christiana care health system | Value institute

What Value Really Means

Value InstituteChristiana Care Health SystemJohn H. Ammon Medical Education Building2nd Floor, Suite 2E554755 Ogletown-Stanton RoadNewark, Delaware 19718

302-733-4380 | Phone302-733-5884 | Fax

TheValueInstitute@ChristianaCare.orgwww.ChristianaCare.org/ValueInstitute

“Health care reform must be the social revolution of our time. But it can’t

come from the grass roots; it’s too complicated. Instead it must be driven

by the experts in the field as incremental changes.” Jennifer Goldsack, MChem, MA (Oxon), MS, Research Associate, Value Institute

Value“Value is service and care that make a measurable difference in people’s

lives in ways they appreciate and society can afford. It reflects concerns

about quality, safety, cost, accessibility, affordability and efficiency with

the patient’s perception featured prominently.”

Robert Laskowski, M.D., MBA, President and CEO, Christiana Care Health System

Dr. Robert Laskowski

Value Institute Leadership TeamTimothy Gardner, M.D.Executive Director

Eric Jackson, Jr., M.D., MBAAssociate Director

Vernon Alders, MBA, MSW Sharon Anderson, RN, MSClaudine Jurkovitz, M.D., MPHMichael Rhodes, M.D.Herbert ScherrerSeema Sonnad, PhDWilliam Weintraub, M.D.

Patients perceive value as access to high-

quality care that they can afford. For physicians,

value is practicing medicine that benefits

patients, while for health care systems,

policymakers and payers, value exists in an

efficient and sustainable system of care.

The deep seated issues in health care in the

United States center on value.

Christiana Care created the Value Institute in 2011

recognizing both the need for answers to health

care challenges and their unique ability to address

that need. The Value Institute unites the Center

for Outcomes Research, already known for clinical

trials, epidemiological and cost effectiveness

research; the Center for Operational Excellence;

and the Center for Quality and Patient Safety; and

adds a new, critical component – the Center for

Health Care Delivery Science, a team focused on

applying scientific approaches to create and

analyze system-based processes to improve

health-related outcomes, increase access and

lower costs.

The Value Institute comprises communities of

researchers, project managers, biostatisticians

and data analysts, all working together to develop

the best models of evidence-based care for our

patients. A team with diverse expertise –

medicine, public health, sociology, law, economics

and mathematics – provides a unique range of

perspectives needed to confront today’s problems.

The Value Institute seeks answers to questions

that are complex yet basic. Will patient-centered

approaches improve health and reduce costs?

Can technology be used to direct resources to

those needing them most? What can be done to

prevent life-threatening infections? The Value

Institute applies research methods to provide

clinicians and administrators with data to

support optimal decisions about patient care.

That is what value really means.

What Does Value Really Mean?

Research leadership by a multi-disciplinary team of experts is a fundamental part of the Value Institute.

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Centering Care on Patients, Needs

Visits by social workers and nurses

provide patient-centered care outside

the clinical setting.

When she heard from clinicians about a

program for hospital “super-users,” Sharon

Anderson, RN, MS, director of the Value

Institute’s Center for Quality and Patient

Safety, knew the approach would dovetail with

Christiana Care’s mission to provide services

that community members not only need but

also want and value.

Less than a year later, Medical Home Without

Walls began reaching out to super-users, those

patients who use hospital services more often

than average.

A nurse and social worker in the program visit

patients in the community to link participants

with physicians, then help them keep medical

appointments and follow treatment plans. The

team also serves as a conduit to social services,

helping patients address hunger, homelessness

and even unemployment.

Recognizing the potential of Medical Home

Without Walls to transform lives, Value Institute

Scholar Heather Bittner Fagan, M.D., MPH

collaborated with the Center for Health Care

Delivery Science. The resulting multidisciplinary

team designed a randomized trial to compare

the outcomes of program participants with

other super-users.

Early results indicate that participants’ health has

improved while costs have gone down. The team

expects to publish numerous papers on the

project, giving other organizations a blueprint to

improve health and lower costs while providing

patients with services they value.

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“We’re really focused on creating

safe and effective health care

programs that our community

values. We do this through

pragmatic, innovative research.” Timothy Gardner, M.D., Executive Director,

Value Institute03

Confronting Challenges from All SidesThe Value Institute unites Christiana Care’s educational programs, more than two dozen clinicians, researchers, biostatisticians, data analysts and project managers and four centers:

Center for Health Care Delivery Science Creating and analyzing system-based processes across the full patient experience to improve outcomes, increase access and lower costs.

Center for Operational Excellence Redesigning services to improve safety and efficiency.

Center for Outcomes Research Focusing on clinical and translational research to measure the effectiveness and efficiency of health services.

Center for Quality & Patient Safety Developing nationally recognized programs to

increase the quality and safety of health care.

Making Data Manageable

“Reform has placed a whole new perspective on patient care and

patient-centeredness. The institute was designed to meet the

challenges of health care changes in ways the patient appreciates.

That’s our core focus.”

Susan Smola, JD, MBA, Research Investigator, Value Institute

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Making Data Manageable

Making Data Manageable

Counted Among the BestThe Center for Medicare and Medicaid Innovation chose the Value Institute’s Bridging the Divides as one of 107 projects out of 3,000 submitted to receive a first-round, $10 million innovation grant. In its first 18 months, the Value Institute received funding from 38 sources.

Research shows that following evidence-

based guidelines helps heart patients stay

healthy. But the real world often gets in the

way, and the massive amount of information

needed for effective and efficient case

management has been a barrier. Until now.

William Weintraub, M.D., director of the Center

for Outcomes Research, and Value Institute

Scholar Daniel Elliott, M.D., MSCE, lead a team

that has overcome multiple challenges to

devise a technologically sophisticated system

alerting case managers when heart patients

need care.

The project, Bridging the Divides, restructured

an existing software program to use

algorithms developed at Christiana Care to

identify heart patients most at risk for

complications and flag those needing attention

from the case management team.

This improved software merges real-time

information about patients from cardiac

practices, hospitals, labs and pharmacies.

Adapting commercially available software will

enable hospitals across the country to replicate

the program.

The project will answer a question at the crux

of health care reform: Can new systems of care

for cardiac patients improve health while lowering

costs? If so, the Value Institute’s research will give

hospitals large and small a technological

advancement that provides real value.

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The Bridges team created a unique

system, Neuron, to manage data from multiple sources to

improve patient care.

Harnessing Technology to Save Lives

Novel applications of existing technologies can create innovative solutions to persistent health care problems.

Sepsis kills 300,000 Americans annually,

costing the U.S. health care system $17 billion.

Could hospitals stem the tide by harnessing

technology to identify patients most at risk,

then begin aggressive treatment immediately?

Eric Jackson, Jr., M.D., MBA, director of the

Value Institute’s Center for Health Care

Delivery Science, says yes.

With the reduction of sepsis being a major goal

of virtually every hospital in the country,

Dr. Jackson, his team at the Center for Health

Care Delivery Science and colleagues from

throughout Christiana Care attack the challenge

in an innovative way – using the Global Trigger

Tool, a technique normally employed

retrospectively to identify adverse events.

The team chose almost two dozen triggers,

or clues, that could indicate early stages of

sepsis. Clinical investigators, statisticians and

programming experts then designed an

algorithm to search electronic medical records

for lab results and vital signs, looking for a

combination of clues indicating emerging sepsis.

The study compares the institute’s algorithm

to commercially available software that

has machine learning and natural language

processing capabilities to determine the

effectiveness of each.

The study also addresses a second issue: Given

variations in medical teams, when is the best

time to start an intervention? Dr. Jackson and

his team are investigating the efficiency of

alternate protocols in providing the most

effective and timely treatment.

The number of deaths from sepsis increases

year after year. The Value Institute combines

technology with implementation science to

save lives.

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Harnessing Technology to Save Lives Collaborating Across DepartmentsThe research created and supported by the Value Institute unites a wide range of disciplines and departments, each adding a unique and valuable perspective. The sepsis project involves researchers, data specialists and administrators from the institute's centers of Health Care Delivery Science and Patient Quality & Safety as well as nurses, respiratory therapists, pharmacists and physicians. The project includes staff from numerous departments, including surgery, medicine and IT, and from both hospitals in the Christiana Care Health System.

“Having the core competencies under one roof in the Value Institute

allows us to have team-based learning and enhanced horizontal

networking, so we’re more effective in addressing problems.

We maximize resources.” Eric Jackson, Jr., M.D., MBA, Director, Center for Health Care Delivery Science and Associate Director,

Value Institute

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“In the modern world, we need to be committed to measuring, quantifying

and proving that the things we do bring value to our community.” Seema Sonnad, PhD, Director of Health Services Research, Value Institute

The Value Institute believes that research education is essential

to empowering our front-line

practitioners and future clinicians.

Empowering Professionals with Education

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Research Methods

Research Fellowship

Core Lecture Series for Fellows: Epidemiology and Statistics Lectures

Translational Research

Health Care Delivery Science Research

Statistics 2: General and Generalized Linear Models

Research Seminar Series: Value Institute

Current Issues in Research Series

Research Fundamentals: Introduction to Research Design and Statistics

Biomedical Human Subjects Research Training (CITI Training)

Historical Perspectives on Human Subjects Research

Conducting a Literature Search: Finding the Evidence

Institutional Review Board (IRB) Processes and Regulations

The Value Institute Academy offers a wide range of courses, including a curriculum dedicated to research methods.

basic

intermediate

advanced

The passion that Christiana Care’s clinicians

feel about providing the best care for patients

inevitably leads them to ask questions: Would

care improve by making one small change?

Would costs decrease if we combined steps?

Would patients benefit from a different

approach? Through education and mentoring,

the Value Institute equips clinicians with

the tools to discover answers with pragmatic

research.

In 2012, Christiana Care formed the Value

Institute Academy by consolidating existing

educational offerings and bolstering those in

research, improvement science and patient

safety. “We are using our unique capabilities

to develop educational offerings equivalent to

those of a university-based medical center

without the constraints,” said Carol Moore,

MS, RN, education specialist at the Value

Institute Academy.

Formal offerings range from the nuts and bolts

of clinical trials to research design and statistics.

In a course that Christiana Care helped the

Robert Wood Johnson Foundation pioneer, health

care professionals learn a systematic approach

to analyzing and solving problems complete with

data collection. Tracks on improvement science

and patient safety round out the offerings.

In addition to offerings through the Value

Institute Academy, the Value Institute

co-sponsors a large, federally-funded, summer

internship program. Undergraduate and

graduate students from around the country have

made significant contributions to more than 50

projects. In addition to research experience, the

Value Institute provided classroom and

individual instruction on clinical and health

services research to this next generation of

researchers.

Less formal education occurs via mentoring

during consultations that team clinicians with

Value Institute researchers and biostatisticians.

Both formal and informal meetings allow Value

Institute Scholars to share new ideas with their

peers, present initial results and receive feedback

on projects and manuscripts. Clinicians and

administrators throughout Christiana Care

benefit from “lunch-and-learn” workshops

featuring internal and external experts.

Through education across many levels, the Value

Institute empowers everyone at Christiana Care

to find solutions to the nation’s most vexing

health care problems.

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“To establish something like the Value Institute, you have to have a

truly committed leadership that understands we have no choice in

this day and age but to prove the efficacy of the care we offer.” William Weintraub, M.D., Director, Center for Outcomes Research, Value Institute

Creating a Research Culture

Collaborations with Christiana Care

clinicians on the front lines of health care are fundamental to Value

Institute success.

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Anesthesia The Cancer Center Cardiology

Infectious Disease Internal Medicine Laboratory Science

Pharmacy Psychology Pulmonology

Emergency Medicine Family & Community Medicine Genetic Counseling

Oral & Maxillofacial Surgery Orthopedics Pediatrics

Neurology Nursing Sciences Obstetrics and Gynecology

Radiology Surgery Trauma

Reaching Into Every Area

The Value Institute partners with departments and specialties across the Christiana Care Health System.

Attracted to the startup environment at the

Value Institute, Seema Sonnad, PhD, director

of Health Services Research, joined the

organization to expand the culture of research

at Christiana Care.

The Value Institute works with departments and

individuals to develop research programs. This

includes establishing the value of publication,

instituting long term grant planning and

integrating related efforts so that research can

play a continual and growing role in answering

important clinical questions. Sudhakar Satti,

M.D., a neuro-interventional surgeon, posed one

such question.

Dr. Satti came to Dr. Sonnad with several

research ideas. They decided to tackle his list

starting with the project most important to Dr.

Satti’s clinical work. Together they applied for

and received a mentored research grant that

included funding for a Value Institute research

associate and a student intern. The project is

using research to confirm Dr. Satti’s clinical

belief that national recommendations against

surgery for brain aneurysms smaller than 7

millimeters lead to unnecessary ruptures. The

study has the potential to change national

guidelines – saving lives.

Dr. Satti’s project is one example of the many

ideas arising in surgery, nursing, emergency

medicine and other areas that have blossomed

into rigorous research through mentoring and

collaboration provided by the Value Institute.

An institution that helps turn clinical

observations into innovations and uses hard

data to guide decisions – that is value.

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Value Institute experts from medicine and informatics collaborated to develop an automated screening tool, AUDIT-PC, to predict alcohol withdrawal in recently admitted patients.

The Value Institute guided staff from Christiana Care’s clinical laboratory in sharing research with colleagues across the country through the unit’s first peer-reviewed study. It focused on improving patient outcomes by improving communication between the lab and the Emergency Department.

Health professionals from Obstetrics and Gynecology working with the Value Institute have significantly decreased admissions to the Neonatal Intensive Care Unit by establishing a policy limiting elective delivery before 39 weeks.

The Value Institute joined a multidisciplinary team of clinicians to determine the root cause of inpatient falls and identify interventions.

Health professionals working with the Value Institute collaborated with colleagues in the Intensive Care Unit to integrate telemedicine monitoring with sedation management. Their innovation decreased drug costs and improved outcomes.

Join Us on Our JourneyThe Value Institute is built on a model of high-level, successful collaboration. The team is committed to fostering relationships with patients, clinicians, sponsors and other partners with the common goal of using high-quality, high-impact research as a vehicle to advance population health, patient experience, system performance and health policy.

Please contact the Value Institute to join us on our journey.

TheValueInstitute@ChristianaCare.org

The Value Institute’s

influence includes smaller

studies with the potential

for significant impact.

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Advancing Projects System Wide

Value“Value is service and care that make a measurable difference in people’s

lives in ways they appreciate and society can afford. It reflects concerns

about quality, safety, cost, accessibility, affordability and efficiency with

the patient’s perception featured prominently.”

Robert Laskowski, M.D., MBA, President and CEO, Christiana Care Health System

Dr. Robert Laskowski

Value Institute Leadership TeamTimothy Gardner, M.D.Executive Director

Eric Jackson, Jr., M.D., MBAAssociate Director

Vernon Alders, MBA, MSW Sharon Anderson, RN, MSClaudine Jurkovitz, M.D., MPHMichael Rhodes, M.D.Herbert ScherrerSeema Sonnad, PhDWilliam Weintraub, M.D.

“Health care reform must be the social revolution of our time. But it can’t

come from the grass roots; it’s too complicated. Instead it must be driven

by the experts in the field as incremental changes.” Jennifer Goldsack, MChem, MA (Oxon), MS, Research Associate, Value Institute

christiana care health system | Value institute

What Value Really Means

Value InstituteChristiana Care Health SystemJohn H. Ammon Medical Education Building2nd Floor, Suite 2E554755 Ogletown-Stanton RoadNewark, Delaware 19718

302-733-4380 | Phone302-733-5884 | Fax

TheValueInstitute@ChristianaCare.orgwww.ChristianaCare.org/ValueInstitute

“Health care reform must be the social revolution of our time. But it can’t

come from the grass roots; it’s too complicated. Instead it must be driven

by the experts in the field as incremental changes.” Jennifer Goldsack, MChem, MA (Oxon), MS, Research Associate, Value Institute