Milestones from the Past / A Spotlight on the Future

• Quality Improvement• Operations Management• Research

Randall Wetzel, MD, MBA- Chief Executive Officer, VPS- VPS Board Member- Chairman, Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles

The MISSION of VPS

To improve critical care quality and outcomes for all children and their families through collaborative high

quality data management and actionable comparative reports for

clinicians and other health care leaders.

Participating Units In VPS: 124VPS Participating Units From January 2002 through November 2014Current Participating Units = 127 Units

2002 Q1

2002 Q3

2003 Q1

2003 Q3

2004 Q1

2004 Q3

2005 Q1

2005 Q3

2006 Q1

2006 Q3

2007 Q1

2007 Q3

2008 Q1

2008 Q3

2009 Q1

2009 Q3

2010 Q1

2010 Q3

2011 Q1

2011 Q3

2012 Q1

2012 Q3

2013 Q1

2013 Q3

2014 Q1

2014 Q3

2015 Q1

0

20

40

60

80

100

120

140

January 2002 - March 2015

Cardiac ICU

Pediatric ICU

Year and Quarter

Num

ber o

f ICU

s Par

ticip

ating

2002

Q1

2002

Q2

2002

Q3

2002

Q4

2003

Q1

2003

Q2

2003

Q3

2003

Q4

2004

Q1

2004

Q2

2004

Q3

2004

Q4

2005

Q1

2005

Q2

2005

Q3

2005

Q4

2006

Q1

2006

Q2

2006

Q3

2006

Q4

2007

Q1

2007

Q2

2007

Q3

2007

Q4

2008

Q1

2008

Q2

2008

Q3

2008

Q4

Fina

l Des

ktop

Web

1 (D

ec 2

009)

Web

2 (J

uly

2010

)

Web

3 (D

ec 2

010)

Web

4 (F

eb 2

011)

Web

5 (M

ay 2

011)

Web

6 (A

ug 2

011)

Web

7 (N

ov 2

011)

Web

8 (Q

1 20

12)

Web

9 (Q

2 20

12)

Web

10

(Q3

2012

)

Web

11

(Q4

2012

)

Web

12

(Q1

2013

)

Web

13

(Q2

2013

)

Web

14

(Q3

2013

)

Web

15

(Q4

2013

)

Web

16

(Q1

2014

)

Web

17

(Q2

2014

)

Web

18

(Q3

2014

)

Web

19

(Q4

2014

)

Web

20

(Q1

2015

)

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000VPS’s Total Current Count = 840,130 Cases

Case Count Desktop Case Count Web

Quarter and Year

Coun

t of C

ases

The VPS RegistryVPS Participating Units From January 2002 through November 2014

Current Participating Units = 127 Units

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4 FD W1

W2

W3

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

2015

VPS Enhancements

VPS Comparative Database Started

Risk Adjustment

PIM 2 (required)PRISM 2PRISM 3

PCPC / POPC Added

Site Profiles Initiated

(comparison group

developed)

VPS BETA Version

VPS v3.5 VPS v4.1 VPS v5.0

Data Collection Profiles

(completed non-required

fields)

User requested

improvements

PRISM 3 individual

scores

PELOD

VPS WEBCardiac Module Quality ModuleDiagnosis/Procedure Enhancements Post-Index Scoring PIM/PRISM Adjusted LOS Recalibrated myReports PICSIM PIM 3

2002 2003 2004 2005 2006 2007 2008 2011 2012 2013

Minimum dataset plus

non-required fields

2014

VPS: The Initial Vision• Back in 1997, Dr. Tom Rice and Dr. Randall Wetzel…..

VPS: Our Roots• 1997: Collaboration between NACHRI PICU FOCUS group

and CHLA’s Virtual Pediatric Intensive Care Unit (VPICU)– Goal: Create data solutions to support the improvement and

research interests of pediatric critical care clinicians and leaders

• Critical Care Clinicians, ICU Administrators, hospital leaders, and others developed the first data collection system

• The National Outcomes Center (CHHS, Milwaukee) joined VPS to provide quality control, scientific and reporting services

* since 2004

568

1031

31

AnnualQuarterlyCCS

VPS Annual, Quarterly and CCS Reports

Completed VPS Reports: 1,630

Use of VPS Data for Research Sample of Recent Research Requests• PICU Volume and Outcomes• Validation of the PIM2 Risk of Mortality Tool in the United States • Predictive Models of Readmission to the PICU• Deaths in the PICU: Timing and Associations• Development of a risk-adjusted morbidity tool for the pediatric intensive care unit• Developing a methodology to benchmark PICU functional outcomes• Racial and Ethnic Health Care Disparities in the PICU: Acute Respiratory Failure• The use of Rotary Wing Interfacility Transport Decreases Mortality for Pediatric

Patients Admitted to PICUs• The Epidemiology of Catheter-Associated Bloodstream Infections in a Multi-Center • Ethnic differences in timing of stages of Single Ventricle Palliation and its impact on

Outcome• Respiratory Failure in Children with Acute Asthma• Ventilator Associated Pneumonia Registry• Early Enteral Nutrition in the PICU

94 Topics in the VPS Research

Database

VPS Reporting Services• myReports: On demand querying of data by users with requisite access

• Standardized Reports: Generate reports on demand by users

• Data Downloads: Users access data with ability to manipulate in Excel or Access

• Annual and Quarterly Comparative Program Performance Reports– User defined comparison group– Statistically analyzed and professionally presented– One-on-one consultation with each unit to interpret results/generation

of recommendations for improvement

• Ad Hoc Data Requests• Coming June 2015: VPS Analytics

VPS Cardiac

Cardiac Surgical Specific Risk Adjustment Allows for Stronger Comparisons

Pediatric Index of Cardiac Surgical Intensive Care Mortality (PICSIM score)

* Stay Tuned for the Dr. Howard Jeffries Presentation, Thursday @ 10:50a

VPS Cardiac• Supports both free standing CICUs and mixed PICUs to

strengthen the ability to compare outcomes and benchmark best practices.

• Allows following patients across the continuum of care.• Promotes guidance of future developments through

collaboration to improve the overall care of cardiac patients • Facilitates current and future program advancements through

a dynamic alliance of cardiac advisory team physicians.• Supports group research efforts to strengthen the knowledge

base and improve pediatric cardiac critical care.

The VPS Quality Module

• Developed to support the needs of our customers in providing data for required and voluntary reporting

• Includes the three pediatric critical care core measures endorsed by the National Quality Forum – PRISM 3 standardized mortality ratio, PRISM 3 adjusted length of stay, and

unplanned readmission rate within 24 hours including case level review of all unplanned readmissions

– Baseline and ongoing pain assessment/reassessment (previously endorsed by NQF and required by The Joint Commission)

• For on demand production of automated reports to support unannounced visits and urgent requests for data

Questions?

We have come a long wayTogether!