Why is this research study important?

In 2015 Intermountain received 501,838 emergency department visits and 626,688 urgent care center visits – with higher patient levels expected for 2016. The Moore Foundation study aims to address this trend by identifying potentially preventable events that lead to these visits, followed by rapidly applying what is learned through evidence-based solutions. “It is only through proper accounting and classification of problems that we can discover solutions that improve patient care and deliver the best medical result at an affordable cost”, Says Dr. Allen.

The primary endpoint of the study will be the incidence rates of causes for failures in outpatient care leading to potentially avoidable emergency department and urgent care visits. The secondary endpoints will include:

Disposition from the emergency departments and urgent care centers

Length of stay for admitted patients

• A classification of the effects of the failure of outpatient care using categories similar to the

• National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)

  method

• 30 and 90-day episode costs

This research initiative will result in three critical outputs:

1. A first-pass taxonomy that classifies the causes and effects of failures of outpatient care leading to potentially avoidable emergency department and urgent care center visits

2. An estimate of the proportion of emergency department and urgent care center visits that result from a failure of outpatient care, with a classification of the causes and outcomes according to the taxonomy

3. A measurement of the 30 and 90-day episode costs of emergency department and urgent care center visits associated with a failure of outpatient care beginning the day of the visit

The discoveries from the study will help clinicians craft real and evidence-based solutions to these problems that will better protect our patients and increasingly prevent unintended illness or injury due to failures or misses of the care delivery system.

A team of clinical experts from Intermountain Healthcare’s Clinical Programs, the Office of Research, and the Institute for Healthcare Delivery and Research will participate in this study.  All have strong backgrounds in research, patient safety, and quality improvement work. The study is in strong alignment with the foundational mission and values of Intermountain Healthcare including the Zero Harm initiative.  The study was originally conceived after the Moore Foundation approached Dr. Brent James, Vice-President for Quality and Research and the Director of the Institute for Healthcare Delivery Research at Intermountain Healthcare, to seek his expertise and guidance. Dr. James will play a key advisory role in the study.

The study will build upon the singular work in the area of patient safety designed by Intermountain Healthcare over its history.  This includes the foundational work on adverse drug events conducted by Stan Pestotnik, Scott Evans, and Dr. John Burke more than a decade ago.  It also builds upon the pioneering work of Greg Poulsen and others with respect to Intermountain’s cost accounting system.

The research team for the project includes: Drs. Todd Allen, Michael Woodruff, Joseph Bledsoe, Brent Smith, and James Hart. Dr. Brad Isaacson, Jean-Ann Wurtz,  Saralee Johnston, Dr. Lydia Dong, and Dr. Kim Brunisholz will also have critical roles in the study. Drs. Brent James, Lucy Savitz, and Raj Srivastava, along with Robin Betts will serve as special advisors to the team. The Intensive Medicine Clinical Program, led by Nancy Nelson and Dr. Terry Clemmer, and the Institute for Healthcare Delivery Research will host the study.

The Moore Foundation is an innovative and forward thinking organization. And the team of Intermountain researchers are proud and excited to join with the Moore Foundation in an attempt to improve patient safety.  “We are grateful for the trust that they have placed in us,” said Dr. Allen in speaking of the Moore Foundation.  “We will do our best to get some meaningful answers that both make our patients safer and fulfill the mission of the Moore Foundation.” Located in Palo Alto California, the Gordon and Betty Moore Foundation was established “to foster path-breaking scientific discovery, environmental conservation, patient care improvements, and preservation of the special character of the Bay Area.”  Their focus on patient care includes special emphases in two areas:

1.     Patient safety

2.     Serious illness care

This grant was funded under the Patient Safety initiative.

The grant application was completed over the course of just about a month thanks to the help of the Office of Research and Dr. Brad Isaacson and Ms. Saralee Johnston. Said Dr. Allen, “This process was a great example of how Intermountain really supports research that is designed to have a rapid impact on care delivery performance and patient outcomes that is focused on achieving the best medical result the lowest necessary cost. “This study is an example of how Intermountain can partner with thoughtful and gracious organizations like the Moore Foundation to do some cool and important stuff,” says Dr. Allen.

To find out more about Intermountain Healthcare Research and the advancement of medical knowledge in many clinical areas visit intermountainresearch.org