Target Based Care: An Intervention to Reduce Variation in Postoperative Length of Stay

June 2nd, 2021

Inconsistencies in the inputs of healthcare delivery such as variability in which and when therapies are introduced, titrated, or tapered importantly contribute to differences in outputs such as quality, patient experience, and cost. In this lecture, we will discuss a clinical effectiveness intervention aimed at reducing practice variability developed at Stanford called Target Based Care that promotes a shared mental model between providers and patients by establishing transparent clinical targets within the hospitalization. For a given patient undergoing surgery, the local electronic health record is used to derive a personalized comparative cohort resembling the patient undergoing surgery. From this electronic “control population” a median experience for each clinical milestone is obtained, from which we develop achievable targets in clinical care. These clinical targets are displayed at the point of care transparent to all the stakeholders in the patient’s care, including families throughout the patient’s hospital stay. We have found Target Based Care to be associated with reduced outcome variability and improved length of stay with preserved safety. The program is now live in over 40 surgeries across Stanford Children’s Health. Its generalizability is being evaluated as part of a multicenter learning collaborative with 18 participating pediatric cardiology programs across the country

Claudia Algaze

Claudia Algaze, MD, MS is an Assistant Professor in Pediatrics (Cardiology) and Medical Director of Clinical Effectiveness at Stanford Children’s Health at Stanford University. Her purpose is to transform our healthcare delivery system into a continuous learning system so that the experience and lessons from every patient lead to the improvement of that experience for every subsequent patient. She completed a pediatrics residency, cardiology fellowship, and QI fellowship at Stanford.

Andrew Shin

Andrew Shin, MD is a Clinical Professor in Pediatrics (Cardiology). He is the Executive Medical Director of Innovations & Clinical Effectiveness and Medical Director of Systems Utilization Research for Stanford, combining high throughput analytics/informatics with value-based care. He completed his residency, and chief residency, along with dual fellowships in cardiology and critical care at Boston Children’s Hospital.