These three themes represent areas of health care identified as priorities for focus and collaboration across and within the five programs in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Orthopedics care and hip/knee arthritis
In 1969, orthopedic surgeons at Mayo Clinic performed the first Food and Drug Administration-authorized total hip replacement surgery. Today, total hip replacement and total knee replacement surgeries are the most common procedures performed at Mayo Clinic's campuses in Phoenix/Scottsdale, Ariz.; Jacksonville, Fla.; and Rochester, Minn.; and at most medical centers around the U.S.
Given this high volume, the center is working to better understand the value of care provided to patients contending with major joint arthritis across Mayo Clinic. This includes:
- Ensuring systematic collection of decision-aid documentation and patient-reported outcomes
- Quantifying the cost of care using a novel cost methodology study
- Studying the comparative effectiveness of outcomes at Mayo Clinic compared with other medical centers, which includes work with the High Value Healthcare Collaborative, a group of institutions dedicated to improving the value of care (Mayo is a founding collaborator with this group)
For this project, the center has taken a multidisciplinary approach, bringing together people with expertise in health care value and finance, shared decision-making and patient-reported outcomes, and systems engineering. Data from the center's collaboration with Optum Labs also has been used.
By better understanding the value of care provided, it's possible to strive toward ongoing improvements — better outcomes at lower costs over time for patients with arthritic joint diseases, including those undergoing total hip and knee replacements.
The Mayo Clinic Kern Center for the Science of Health Care Delivery has already identified areas of variability at Mayo, such as how patients receive continuing care after being discharged from the hospital, and is using those findings to improve clinical practice.
As psychiatric care in the U.S. has shifted from long stays in public hospitals to briefer, acute care in private settings, there has been a resulting decrease in the number of hospital beds dedicated to psychiatric patients.
In fact, the state of Minnesota, home of Mayo Clinic's Rochester campus, had the fewest number of psychiatric beds in the country (just 3.9 beds for every 100,000 people in 2010), according to a report by the Treatment Advocacy Center. In addition, a recent review of Mayo Clinic data showed that inpatient psychiatric hospitalizations strongly drive the use of health care services.
So today, it is increasingly important to ensure that psychiatric beds are used for the right patients at the right time and provide alternative ways for people to receive mental health care.
This creates an opportunity for the center to partner with the Mayo Clinic Department of Psychiatry and Psychology, Integrated Behavioral Health specialists, primary care physicians, and others to optimize mental health care delivery by:
- Preventing emergency department visits and hospital admissions unless absolutely necessary by managing conditions within primary care settings and coordinating with community mental health resources
- Improving care and the patient experience, as well as reducing costs and overuse of services, by studying changes to the doctor-and-patient encounter
- Modeling and studying how mental health patients flow through various health care settings and resources (primary care, emergency department, inpatient settings, and county and community resources) and examining the impact of certain changes
Current Mayo Clinic efforts focused on those goals include:
Managing depression in primary care. In many cases, depression can be diagnosed and treated by primary care physicians without requiring the patient to visit a psychiatrist. Empowering primary care physicians to manage patients with depression helps ensure appropriate utilization of psychiatric health care resources.
The Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) program aids primary care providers in managing depression by involving a care manager and consulting psychiatrist for Minnesota adult patients seen in Mayo Clinic primary care settings in Rochester or Kasson, with a focus on relapse prevention. Research in the center is underway to examine how this kind of coordinated care for depression impacts costs and use of health care resources.
Likewise, Mayo has the Early Management and Evidence-Based Recognition of Adolescents Living With Depression (EMERALD) program for younger people with depression. Based on DIAMOND, EMERALD helps primary care physicians become more comfortable identifying, diagnosing and managing depression in adolescents.
EMERALD began as a pilot in summer 2011 and has since expanded across Mayo's primary care-related departments with excellent results, such as improvements in staff confidence and all standard patient-reported outcomes, as well as higher patient and family satisfaction.
Shared decision-making and patient-centered outcomes. Mayo Clinic developed a depression medication choice decision aid, a series of cards that helps a patient choose a depression medication based on its effectiveness, side effects and other factors in collaboration with his or her physician.
Mayo conducted a study in 10 practices in Minnesota and Wisconsin to compare the efficacy of the depression choice decision aid to standard care. Improvements were observed at six months in terms of patient comfort, satisfaction, knowledge, involvement in decision-making and mood.
Based on these findings, the center and the Integrated Behavioral Health team is working to:
- Integrate the decision aid into more practices
- Include treatments other than medications
- Take into account factors such as anxiety, pain, children and pregnancy
- Cover mental health conditions other than depression
- Innovation grant. Care of Mental, Physical and Substance Use Syndromes (COMPASS), an innovation grant from the Centers for Medicare and Medicaid Services, is in its third year at Mayo Clinic. Mayo is using the grant to look at the impact of mental health care coordination on clinical, process and cost outcomes.
Palliative care involves managing pain and other symptoms, as well as providing emotional and spiritual support, for patients and families contending with chronic or life-threatening illnesses. Unlike end-of-life or hospice care, palliative care is available at any stage of a health condition and complements ongoing standard medical treatment.
Importantly, palliative care can lead to greater empowerment of patients and improved outcomes, including quality of life, mood and patient satisfaction, while at the same time reducing certain costs.
The Mayo Clinic Kern Center for the Science of Health Care Delivery is in the early stages of defining high-value palliative care at Mayo Clinic. This involves selecting measurements that can be used as objective metrics that define quality — specifically, what constitutes outstanding palliative care from the perspectives of patients, health care providers, health care administrators and payers. It also means looking at costs, not only in the immediate term but also over time, such as those associated with potentially unnecessary acute care visits and hospitalizations.
By studying the comparative effectiveness of current palliative care programs at Mayo Clinic, the highest value care can be recognized and implemented at Mayo and by others involved in caring for such patients.