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Gabriel J. Escobar, MD

Research Scientist III, Division of Research

Advance Alert Monitor

“It’s not unusual for health care organizations to be thinking about deploying, or planning to deploy, predictive analytic models. What is unique is that, unlike many organizations, Kaiser Permanente is able to quantify the impact of actually using them.”

“Twenty years ago, when Dr. Escobar started imagining a predictive analytic system that could identify hospitalized patients at high risk of deterioration, no one thought it was possible,” says Tracy Lieu, MD, director of the Division of Research (DOR).

Fast forward to today, and hospitals throughout Kaiser Permanente Northern California are using a first-of-its-kind algorithm that does just that, thanks to Dr. Escobar.

Advance Alert Monitor (AAM) is a predictive analytic tool that generates hourly risk scores to help physicians and nurses identify adult patients in our medical-surgical or transitional care units who are at risk for either an unplanned transfer to intensive care or an unexpected death within the next 12 hours.

Dr. Escobar conducted studies of KP hospitals in Northern California from 2004 to 2010 and found that, after controlling for severity of illness, patients unexpectedly transferred from medical-surgical units to intensive care have mortality rates 2 to 5 times higher than those admitted directly to intensive care, and comprise 20 percent of all hospital deaths.

The AAM algorithms are based on patterns in historical data, collected from hundreds of thousands of patient hospitalizations over a 13-year period. By synthesizing and analyzing vital signs, lab results, and other variables, the AAM equations identify patients who have a greater than 8 percent chance of deteriorating.

A regional team of ICU-trained registered nurses receive these alerts and then partner with local medical centers to avert deterioration by identifying potential care gaps through real-time reviews of patients’ electronic health records.

Dr. Escobar’s recent analyses suggest AAM is saving approximately 500 lives each year. Other Kaiser Permanente regions are planning to deploy, or are in the process of deploying, similar systems.

“Some of Dr. Escobar’s greatest qualities are that he combines a quantitative approach with profound clinical understanding, which allows him to grasp the big picture,” Dr. Lieu says. “He’s done such an amazing job at bridging the worlds of cutting-edge research and what’s needed for practical applications in care delivery.”

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