Download PDF
Clin Colon Rectal Surg 2013; 26(01): 056-062
DOI: 10.1055/s-0033-1333662
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Integrating Hospital Administrative Data to Improve Health Care Efficiency and Outcomes: “The Socrates Story”

Justin Lawrence
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
,
Conor P. Delaney
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

Keywords

costs - performance - technology
 

  • References

  • 1 West MA, Farr JL. Innovation and creativity at work: psychological and organizational strategies. Hoboken, NJ: Wiley; 1990
    Google Scholar
  • 2 Birkmeyer JD, Gust C, Dimick JB, Birkmeyer NJ, Skinner JS. Hospital quality and the cost of inpatient surgery in the United States. Ann Surg 2012; 255 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 3 Fry DE, Pine M, Jones BL, Meimban RJ. The impact of ineffective and inefficient care on the excess costs of elective surgical procedures. J Am Coll Surg 2011; 212 (5) 779-786
    CrossrefPubMedGoogle Scholar
  • 4 Flum DR, Pellegrini CA. The business of quality in surgery. Ann Surg 2012; 255 (1) 6-7
    CrossrefPubMedGoogle Scholar
  • 5 Koch CG, Li L, Hixson E, Tang A, Phillips S, Henderson JM. What are the real rates of postoperative complications: elucidating inconsistencies between administrative and clinical data sources. J Am Coll Surg 2012; 214 (5) 798-805
    CrossrefPubMedGoogle Scholar
  • 6 Manyika J, Chui M, Brown B , et al. Big data: The next frontier for innovation, competition and productivity. New York, NY: McKinsey Global Institute; 2011
    Google Scholar
  • 7 Delaney CP, Senagore AJ, Gerkin TM , et al. Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey. Am J Surg 2010; 199 (3) 299-304 , discussion 304
    CrossrefPubMedGoogle Scholar
  • 8 Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP. Standardized postoperative pathway: accelerating recovery after ileostomy closure. Dis Colon Rectum 2008; 51 (12) 1786-1789
    CrossrefPubMedGoogle Scholar
  • 9 Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011; 149 (6) 830-840
    CrossrefPubMedGoogle Scholar
  • 10 Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH. 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001; 88 (11) 1533-1538
    CrossrefPubMedGoogle Scholar
  • 11 Kariv Y, Delaney CP, Senagore AJ , et al. Clinical outcomes and cost analysis of a “fast track” postoperative care pathway for ileal pouch-anal anastomosis: a case control study. Dis Colon Rectum 2007; 50 (2) 137-146
    CrossrefPubMedGoogle Scholar
  • 12 Salhiyyah K, Elsobky S, Raja S, Attia R, Brazier J, Cooper GJ. A clinical and economic evaluation of fast-track recovery after cardiac surgery. Heart Surg Forum 2011; 14 (6) E330-E334
    CrossrefPubMedGoogle Scholar
  • 13 Stellato TA, Hallowell PT, Crouse C, Schuster M, Petrozzi MC. Two-day length of stay following open Roux-En-Y gastric bypass: is it feasible, safe and reasonable?. Obes Surg 2004; 14 (1) 27-34
    CrossrefPubMedGoogle Scholar
  • 14 Verheijen PM, Vd Ven AW, Davids PH, Vd Wall BJ, Pronk A. Feasibility of enhanced recovery programme in various patient groups. Int J Colorectal Dis 2012; 27 (4) 507-511
    CrossrefPubMedGoogle Scholar
  • 15 Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003; 46 (7) 851-859
    CrossrefPubMedGoogle Scholar
  • 16 Raue W, Haase O, Junghans T, Scharfenberg M, Müller JM, Schwenk W. 'Fast-track' multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 2004; 18 (10) 1463-1468
    CrossrefPubMedGoogle Scholar
  • 17 Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP. Multivariable analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg 2006; 191 (3) 364-371
    CrossrefPubMedGoogle Scholar
  • 18 Kiran RP, Delaney CP, Senagore AJ, Steel M, Garafalo T, Fazio VW. Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 2004; 198 (6) 877-883
    CrossrefPubMedGoogle Scholar
  • 19 O'Brien DP, Senagore A, Merlino J, Brady K, Delaney C. Predictors and outcome of readmission after laparoscopic intestinal surgery. World J Surg 2007; 31 (12) 2430-2435
    CrossrefPubMedGoogle Scholar
  • 20 Delaney CP. Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. Dis Colon Rectum 2008; 51 (2) 181-185
    CrossrefPubMedGoogle Scholar
  • 21 Skinner JS, Weinstein JN, Fisher ES. Withholds to slow Medicare spending: a better deal than cuts. JAMA 2012; 307 (1) 43-44
    CrossrefPubMedGoogle Scholar
  • 22 Senagore AJ, Stulberg JJ, Byrnes J, Delaney CP. A national comparison of laparoscopic vs. open colectomy using the National Surgical Quality Improvement Project data. Dis Colon Rectum 2009; 52 (2) 183-186
    CrossrefPubMedGoogle Scholar
  • 23 Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 2003; 12 (6) 458-464
    CrossrefPubMedGoogle Scholar
  • 24 Kim CS, Spahlinger DA, Kin JM, Billi JE. Lean health care: what can hospitals learn from a world-class automaker?. J Hosp Med 2006; 1 (3) 191-199
    CrossrefPubMedGoogle Scholar
  • 25 Lagasse RS, Steinberg ES, Katz RI, Saubermann AJ. Defining quality of perioperative care by statistical process control of adverse outcomes. Anesthesiology 1995; 82 (5) 1181-1188
    CrossrefPubMedGoogle Scholar
  • 26 Mohammed MA. Using statistical process control to improve the quality of health care. Qual Saf Health Care 2004; 13 (4) 243-245
    CrossrefPubMedGoogle Scholar
  • 27 Favuzza J, Samia H, Brady K, Sivashankaran S, Delaney CP. TAP blocks and enhanced recovery pathways: making 23 hour stay a realistic goal after laparoscopic colectomy. ASCRS 2012; ; Submitted
    PubMedGoogle Scholar
  • 28 Rosenälv J, Lundell KH. The Swedish strategy and method for development of a national healthcare information architecture. Stud Health Technol Inform 2012; 174: 8-16
    PubMedGoogle Scholar
  • 29 Stulberg JJ, Koroukian SM, Delaney CP. Surgical Care Improvement Project Adherence and Postoperative Infections-Reply. JAMA 2010; 304 (15) 1669-1672
    PubMedGoogle Scholar
  • 30 Fry DE, Pine M, Jones BL, Meimban RJ. Control charts to identify adverse outcomes in elective colon resection. Am J Surg 2012; 203 (3) 392-396 , discussion 396
    CrossrefPubMedGoogle Scholar
  • 31 King PM, Blazeby JM, Ewings P , et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis 2006; 8 (6) 506-513
    CrossrefPubMedGoogle Scholar
  • 32 Fry DE, Pine M, Jones BL, Meimban RJ. Surgical warranties to improve quality and efficiency in elective colon surgery. Arch Surg 2010; 145 (7) 647-652
    CrossrefPubMedGoogle Scholar