February 13, 2025 03:00 PM

Action, Perseverance and the Road to Measurably Better Outcomes

MAXIMIZING THE POTENTIAL OF HEALTHCARE RESOURCES IS A VICTORY FOR ANY HEALTH SYSTEM, particularly when benefits include improved wellness, reduced risk and mitigated costs. Best practices in healthcare should be celebrated, amplified and replicated across the globe, where possible. With these goals in mind, the UNIVANTS of Healthcare Excellence award program honors elite healthcare teams for achieving measurably better outcomes through teamwork and avant-garde approaches.

Recently, three teams received top honors for their integrated clinical care initiatives that have addressed care gaps, enabled access to care and improved prevention across cardiovascular disease, sexually transmitted and blood-borne infections, and liver disease. Each best practice spans different geographies and approaches, but they have all leveraged the power of laboratory data and insights to change patient care and improve outcomes.

Colleen Strain, PhD, Scientific Lead for the UNIVANTS of Healthcare Excellence award program, led an exclusive roundtable with experts, healthcare leaders and representatives from each of the three top winning teams from 2024. With the goal of sharing insights and inspiring others, these healthcare leaders explored themes across their care initiatives, including the importance of taking action, the criticality of building relationships, and the need to persevere in the face of failure.

COLLEEN STRAIN: Describe the laboratory-derived insights for each of your initiatives. How did the findings trigger new cascades of care?

HAREEFF MUHAMMED: In Malaysia, liver function tests (LFTs) are extremely common; however, many individuals still suffer from liver problems. This highlights the urgent need for earlier identification and treatment of liver disease. Guidelines recommend using the Fibrosis-4 (FIB-4) score to risk stratify patients, but doing so requires specific inputs and calculations. To address this, we have automated the FIB-4 calculation for patient groups, while providing clear explanations to clinicians, enabling early identification and intervention.

DEVON HAAG: When it comes to sexually transmitted and blood-borne infections (STBBIs), rates are on the rise, so screening is a critical step in ensuring better outcomes. For GetCheckedOnline (GCO), there is a need to go beyond traditional testing approaches to reach people not currently engaged in STBBI testing. Our goal was to enable low-barrier access to testing and care that was inclusive for all genders and sexualities. To do so, we needed to address operational considerations to ensure we met the needs of our patients, while also striving for inclusivity.

MATTHEW MEFFORD: At Kaiser Permanente Southern California, we evaluated low-density lipoprotein (LDL) cholesterol results for our patient population, along with statin prescription data, to find that only about one-fifth of patients were taking the recommended statin intensity needed to reduce cardiovascular risk and subsequent avoidable hospitalizations.

MICHAEL KANTER: Too often test results don’t have follow-up, with evidence suggesting that 5-10% of abnormal test results do not have the expected follow-up. For our Statin Start program to be successful, we needed to alert physicians and ensure actionable follow-up for patients with cardiovascular risk (i.e., LDL ≥190 mg/dl) who did not appear to be on treatment.

DAVID GRENACHE: Lab data is discreet; it is easy to analyze and powerful in finding associations. It is also available in real time, which means the laboratory is often the first to know a person’s diagnosis. Thus, laboratory data can drive actionable decision-making in new and important ways. It can answer important questions such as, ‘How big is the problem?’ and ‘Where are the gaps in care?’ You can do all the testing you want, but unless there is action taken, data is just information.

STRAIN: Let’s discuss the evolving role of the clinician and nurse stakeholder. Was there immediate acceptance upon project initiation or any resistance to the substantial changes involved?

KANTER: We encountered some resistance at the start, as it can take time to create a blame-free culture. Progress requires cultural shifts to help teams appreciate that our program is protecting their patients, versus blaming anyone. Communication was key, including announcing the program, garnering acceptance from key champions, as well as ensuring adequate lead time. We also learned that using conservative criteria with a high LDL-C helped mitigate potential concerns. For example, it is hard to dispute that someone with an LDL ≥190 mg/dl needs to be treated, thus minimizing resistance.

MUHAMMED: We initially faced some resistance from physicians who felt that our new insights were attempting to dictate how they should manage their patients. However, through mutual learning and addressing their questions and concerns, we transformed the program into a highly successful initiative.

MEGHAN MCLENNAN: Building relationships was fundamental to our program. Interestingly, and because GCO made sense medically, support from clinicians was almost immediate. However, upon implementing the program, there were operational challenges and resistance. The same was true as the program expanded. Meeting high demands for the program became unsustainable without additional support. Thus, a key takeaway is the importance of having all partners at the table — operations and medical, program and laboratory.

STRAIN: Let’s discuss the power of information technology (IT). What are some of the most valued IT capabilities that enabled success?

YOKE LEE LOW: The wide availability of data within our laboratory information system (LIS) enables real- time calculations for physicians. It also means that we can extract data for analysis, which is very powerful.

MEFFORD: Multiple spheres of IT within our system have been critical to our success, including the ability to integrate the High LDL-C Statin Start SureNet program into the existing electronic health record, deploying algorithms and enabling checks and balances. This also facilitates a passive monitoring system that can send emails and alerts to physicians that are customized to limit notification fatigue and minimize workflow interference.

KANTER: The ability to share and access data is integral, while privacy is equally important. Security that is too loose can lead to data leaks, but if you are too strict, then you risk being too siloed.

EDUARDO FREGGIARO: Managing very sensitive information means that when it comes to managing IT, there is an extra layer required for security.

STRAIN: While each of your best practices spans very different disease areas, they embrace common themes. Healthy patients, for example, tend not to believe or appreciate the importance of health screening. How important is it to change that mindset?

MEFFORD: Patient education and engagement was integral to success for our program since patients are ultimately responsible for completing their own follow-up. Helping people understand what their medication is and why it is important to take it regularly ensures better patient outcomes.

HAAG: One thing that is foundational to patient care is trust. Lack of trust means that many people will not seek care, which can result in very poor health outcomes.

MUHAMMED: Creating awareness is one of our key objectives for both clinicians and the communities we serve. Since patients undergoing FIB-4 assessments do not always appear or feel unwell, engagement is crucial for improving health outcomes.

STRAIN: Please describe some top outcomes across each of your initiatives and why they were so impactful.

MEFFORD: We looked at several metrics that were critically important, including whether clinicians were more likely to prescribe high-intensity statins, if patients were more likely to pick up their medications and have their cholesterol rechecked, and importantly, if patients lower their cholesterol. Across all those measures, we saw important improvements.

HAAG: Economic analyses indicate that it is 45% less expensive to test through GCO versus a regular STI clinic. These savings are mostly attributed to the fact that doctors and nurses are only involved when follow-up care is needed for a positive diagnosis.

LOW: For our care initiative, we saw an increase in liver disease diagnoses through our risk assessment, which is an important first step to impacting overall patient wellness.

GRENACHE: When it comes to showing the value of laboratory medicine, linking insights to improved patient outcomes is the holy grail.

STRAIN: Let’s talk about shifting mindsets from reactive medicine to preventive medicine.

HAAG: Preventative medicine is public health in action. Our approach is that we know prevention is critical, so how can we ensure low barriers and cultural safety to engage accordingly?

MCLENNAN: Programs like GCO will continue if people believe in prevention, the value of early diagnosis and detection, and mitigating spread. Interestingly, I believe GCO is also changing the mindsets of laboratorians because this is a different way of doing things.

MUHAMMED: Changing mindsets is critical and involves multiple layers. Laboratorians often see themselves solely as providers of results. By adding insights derived from these numbers, we enhance the overall value of laboratory services.

KANTER: The SureNet program as an error reduction safety program is a big cultural change. It is widely accepted that treating high cholesterol with statins is medically correct, however, ensuring we are doing that in a more consistent and reliable way is new. Reliability is not part of medical care culture, so it is a huge cultural shift.

IMPROVING OUTCOMES BY MAXIMIZING POTENTIAL

The 2024 top honorees of the UNIVANTS of Healthcare Excellence awards exemplify what it means to unify for something greater. Alex Carterson, Divisional Vice President of Medical and Scientific Affairs at Abbott, shares that “the passion for change and improvement across these care initiatives is evident in the way each of these leaders has overcome challenges, galvanized teams and taken action to improve health outcomes.”

By doing so, these teams have enabled outcomes that improve patient wellness, enhance resource utilization, facilitate easier decision-making, mitigate healthcare costs and more. Eduardo Freggiaro, President of the Argentine Biochemical Foundation, shares that “it is incumbent upon all of us to change mindsets about the value of laboratory medicine. Clinical laboratories are clearly saving money for the healthcare system and have the potential to do so much more.”

Special thanks are extended to the organizations who make the UNIVANTS of Healthcare Excellence awards possible, including IFCC, ADLM (formerly AACC), EHMA, Modern Healthcare, HIMSS, NAHQ and IHE, who have collectively partnered with Abbott. These collaborators have united with the goal of inspiring and celebrating best practices. If you or your integrated clinical care teams want to learn more about UNIVANTS or view previous winners, please visit www.UnivantsHCE.com.