Pamela Johnson was looking at the American Hospital Association’s website when she noticed the group had created two or three quality improvement guides on high value care and then seemed to stall out. She inquired about working together, and in May the group’s Health Research and Educational Trust announced it would collaborate with Johns Hopkins to co-host and direct the High Value Practice Academic Alliance’s second annual high value health care conference.

Held in September, the three-day event attracted over 250 physicians from 56 academic medical centers. The conference featured more than 200 abstract presentations about high value care, 25 educational sessions on appropriate use criteria and eight value-based workshops on topics like opioid stewardship and preoperative testing.

“From my perspective, it’s like a dream come true,” says Johnson, vice chair of quality, safety and value for the Department of Radiology and one of the physician leads of the Johns Hopkins Health System High Value Care Committee. The AHA has about 5,000 member hospitals, representing about 85 percent of medical centers nationwide. “I can’t think of a better partnership for us to reach so many different medical providers across the country.”

High value care is on a roll at Johns Hopkins, following efforts started in 2015 to engage students and residents in multidisciplinary, quality-improvement work designed to reduce unnecessary tests and treatments. “Really, everybody is looking at what we’re doing and thinking, ‘Do we really need to do that? Where can we stop the excess?’” Johnson says. Professional development programs in high value care have been launched for housestaff and now for junior faculty. Each department at Johns Hopkins has appointed high value faculty leads to champion projects in their own spheres.

In the Department of Emergency Medicine, for example, faculty members Mustapha Saheed and Susan Peterson led an effort that has built clinical decision support pathways directly into the electronic medical record system for 60 scenarios including chest pain, abdominal pain and dizziness. These pathways include calculators where physicians can enter criteria like heart rate and patient age to help decide how at risk someone is for pulmonary embolism, links to current evidence-based practice guidelines from organizations such as the American Heart Association, and logistical details, noting the available hours certain hospital departments have for performing some tests. They help with efficiency, minimizing unnecessary tests and educating residents, students and others who rotate through the emergency department, says Peterson.

“Pathways have been around a long time,” she says. “The problem is their utilization can be limited when you have to go to another place to find them somewhere. This is valuable because it’s right in the EMR.”

While the department this year will focus on creating dashboards to look at utilization patterns for the pathways and related outcomes, says Peterson, the team already has identified some improvements, such as reduced length of stay among patients with low acuity dental pain and reduced hospital admissions for some patients with chest pain.

There are even more high value plans on the horizon, Johnson notes, including a campaign with Dell Medical School at the University of Texas at Austin to get every medical school and residency program in the country to include high value care in their curricula. In addition, the group would like to engage nurses and other health care practitioners. “Our goal is to keep growing, expanding and engaging anyone who wants to be involved,” Johnson says.  

For more information: 855-390-5803 or visit Johns Hopkins Medicine Alliance for Patients