How Rijnstate uses the LOGEX Appropriate Care Monitor to turn treatment variations into opportunities for improvement of care
About the client
Dr. Sean Roerink, a specialist in internal medicine and endocrinology at Rijnstate, uses the LOGEX Appropriate Care Monitor to compare the practice of specialists in his department with those of other hospitals. First, he analyses differences between the group of specialists between other hospitals in their care processes. They then decide for each finding whether the deviation is justified or not. This way, the tool allows them to critically appraise their own delivered care, with benchmarking providing both quality and efficiency improvements and thus translating data into better care.
In practice, this means identifying where the Rijnstate group of specialists noticeably differs from other comparable groups in terms of treatment choices. When the Appropriate Care Monitor flags a potential deviation, it is reviewed to assess whether it is deliberate or whether it paves the way to more efficient treatment choices or a better patient experience. As a result, the Appropriate Care Monitor offers Rijnstate the ability to turn available data into concrete opportunities for specialists to provide even better care to their patients.
The challenge
Before Rijnstate started using the Appropriate Care Monitor, it was difficult to investigate and improve its care processes. Sean Roerink described it as a black hole. He couldn’t get the right information on his care practice and that of his peers. According to Sean, the LOGEX Appropriate Care Monitor has clarified the department’s pathways and has highlighted comparable metrics to its peers. The monitor delivered real insight into what the department was doing, making it easy for Sean and the team to make improvements with real, measurable impact.
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We see that LOGEX facilitates the whole process. It helps a lot when one of the LOGEX data analysts supports us when we have trouble translating the data into real actionable insights. That really broadens the enthusiasm of the doctors who work with it. It creates a feeling that there is support available from people who can explain what they are looking at. Then it starts to live a bit more. This makes it much easier for everyone to start working with the tool and makes it more normal to look at the data. It’s something we doctors have to get used to.
Dr. Sean Roerink, Rijnstate
The solution
Rijnstate uses two analyses within the Appropriate Care Monitor to look at both processes as well as practice variation. It showed that the Rijnstate endocrinology department had a higher-than-expected number of requests for thyroid ultrasounds. Although initially flagged as a deviation by the Appropriate Care Monitor, further review showed that this was related to some unique treatments in the form of radiofrequency and ethanol ablations of thyroid nodules.
As Rijnstate is one of the few hospitals in the Netherlands to offer these novel treatment options, more frequent ultrasounds were requested as part of treatment follow-up. This increased demand for closer patient and treatment monitoring explained the initial deviation. However, by looking at the number of requests made and further analysis of their outcome data, Rijnstate discovered that a reduction of 75 ultrasounds per year could still provide the same level of care.
An equally tangible impact was achieved in laboratory diagnostics. Within endocrinology, they had quite a lot of T3s [triiodothyroxine, active thyroid hormone] flagged for thyroid dysfunction, while that is not always indicated. The Appropriate Care Monitor highlighted that they were significantly above the benchmark here, offering a clear opportunity for improvement. The further review resulted in Rijnstate adjusting its standard lab packages for thyroid patients. It means that they have now reduced their T3s by 300, over six months.
We analysed our data and saw that we could quickly reduce to one ultrasound after an ethanol ablation instead of the three we used to do. So that was the textbook example for us: we were alerted by what we saw in the LOGEX Appropriate Care Monitor, then we started thinking: What are we doing, and should it really be like this?
Dr. Sean Roerink, Rijnstate
Dr. Sean Roerink, Rijnstate
The impact
Efficiency plays a vital role in optimising care at Rijnstate, so the members of the board and Dr Roerink himself believe that analysing their data should become a part of their everyday way of working. For that reason, they agreed that each sub-section – haematology, oncology, endocrinology – will have one person with a clear data responsibility. They will master working with data and the Appropriate Care Monitor, supported by LOGEX specialists. This deliberate choice, to put sub-speciality data at the heart of everything they do, sets Rijnstate apart in its commitment to turning data into even better care for its patients.
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