Making Pediatric Risk Scoring a Reality for Children’s Hospitals

Payers and providers need to understand the risk of their unique patient population to allocate financial and clinical resources. But an accurate risk score is contingent on holistic patient data.

Many payers and providers have mastered risk scoring for their adult populations, as copious amounts of data make it easy for analysts to obtain a clear picture of the patient.

No equivalent exists for pediatric care.

“Pediatrics is not little adults,” Gertrude Leidich, MBA, vice president of quality and medical staff services at Texas Children’s Hospital told HealthITAnalytics.com. “The course of care for a cardiac patient in pediatrics is very different than a cardiac patient in adult. We need to understand those differences so that we can help set the future of care for these kids.”

Disjointed and siloed pediatric data makes it nearly impossible for providers and health systems to accurately understand their patient’s risk for hospitalization or recovery. The lack of a centralized, risk-adjusted data and methodology for pediatrics also makes internal and external comparisons challenging.

“In pediatrics, we don’t have a data pull that is risk-adjusted. Measurement of how you’re doing and benchmarking is reliant on just a few sources. Even when you have an opportunity to get some data, it’s very behind,” continued Leidich.

Payers and providers are risking not understanding their own patient populations by having disjointed data, which makes it nearly impossible for providers to gain actionable insights, added Rahul Shah, MD, MBA, vice president and chief quality and safety officer at Children’s National Health System.

“If you walk into a hospital and ask what the length of stay is for condition X, an administrator, nurse, physician, and therapist will give you four different answers,” he said in a recent interview. “They might be looking at different data sets. They might be looking at different definitions. If we put these different data sets together, we can make sense of it. We’re trying to get one unified answer and understand how one data point impacts another.”

To eliminate data siloes and establish risk adjustment methodology, Texas Children’s and Children’s National are partnering with Configo Health, Inc. The start-up’s analytic tools will integrate multiple pediatric data sets to accurately establish standardized risk scores, allowing providers to internally and externally compare themselves and push for better patient outcomes.

“Part of the problem now is the data gets pushed out and it comes back siloed and disconnected,” observed Shah. “We want to understand how our disparate datasets work together and break down internal silos. We’re not reinventing the wheel.”

Newly connected, real-time data is actionable. Both children’s hospitals will be able to critically look at patients' health outcomes, their risk scores, and understand why they had the outcome they did.

Rather than muddle through layers of data from multiple data sources, providers can look more holistically at the individual patient and through a big picture lens at their patient population.

“If you look at just pure administrative data, it’s not going to capture the outcomes that you need to see in that complex patient population,” Leidich said. “We’re leveling the playing field.”

Connecting various data sources and generating a standardized pediatric risk score will also help children’s hospitals compare their performance to each other.

“Having a risk-adjusted database allows for children’s hospitals that are big and complex to understand what we really are improving on and if we are outperforming. We’ll know there’s a value to the care we give,” explained Leidich.

Children’s hospitals can look at high-performing facilities and collaborate to better improve their own care.

“Eventually, there will be other partner hospitals we can learn from,” Shah noted. “We all want to work together. It gives credibility, helps the risk adjustment, and puts the patient at the center of what we’re trying to do.”

Pediatric hospitals are most notably known for their ability to quickly improve many key quality measures, Shah furthered. Innovation has allowed his hospital to drop its unnecessary readmission rates and hospital-acquired infection rates drastically. But moving this metric completely to zero will require a different way of thinking.

“Part of the problem with getting to zero is events like these don’t happen every day, every week, or every month. An event might happen two or three times a year. When you’re working with a dataset that small, it’s hard to find variables or interventions that would help improve,” Shah said.

“We need to start thinking differently with our data and our collaboratives to get to zero. That’s where we think it’s going to really improve quality of care,” he continued. “When something doesn’t go the way we want in healthcare, we react. It didn’t have the outcome we wanted. With all the data points internally and externally we’re comparing to we’re going to be able to improve care upstream.”

Hospitals will be able to collaborate to reduce key quality measures, practically eliminating harmful outcomes for patients.

“Data is power. Data is everything. If you have good risk-adjusted data, when you really understand your population of patients, the environment, and the social determinants, you can actually change the course of care for these kids, for their lives, and for their families,” Leidich concluded.