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Transforming care across the continuum: every organization can and should drive health care reform by creating its own system transformation and its own care model, which will not only improve access, achieve high quality and lower costs in its own health care system, but will also provide a template from which others can learn.

Denver Health's contributions to these efforts relate to demonstrating the power of public integrated delivery systems, the utility of sophisticated health information technology and the effectiveness of Lean in health care. Denver Health integrates public health with personal health, a safety net hospital with federally qualified health centers, and primary care with specialty care. The system is bound together with a single electronic medical record and single employed academic physician group.

This integration facilitates access, especially for vulnerable children and adults, by establishing multiple points of patient entry--patients get to the right place, at the right time, for the right level of care. Data and information are available at the point of care, and physicians and the enterprise are completely aligned. This integrated structure enables Denver Health to provide very high quality care at low cost.

Seventy percent of Denver Health's patients are members of minority groups; 46 percent are uninsured. Denver Health provided $362 million of uninsured care in 2009. Despite $4 billion of uninsured care since 1991, Denver Health has been in the black since then with the same city and county support, which amount to approximately $28 million a year.

The potential of the integrated system is fully realized through a sophisticated health information technology system that utilizes a single patient identifier across all the clinical components of the system. This makes demographic, clinical, laboratory, radiology and pharmacy data available to the provider at the point of care.

A sophisticated data warehouse enables the use of clinical registries, which facilitates prevention and chronic disease management, yielding a childhood immunization rate of more than 90 percent and hypertension control in 65 percent of patients. The data warehouse also permits real time quality of care information to be available to the clinicians. The computerized provider order entry with order sets enables deployment of standardized evidenced-based care in a teaching institution with constantly changing house staff.

Another contribution to health system transformation has been the use of Lean. Denver Health began its Lean journey almost five years ago, training a group of 25 physicians, nurses and administrative leaders as black belts. Since that time, the group has grown to 200. The systemwide use of these tools is designed to improve efficiency, but has also empowered employees, improved quality and produced tens of millions of dollars of financial benefit for the institution.

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Patricia A. Gabow, M.D., is CEO and medical director of Denver Health.
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Title Annotation:Denver Health
Author:Gabow, Patricia A.
Publication:H&HN Hospitals & Health Networks
Date:May 1, 2010
Words:406
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