Five Delaware health systems – Bayhealth, Beebe Healthcare, Christiana Care Health System, Nanticoke Health Services and Nemours/Alfred I. duPont Hospital for Children—formed a new partnership, EBrightHealth, to improve health across the state.
Robert Dressler, MD, MBA, quality and safety officer at Christiana Care, had previous success implementing Choosing Wisely, including an intervention that reduced orders for unnecessary telemetry. Now he is helping to lead collaboration within EBrightHealth through Choosing Wisely.
The first topic EBrightHealth has decided to tackle is antibiotic stewardship, spurred by research published in JAMA indicating that Delaware antibiotics prescribing rates in 2014 were in the second-highest bracket nationally. The partner organization will look specifically at decreasing inappropriate antibiotics prescriptions for viral upper respiratory infections in the ambulatory setting and discontinuing antibiotics beyond 72 hours in hospitalized patients with no signs of infection.
“Since each organization is different in terms of size, priorities and resources, doing a one-size-fits-all intervention would be difficult,” said Dr. Dressler. “Each organization will design a project that is meaningful and will work best for their clinicians and patients.”
Projects formally kicked off with a meeting in August that brought all the organizations together. To support the work continuing in each of the organizations, they convene via monthly teleconference calls to share learning and ideas and to help one another solve problems. In addition, they hold quarterly meetings to coordinate efforts across a broader group of stakeholders within the state and region, including the Better Business Bureau of Delaware, Carelink CareNow, Delaware Health Care Facilities Association and Delaware Health and Social Services Division of Public Health.
One challenge, Dr. Dressler said, will be to measure the broad impact of improved antibiotic stewardship, since there is no all-payer database in Delaware, which makes statewide data difficult to come by. However, each team will be working to identify institutional measures to monitor their initiatives during the next year.
“Currently, success is having five organizations come together to create a statewide learning network, that through collaboration supports and advances each institution’s efforts to address this health risk all have in common,” Dr. Dressler added. “The aspirational goal of eBrightHealth Choosing Wisely is to have a portfolio of ongoing projects to improve value-based care delivery across Delaware.”
With this approach, Delaware joins several other states in addressing overused tests and treatments through a coordinated collaborative approach of major health systems and community groups. The eBrightHealth organizations plan to report out on the first phase of their work in August 2018.