neonatal Intensive Care, 2007-2012. JAMA Pediatr. 2015 Sep;169(9):855-62. doi: 10.1001/jamapediatrics.2015.1305. Erratum in: JAMA Pediatr. 2015 Sep;169(9):878.
- Kornhauser, M., & R. S. (2017, December 15). How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care. Retrieved from https://www.managedcaremag.com/archives/2010/1/how-plans-can-improveoutcomes-and-cut-costs-preterm-infant-care
- National Center for Health Statistics. (2018, January 31). Retrieved from https://www.cdc.gov/nchs/nvss/births.htm
- Special Care Nursery Admissions. (2011). National Perinatal Information Center Quality Analytic Services. Retrieved from https://www.marchofdimes.org/peristats/pdfdocs/nicu_summary_final.pdf
- IHC IRB #1050915