How OSF HealthCare Improved Patient Safety and Saved Costs with Precision Dosing

50%
Reduction in severe AKI events
1,428
Annualized patient days LOS reduction
$3.6M
Annualized cost reduction

About OSF HealthCare

OSF HealthCare, a not-for-profit Catholic health system based in Peoria, Illinois, is one of the largest in the Midwest. With nearly 26,000 Mission Partners serving patients across 17 hospitals, 200 clinics, and dozens of urgent care and specialty sites, OSF delivers a full spectrum of care—from community-based primary care to advanced specialty services. Its network of more than 2,200 providers is supported by innovative programs in digital health, home health, and hospice care.

Organization Type
Health System
Highlighted Solution
Bayesian MIPD
Therapeutic Area
Infectious Diseases

I’d recommend it without hesitation for anyone with high-risk patients

- Jerry Storm, SVP of Pharmacy Services at OSF

Opportunity

The antibiotic vancomycin is widely used in inpatient settings to treat and prevent bacterial infections — but it is difficult to administer properly. Supra-therapeutic levels of vancomycin caused by overdosing can lead to acute kidney injury (AKI) and longer inpatient stays. Conventional methods of selecting vancomycin dosage are based solely on weight, or rely on manual data entry into spreadsheets or other offline calculators.

 

Solution

To improve efficacy and patient safety, OSF HealthCare reached out to InsightRX to implement its cloud-based platform and precision dosing modules for vancomycin in adults. InsightRX integrated its Nova platform with OSF HealthCare’s Epic electronic health record to make relevant patient data seamlessly available for incorporation in Nova’s PK/PD models. OSF’s infectious disease pharmacy coordinators incorporated the Nova PK/PD model into the Pharmacy-run vancomycin protocol. Clinical pharmacists at OSF HealthCare were
trained to use InsightRX on appropriate patients to predict the pharmacokinetics of different
dosing regimens, enabling them to select a dosing regimen that maximizes the likelihood of achieving clinical targets while minimizing the likelihood of AKI.

We’ve had occasions where the software predicts declining renal function before the serum creatinine rises, allowing us to change a dose and prevent a potential AKI.

- Julie Giddens, Ministry Infectious Disease Pharmacotherapy Coordinator at OSF

Impact

InsightRX was used to select vancomycin dosages for 1,356 adults at OSF HealthCare treated at OSF hospitals from August 1, 2019 to October 31, 2019 (the “post-InsightRX” cohort).1 Compared to a “pre-InsightRX” cohort of 529 patients, the rate of severe AKI was reduced by 50% in the post-InsightRX cohort. Based on literature estimates of length of stay (LOS) and costs for patients with and without AKI, the use of InsightRX reduced LOS by 357 patient-days in this cohort, corresponding to an an annualized LOS reduction of 1,428 patient-days. In addition, preventing AKI events with InsightRX saved an estimated $911,281 in this cohort, with an annualized cost reduction of $3,645,123 as derived from the literature.1

This kind of impact is thanks in part to the Nova PK/PD modeling InsightRX was able to provide OSF.

In the pharmacy, when trying to implement a new program, you really need someone from the vendor side who speaks your same language — and InsightRX gave us that support.

- Julie Giddens, Ministry Infectious Disease Pharmacotherapy Coordinator at OSF

Results

Using InsightRX with a robust protocol reduces AUC24 variation from 33% to 25%

Area under the curve (AUC) describes patient exposure to a drug. For vancomycin, a 24-hour AUC (AUC24) of at least 400 mg*h/L is typically targeted2. An AUC24 above 700 mg*h/L is associated with significantly increased incidence of nephrotoxicity.3

figure-1-AUC-variation

Figure 1 shows all therapeutic drug monitoring results (TDMs) for the pre-InsightRX and post-InsightRX cohorts. The shaded region indicates the target AUC24 range of 400-600 mg*h/L. Coefficient of variation was reduced from 33% in the pre-InsightRX cohort to 25% in the post-InsightRX cohort.

 

Using InsightRX with a robust protocol increases AUC24 on-target rate from 48% to 64%

In the post-InsightRX cohort 64% of TDM levels fell into the desired target range of 400-600 mg*h/L, as compared to 48% in the pre-InsightRX cohort.

figure-2-AUC-target-attainment

Figure 2 shows the proportion of TDM levels falling into AUC24 ranges of <400, 400-600, 600-700, and 700 mg-h/L.

 

Using InsightRX with a robust protocol reduces rate of stage 2 or 3 AKI from 17.2% to 8.5%

AKI class was calculated based on serum creatinine (SCr) values over time according to guidelines published by the Kidney Disease: Improving Global Outcomes (KDIGO) working group.4

Severe AKI events (stage 2 or 3) occurred in 8.5% of patients in the post-InsightRX cohort, as compared to 17.2% in the pre-InsightRX cohort, a reduction of 50%.

figure-3-AKI-rate

Figure 3 shows the proportion of patients in each cohort who had no AKI or stage 1 AKI, compared to the proportions who had stage 2 or 3 AKI.

 

Conclusion

Implementing InsightRX with a robust protocol has made a substantial impact on patient safety at OSF HealthCare, and the platform has been embraced by OSF staff. “When we first adopted the platform, we had only a few pharmacists putting it through the paces,” said Jerry Storm, SVP of Pharmacy Services at OSF. “It was their experience using InsightRX, combined with their results and outcomes, that convinced the rest of the staff that this was really the new best practice and not some pie-in-the-sky new tech.” While additional research is needed to assess the actual impact on cost and length of stay at OSF HealthCare, the data shown here strongly suggest that adoption of precision dosing will benefit inpatients treated with vancomycin.