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Using Analytics to Drive Decisions
As an organization with a long history of research innovation, the University of California and University of California Health (UCH) rely on data analysis to fuel continual improvement. From the COVID-19 pandemic to health equity to our everyday patient care, UCH physicians and researchers seek data to help answer today's most pressing questions.
In recognition of this important need, the University of California Health created a center dedicated to providing data and data analysis to help our clinicians improve care, the Center for Data-driven Insights and Innovation (CDI2).
The center uses de-identified patient electronic health records from our academic health centers. In addition, CDI2 uses claims data from UC's self-funded health plans and external sources of data such as Vizient and California's Office of Statewide Health Planning and Development. The result is a vast set of clinical information that reflects the diversity of California's population, which is essential to improving health equity.
Looking at Large Sets of Data
Because UCH academic health centers collectively see so many patients, we're able to look at large sets of data that helps us identify trends and best practices.
For example, since 2012 (when UCH started its conversion to electronic health records), UCH hospitals and clinics have had more than 200 million patient encounters (e.g., office or hospital visits) with nearly 150,000 health care providers. In those encounters, we conducted 400+ million procedures, ordered or prescribed 600+ million medications, made more than 2 billion vital signs and test result measurements, and were able to make and assign more than 600 million diagnosis codes. And this dataset grows with each passing day.
What does all this information mean? It means that when physicians and researchers come to us with a specific question about how they can improve patient care, we can begin the process of helping them answer it using data.
To do this, we find information about how well UCH patients are doing today. We look at the measures that are already in place to track what is considered best practice for a specific condition or procedure. If we're falling short on some measures (or for some groups over others), we'll quickly see that. And then we'll exchange information across our academic health centers to see how we can, together, change our current approaches.
How We're Using Data to Improve Care Across California
At each of our academic health centers, our physicians, researchers and other clinicians make data-informed decisions that improve today's care and support the discoveries of tomorrow.
The following are a few of the many examples of how we're taking that practice and using it to benefit all Californians — by coordinating the exchange of data across UCH.
When the pandemic hit, CDI2 was able to track and report COVID information to clinical leaders across UCH on a daily basis. They did this through dashboards using data from across the system. This data ranged from the number of patients who tested positive for SARS-CoV-2 to how many patients were in UCH hospitals on a daily basis (inpatient census). The dashboards were further broken out by location and key demographics.
CDI2 provided these daily aggregated dashboards to UCH leadership, plus state and federal public health authorities, including the California Department of Public Health (CDPH), FDA and Centers for Disease Control and Prevention. UCH leveraged its research know-how to establish a secure COVID research dataset, CORDS. Researchers across the UC system used this HIPAA limited dataset to identify meaningful patterns far more quickly than before.
These metrics are regularly published at @UofCAHealth.
University of California Health is the only system in the nation with five cancer centers that have received the highest designation possible from the National Cancer Institute (NCI). The five NCI-designated Comprehensive Cancer Centers within UCH are collaborating together as the University of California Cancer Consortium.
The consortium represents a nearly unparalleled degree of oncology expertise and research capabilities. The group uses data from across UCH to harness immense amounts of data while protecting patients' privacy. The work leverages the scale of the UC system to advance precision medicine in service to our patients.
As one example, the group is using aggregate data from laboratory reports across UCH about cancer genomics tumor types. This work is helping researchers and clinicians advance precision oncology.
Research shows that cancer rates can vary widely among different racial and ethnic groups. There are significant disparities in both incidence and outcome between people of different racial and ethnic groups, caused by genetic, environmental, cultural and socioeconomic factors.
By looking at genomic data across differing populations and ages, they can continually refine and improve quality of care — including health disparities and cost of care — by exchanging knowledge and clinical best practices.
The cardiac surgery programs from five of our academic health centers have joined together as the University of California Cardiac Surgery Consortium. Through this group, cardiac surgery chiefs, quality coordinators and clinicians regularly meet to identify ways to improve heart procedures for adults.
This experienced group closely monitors patient outcomes across a variety of surgical procedures. They then work together to identify improvement opportunities.
Some of the key quality outcomes measures they evaluate are readmissions to the hospital following a coronary artery bypass graft procedure, also known as CABG or bypass surgery; the start of new atrial fibrillation after an operation; the need for re-operation after CABG; hours in the intensive care unit and more.
After reviewing their data collectively, they share ideas and evidence-based best practices to continually improve these measures. The result is a cardiac surgery group that is continually improving, whether the operation is one of the most complex or relatively routine.
Lowering Drug Costs
CDI2 has worked closely with UCH pharmacists and other clinicians and staff to look at how — as a system — we are prescribing medications. This analysis is part of UCH's efforts to ensure the drugs used are optimal for specific conditions and patient outcomes.
As one example, the group tracked the use of acetaminophen being given intravenously (through an IV) versus orally (by mouth). They then looked at a variety of clinical measures with both groups to see where the use of an IV (which is more expensive) could be switched to oral medications and achieve similar or improved outcomes for patients.
Their efforts have resulted in a cumulative savings to date of $1.7 million since the beginning of the project.
Improving Health Across Populations
Looking at data from across University of California Health allows us to drill down to track the health of certain populations. This helps us identify where some groups of people (or neighborhoods) do not have the same health outcomes as other groups — something known as health disparities. Health disparities exist across many conditions, including in cancer, heart disease and diabetes. By analyzing our data and sharing best practices across the UCH system, we can begin to identify better ways to address health inequities.
See how we're working to improve the health of populations across California
Using data to improve clinical care is only one part of the data analytics equation at University of California. UC performs nearly 10 percent of all academic research funded by U.S. federal agencies each year — fueled in large part by sharing data and analytics. We are typically awarded one in seven National Institutes of Health grants.