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Cleveland Clinic's Donley on Telehealth Advances, Clinician Wellness, and Ongoing Efforts to Achieve the Triple Aim
FierceHealthcare (05/17/17) MacDonald, Ilene

In an interview, Dr. Brian Donley discusses the Cleveland Clinic's efforts to achieve the Triple Aim of health care, with better care, better health, and lower costs. Donley, chief of staff at Cleveland Clinic, notes they are actually reaching for the Quadruple Aim, trying to improve caregivers' experiences as well. The organization's initiatives include expansion of its telemedicine efforts, an e-ICU, a mobile stroke unit, standardization of care pathways, and caregiver wellness programs. Donley says that when all doctors follow similar pathways to treat their patients, it reduces variation in care, lowers costs, and increases quality. Care paths have been developed for strokes and the total knee and total hip program. The stroke care pathway has led to a 43 percent decrease in stroke mortality and a 25 percent decline in the cost of care, he says. Stroke costs per day were $3,402 prior to the introduction of the care path, but since implementation they have declined to $2,553. The care paths for the total hip replacement and total knee replacement have also had noticeable results. Cleveland Clinic reports that since the pathways were implemented in October 2013, its average length of stay for a total hip replacement has decreased 29 percent and 34 percent for a total knee replacement. Additionally, patient discharges to home have increased 39 percent for total hip replacements and 44 percent for total knee replacements, and costs have dropped, too. Meanwhile, the organization is also stressing the importance of taking care of its caregivers and reducing burnout. Steps it has taken in this direction include using medical scribes to enter data into the electronic health record, which gives doctors more time with their patients; hiring a pharmacist to handle most prescription refills; and sponsoring regular social events, so physicians can talk with one another.

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