In the not-too-distant future, patients will be more knowledgeable-and more demanding-about their healthcare. Health systems will have more incentives to manage patient risk from cradle to grave. And the University of Pennsylvania Health System wants to be ready for the change.
Penn started its disease-management initiative in 1995 to provide a method to the madness of practicing medicine and reduce some of the disparity in how physicians treated patients.
Establishing protocols. The logic behind the program is simple: If it's possible to define the clinical outcomes you want to achieve, it should be possible to develop standardized protocols to reach them.
"It seems that this variety in practices is leading to poor-quality outcomes and is increasing the cost of care," says David Bernard, M.D., senior medical director and champion of the program at Penn. "We're not trying to eliminate variations in practice, just limit them. And we're using evidence-based medicine to do that."
The system's program attempts to coordinate healthcare services through clinical guidelines, physician and patient education, and preventive-care and wellness activities. The most significant components of the award-winning program are its inpatient clinical pathway strategy and the outpatient disease-management programs.
Penn uses inpatient pathways-a system of following patients from the operating room through the outpatient rehabilitation and healing processes-to manage such procedures as bone marrow transplants and abdominal hysterectomies. Disease-management programs cover 16 chronic conditions, including asthma, depression, diabetes and osteoporosis.
The health system uses an intranet, a computer network for all its facilities, to facilitate easy access and rapid dissemination of information to all care sites.
But this isn't your standard disease-management program, Bernard insists.
"A lot of people talk about disease management, but what separates us is that we are trying to put programs in place as fast as we can across the entire health system," Bernard says. "We're not limiting ourselves to diseases where we can make quick cost cuts. We're looking for long-term benefits."
Penn's goal is that 80% of all patient visits will be managed by the protocols by 2002. Incremental goals include putting 10 disease-management programs in place per year for the next four years.
First of its kind. Penn officials say they're proud that their facility is the first academic medical center to win the award.
"A university setting . . . is the perfect setting for this kind of program," Bernard says. "Here we have leaders who are experts in their fields, who are on top of what's new and researching that. We spend a lot of time being certain that the programs are the most up-to-date and cutting edge."
The secret to the success of the system's risk-management program can be found in its dynamic nature, Bernard says.
"There's never a time when we're doing something so well that we can't do it better," he says. "That sets us apart from many other institutions where guidelines take a long time to get developed and changed and reviewed. We are constantly modifying these programs."
Adds David Shulkin, M.D., Penn's chief medical officer and chief quality officer: "Traditional medical centers always thought their job ended with publishing in a journal or presenting results at a meeting. We want to take those results and implement them. Medical information is changing so rapidly that the value of what we build is the ability to survey new information and make improvements."
(Shulkin was a 1997 MODERN HEALTHCARE Up & Comer, or rising young healthcare executive.)
About 75 of Penn's 100 primary-care sites are using the protocols developed through the disease-management program. Soon, under a deal signed with VHA, an Irving, Texas-based alliance of not-for-profit hospitals, the protocols developed by Penn will become the exclusive ambulatory practices for VHA members.
"Part of the mission of a university like ours is to be a national model and transmit our ideas to others," Bernard says.
Terms of the system's agreement with VHA were not disclosed.