Fortis Healthcare Limited, is one of the largest integrated, healthcare services provider in the country today. It aspires to drive clinical excellence through continuous improvement and enhancement of its clinical care and services. To strengthen its core value of Patient Centricity, Fortis became the first, privately held, Indian healthcare chain to introduce monitoring of its clinical outcomes – starting with Fortis Escorts Heart Institute (FEHI), New Delhi. This initiative reinforces organisational accountability and transparency towards both, its patients as well as the payers.
Clinical Outcomes are the globally agreed upon, evidence based measurable changes in health or quality of life resulting from patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving quality of patient care. A user friendly reporting and monitoring structure leads to greater understanding of clinical outcomes, thereby facilitating rational decision making by patients.
FEHI has been part of the ICHOM (International Consortium for Health Outcomes Measurement) Coronary Artery Disease Steering Committee and has become the first Asian hospital to implement the ICHOM Coronary Artery Disease set. This requires monitoring and reporting of internationally accepted outcomes for monitoring clinical quality, example, incidents of post-operative complications (kidney failure, heart attack, wound infections) in patients undergoing Cardiac Bypass Surgery. ICHOM is a non-profit organization founded by three esteemed institutions:
ICHOM supports Value-Based Health Care Delivery framework for transforming world health care systems through standardized measuring and reporting of patient outcomes.
Fortis Healthcare has now tied up with VitalHealth™, an ICHOM certified software provider for use of its Quest Manager software for reporting clinical outcomes data. This ensures that data collection and reporting methodology at FEHI conforms to the highest international norms and standards. Introduction of Quest Manager has added the feature of Patient Reported Outcome Measures (PROMs) to the Fortis outcomes reporting initiative, to ensure greater objectivity by adding the Voice of Consumer into the entire initiative.
The ICHOM Standard Set for Coronary Artery Disease, implemented at FEHI measures and monitors Clinical Outcomes for 2 procedures, namely:
List of Clinical Outcomes parameters for PTCA and CABG is as under:
| PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) | Jul'14 - Dec'14 | Jan'15 -Jun'15 | Jul'15 - Dec'15 | Jan'16 - Jun'16 | Jul'16 - Dec'16 | Benchmarks |
| Emergency CABG for failed procedure | 0.07% | 0.06% | 0% | 0.00% | 0% | 1.2%* |
| Vascular complication at puncture site requiring intervention (beyond simple compression) | 0% | 0.06% | 0.07% | 0.00% | 0% | 1.1%* |
| Acute vessel occlusion requiring emergency re-intervention | 0% | 0% | 0% | 0% | 0% | - |
| Post procedure neurological stroke | 0% | 0.13% | 0.13% | 0.06% | 0.06% | 0.284%** |
| Post procedure Renal failure requiring hemodialysis | 0% | 0% | 0.07% | 0.13% | 0.13% | - |
| Any Bleeding event requiring transfusion/intervention (within 72 hrs.) | 0.07% | 0.06% | 0.07% | 0.51% | 0.39% | 4.0%* |
| Delayed vascular complication at puncture site | 0% | 0% | 0.07% | 0.00% | 0.13% | - |
| Readmission with acute Myocardial Infarction within 30 days | 0% | 0% | 0% | 0.13% | 0.26% | - |
| Mortality during same hospital admission | 0.26% | 0.97% | 0.26% | 1.34% | 0.71% | 1.7%* |
References:
* US National Registry Data 2013
** Cleveland Clinic Outcomes Report 2014
| CORONARY ARTERY BYPASS GRAFT (CABG) | Jul'14 - Dec'14 | Jan'15 -Jun'15 | Jul'15 - Dec'15 | Jan'16 - Jun'16 | jul'16 - Dec'16 | Benchmarks |
| Use of left Internal Thoracic Artery graft | 78.50% | 77.36% | 79.01% | 80.25% | 73.71% | 74.20%* |
| Need for a Bail out Intra Aortic Balloon Pump (IABP) | 1.31% | 0.99% | 0.64% | 0.31% | 0.65% | - |
| Perioperative Myocardial Infarction | 0.16% | 0.50% | 0% | 0.00% | 0% | 0.96%** |
| Post procedure neurological stroke | 0% | 0% | 0.48% | 3.40% | 0.16% | 0.80%* |
| Need of Re-exploration surgery | 1.97% | 3.31% | 3.50%* | 0.46% | 2.42% | 3.50%* |
| Deep sternal wound infection | 0.33% | 0.50% | 0% | 0.15% | 0.32% | 0.20%* |
| Predicted mortality (using Euroscore II) | 2.24% | 2.21% | 2.25% | 2.2% | 1.95% | - |
| Observed mortality | 2.30% | 1.82% | 2.54% | 2.01% | 2.26% | - |
References:
*Cleveland Clinic Outcomes Report 2014
** Texas Heart Institute 2014
