Pediatrix: Small Companies, Big ReturnsBy David F. Carr | Posted 2003-10-01 Print
The medical group turns notes into data that can be analyzed and compares results of its infant care facilities.
Pediatrix's big idea: Collect deep, objective data, then comb it to identify areas of patient care that offer opportunities for improvement. Researchers analyze trends, isolate best practices, and apply those practices to help babies get off to a better start.
Pediatrix provides neonatal and maternal-fetal physician services. Neonatal case records are kept in a clinical database called the Research Data System, or RDS. Originally designed to replace handwritten physician notes with more legible computerized reports, RDS is now used to support research, improve quality of baby care and, significantly for the business, justify insurance claims. It has grown to 50 gigabytes, with records on more than 192,000 babies.
Bryant says the RDS development is typical of how the organization has enhanced its systems one step at a time. "We've racked up a series of small successes that have added up to significant overall success for the organization," he says.
In 2000, Pediatrix set out to improve weight gains for very small infantsthose born between 400 and 1,500 grams, or less than 1 lb. to about 3 lbs., 5 oz. Infants born prematurely grow more slowly than they would in the womb, impeding their physical and mental development. Generally speaking, techniques that improve their growth should also improve their health.
Pediatrix used the RDS data as a starting point. It didn't show doctors what to change about the babies' care, but it gave them clues about where to look for better ways to do things.
Researchers used the database to identify the Pediatrix neonatal intensive care units, or NICUs, with the highest and lowest weight gain results. They visited the units at both extremes and found 16 significant differences in practices. For example, virtually all high-performance units focused on supplementing intravenous feedings with feedings through the stomach as soon as practical, while the low-performance units were more likely to delay that changeover.
Once shown this evidence, NICU staffs were motivated to apply the beneficial processes more consistently.
"This really is moving away from the idea that medicine is all art and no science," says Dr. Barry Bloom, director of Pediatrix's quality improvement program. While the judgment behind a doctor's orders is important, so is the efficiency and consistency of the organization that carries them out.
In 2001, Pediatrix found 76% of the participating NICUs improved their weight gain record compared to 1999 (the "baseline" year, prior to the start of the quality improvement project). Further improvements followed in 2002, when a bell curve showed the crest of the waverepresenting the majority of locationsshifting toward the high end of the range.
As detailed in the medical journal Pediatrics, babies were sent home at an average weight just over 5 lbs. in 2001, compared with an average weight of 4 lbs., 12 oz in 1999. That covers more than 2,600 babies studied, with lessons for an organization that cared for more than 55,000 infants last year.
Meanwhile, research and education programs help Pediatrix show it is concerned with more than profits. "It both surprises and pleases me" that Pediatrix would make those investments, says Dr. Avroy Fanaroff of Case Western Reserve University in Cleveland. "At the same time, I think it's essential."
Though he's not a Pediatrix employee, Fanaroff has taught courses through NatalU.com, Pediatrix's neonatal "open university" on the Web, and followed the progress of its research and quality programs. He points out that these programs help doctors feel good about working for the company.
Pediatrix staffs 200 NICUs nationwide. To grow, it buys physician practices that staff hospital neonatal units, letting doctors focus on patient care while the company manages administrative details. Other companies formed around the concept of aggregating physician practices in the 1990s, but Pediatrix is one of the few survivors, with a profit of $68.8 million last year on revenue of $465.5 million.
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