Background: Prior to this project, inpatient Advanced Practice Providers (APPs) at UW Health lacked organizational data including volumes, patient experience, hospital acquired conditions, and operational efficiency metrics. In 2016, inpatient APPs collaborated with UW Health’s Analytics and Information Systems team to develop a method for inpatient APP attribution and identification of team-based, APP sensitive metrics to develop an Inpatient APP Specific Scorecard.
Purpose: The purpose of this innovative project was to obtain APP specific data to demonstrate the value of inpatient APPs and their contributions to the organization’s quality, safety, and efficiency. Data is updated and disseminated monthly to all inpatient providers at the provider, specialty, and department level for utilization in quality improvement initiatives.
Description: UW Health’s Analytics and Information Systems teams were consulted to identify a mechanism for data collection and APP attribution. This included utilizing the ‘Treatment Team’ functionality in EPIC. Inpatient APPs throughout the system were engaged to identify and define inpatient quality metrics aligned with important organizational metrics. It was critical to have metrics similar to data physicians receive and also specific to the care provided by APPs. Metrics developed included volume of patients, patient satisfaction, hospital acquired conditions, and operational efficiency metrics including length of stay, avoidable days, 30-day readmissions, and discharge metrics.The Hospital Medicine Service currently has ten APPs who provide services at two UW Health locations. This team has utilized this data to better understand their contributions and to further advocate for expanding services and identifying operational areas of improvement. Additionally, the Hospital Medicine Service sets targets for metrics important to its team and organization to begin evaluating and identifying opportunities for improvement.
These targets include:
1. Utilizing volume data to assess workforce planning needs
2. Identifying and escalating solutions for addressing hospital acquired conditions
3. Developing standards to discharge patients before noon, reducing overall length of stay and improving throughput and capacity management
4. Incorporating provider specific metrics and goals into the annual professional evaluation process
By utilizing this data, one significant goal related to capacity management and discharges before noon was achieved. Within six months of implementation, the Hospital Medicine Service saw an 8.2% increase in the percent of patients discharged by noon, exceeding the organizational goal by 5.9%.
Conclusions: Prior to this project, it was challenging to identify and attribute data to inpatient APPs. By implementing the Inpatient APP Scorecard, our Hospital Medicine Service is now equipped with the tools to drive improvement initiatives on the service and evaluate the impact of improvement ideas related to the care provided by APPs.