6/21/2011
June 2011
Secretary Sebelius has launched a new nationwide public-private partnership
to tackle all forms of harm to patients. Our goals are:
1.
Keep patients from getting injured or sicker. By the end of 2013, preventable
hospital-acquired conditions would decrease by 40% compared to 2010.
ƒ
Achieving this goal would mean approximately 1.8 million fewer injuries to
patients with more than 60,000 lives saved over the next three years.
2.
Help patients heal without complication. By the end of 2013, preventable
complications during a transition from one care setting to another would be
decreased so that all hospital readmissions would be reduced by 20% compared
to 2010.
ƒ
Achieving this goal would mean more than 1.6 million patients would
recover from illness without suffering a preventable complication requiring rehospitalization within 30 days of discharge.
Potential to save up to $35 billion dollars over three years.
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6/21/2011
Partnership
ƒ 3,500+ partners have signed the Partnership pledge, including over 1700 hospitals, 883 Clinicians, 549 consumers, community organizations and patient groups, and 159 employers, unions, health plans, governments.
Media Coverage
ƒ Earned Media: Nearly 150 articles have been written in national print and online publications about the Partnership and initial outreach events.
ƒ Trade Press and Scientific Publications: include JAMA, American Medical News, WSJ blog, The Remington Report ƒ Social Media: 300+ blog posts, Facebook links, and Twitter #HHSPFP hits posted post‐launch
Field Events
ƒ The Partnership has been central to 51 field events, including 12 organized by HHS and 39 organized by partners.
Alignment
ƒ A number of Affordable Care Act provisions – including the Medicaid Provider‐Preventable Conditions Rule, Medicare IPPS Rule, Medicare Value Based Purchasing Rule, and Community‐Based Care Transitions Program ‐ have been aligned with Partnership activity.
Early Engagement
ƒ Applications are beginning to come in for the Community Care Transitions Program.
3
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ƒ
ƒ
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There is no “silver bullet.”
We must apply many incentives.
We must show successful alternatives.
We must offer intensive supports.
ƒ Help providers with the painstaking work of improvement.
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6/21/2011
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ƒ
ƒ
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Harness attention and energy to engage every hospital and help them master the basics of patient safety.
Propel an advanced participant group to achieve unseen levels of performance.
Engage a National Content Developer to develop best‐in‐
class education & training, and supply contractors assisting participating hospitals with knowledge and innovations that will drive change.
Evaluate our progress as we go and implement lessons learned.
5
ƒ
All hospitals will be able to tap into a national learning platform offering vast set of best‐in‐class learning supports
ƒ Virtual Grand Rounds led by expert faculty
ƒ Case studies and live‐case visits conducted at participating institutions
ƒ Audience Response Systems to provide instant feedback and education
Hospitals will be also be able to get local state, system and association‐based forms of support to address common forms of harm (e.g., state consortiums, large private systems, associations) ƒ Ambitious hospitals with a history of improvement invited to:
ƒ
ƒ Achieve Partnership goals in a more accelerated timeframe
ƒ Tackle the challenge of reducing all‐cause harm
ƒ Learn from their peers and mentor participating hospitals
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6/21/2011
Existing Department Resources
ƒ OASH Partnering to Heal
ƒ CDC HAI Prevention Activities
ƒ AHRQ Patient Safety materials ƒ QIO 10th Statement of Work.
ƒ Other Department resources included on Partnership for Patients website.
Additional Resources Available (Summer 2011)
ƒ NQF/NPP webinars focused on each intervention
ƒ Each stakeholder to pursue “First Five” (five key actions to begin to advance this work)
ƒ [Your rich resources here]
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The effort will seek to support a grassroots movement for change.
ƒ
It will include a national education campaign to inform patients, families, caregivers, and the public of Partnership goals and activities.
ƒ
It will involve patients and families in effective redesign of care. ƒ
It will provide accessible patient safety and care transitions resources (e.g., discharge planning tools). 8
4
6/21/2011
Raising Awareness Getting Started
NQF/NPP convenes
first partner group
meeting
Release solicitations for Innovation Center
supports (mid-June 2011)
Launch
Announce $500M Community
Based Care Transitions Program
Host 7 awareness-raising
stakeholder calls for providers,
hospitals, plans, advocates,
employers, and others
Hospital Engagement
Advanced Participants
OPDIV-led calls raise awareness &
secure pledges from their
constituents
Initial Media/SoMe Outreach
Multiple events in each HHS region
keynoted by Secretary,
Administrator & other principals
National Content Development
Patient & Family Engagement
Measurement and Evaluation
NQF/NPP launches “Getting Started”
webinar series (One per week on each
targeted adverse event in June –
August)
Initial awards
(September – October 2011)
HHS principals keynote large
national meetings (e.g., ACC, AHA,
NRHA, SHEA
Informal “Advanced Participant
Network ” launch at IOM New
Frontiers in Patient Safety
Align new policy levers (e.g., ACA § 3008) & HHS program (e.g., HHS HAI Campaign) with ongoing PFP activity
April
2011
May
2011
June
2011
July
2011
August
2011
September
9
2011
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The Partnership is not authentic, viewed simply as a government program (no mutual obligation)
ƒ
Leadership is not engaged ƒ
Nominal involvement (hospitals sign pledge but don’t participate in learning & improvement)
ƒ
Lack of specifics ƒ
Inability to track outcomes and financial impacts
ƒ
Measurement wars
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6/21/2011
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
They have shared, crisp, public aims, owned by leadership.
They welcome everyone. (Unleash, don’t control.)
They get to the field. Their work is rooted in actions and transactions. (Value)
They are “brutally opportunistic.” (Jazz)
They play well with levers.
They operate a “Recognition Economy.”
They have a shared story and they use the language of creation (not avoidance). They examine and revise their rules base.
The patient is in the room…always.
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“I’ve never seen public‐private cooperation like this…it’s kind of shocking.”
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“I can’t believe we had this much potential…look at what we unleashed!”
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“This initiative was just so helpful to me every day.”
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“I love this network! It produces results faster than anything I’ve seen before.”
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“I am so grateful for this initiative…it helped us feel less overwhelmed and made us feel so much safer.”
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6
6/21/2011
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
They have shared, crisp, public aims, owned by leadership.
They welcome everyone. (Unleash, don’t control.)
They get to the field. Their work is rooted in actions and transactions. (Value)
They are “brutally opportunistic.” (Jazz)
They play well with levers.
They operate a “Recognition Economy.”
They have a shared story and they use the language of creation (not avoidance). They examine and revise their rules base.
The patient is in the room…always.
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Joe, age 62
Frank, age 88
Chris, age 87
Judy, age 86
Ed, age 82
Linda, age 84
Kelly, age 1
Joan, age 76
Susan, age 28
Karen, 45
Jane, age 56
Jim, age48
October 2008 through September
2009
Sal, age 80
108
2008
Lisa, age 60
Rob,
age
total
Tim, age 76
76
Mary, age 81
28
2009
Doug, age 72
2
Goal
Kevin, age 50
54
Sam, age 90
Karl, age 33
Joe, age 65
2009
Total
3
8
27
2010
Goal
0
6
Rose, age
Ted, age
Susan, age8962
77
Marie,
age
Rick, age 80
2
Dan, age
0 2011
89
Bill,
age
77
Goal
66
Leo, age 80
Paul, age 67 Peter, age 78
Bob, age 76
Felicia, age
80
Michael, age
90
Timothy, age 84
Matthew, age
89
Raymond, age 54
Fiscal Year 2009 Goal: Reduce preventable harm by 50%
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6/21/2011
ƒ
Hear from some experienced leaders of change (what will it take from us)
ƒ
Define the actions each of us can take
ƒ
Breakout conversations on your questions
ƒ
Ongoing connection (and a September reconvening)
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HOSPITAL EXPERIENCE OF TODAY
•
•
•
•
•
Irregular leadership review of quality data.
Hodge‐podge of different quality programs.
Sometimes outcomes change, and sometimes they don’t. Hospitals get credit for participating.
Limited work on readmissions; no clear strategy for care transitions.
Patients and families not an active part of the process; unable to advocate for the highest‐quality care.
HOSPITAL EXPERIENCE OF TOMORROW
•
•
•
•
•
The Board demands more attention to quality; the hospital administrator reviews safety and quality data every week.
The organization has a portfolio of 10‐12 improvement projects.
Major incentives to change outcomes (payment at risk, increased transparency and media scrutiny).
Dedicated staff, programming and community partnerships focused on seamless care transitions
The organization interfaces with the patient and family movement, supported by the Partnership.
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6/21/2011
the road to a healthy south carolina
ƒ population of 4,625,364
ƒ four defined geographic regions
ƒ 65 acute care hospitals
-
Strong foundation of collaboration and team
work
One of top 5 states in improving quality per
AHRQ
Major opportunities to impact population
health and disparities
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6/21/2011
every patient counts partnership
Led by SCHA’s quality team, Every Patient Counts (EPC) is a
partnership of all SC hospitals and over 30 other health care
organizations dedicated to a collaborative vision of making
health care better and safer for each patient, every time.
System Level Aims
Create an organizational culture of safety with engaged leadership
Actively improve the quality & outcomes of evidence-based care for key
patient populations
Eliminate preventable serious adverse events and unintended patient
harm
Establish a patient-centered environment of care with open and
transparent communication
epc achievements
Average Door to Balloon Time
37% Improvement Rate
Time measured in minutes.
Based on 2007-2010 data pulled from the Action/Get with the Guidelines Registry
STEMI-receiving hospitals participated in the registry and sent SCHA data monthly
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6/21/2011
epc achievements
CLABSI Infection Ration (SIR)
and Data
2
1.8
1.6
1.5
SIR
Confidence Interval
1.4
1.39
1.2
1.15
1
0.92
SIR
O=E
0.8
0.6
0.4
0.2
0
Jan 08 - Jun 08
Jul 08 - Dec 08
Jan 09 - Jun 09
Jul 09 - Dec 09
Trend Point
safe surgery 2015: south carolina
ƒvision
Every surgical patient in South Carolina will receive the highest
quality and safest care in all surgical settings.
ƒgoal
By 2014 a modified version of the WHO Surgical Safety
Checklist with team based communication will be used in
every operating room for every surgical patient every time a
surgical procedure is performed in the state of South Carolina.
ƒ100% of hospitals committed
To date, all SC acute care hospitals with surgical suites have
fully committed to implementing the surgical checklist.
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6/21/2011
healthy south carolina vision
ƒ South Carolina will be able
to document the highest
rates of improvement
nationally by 2020 within
three targeted spheres:
ƒ Improvements in health status
of defined populations within
our state
ƒ Improvements in patient
access, care processes and
clinical outcomes
ƒ Reductions in the health care
cost burden on our state and
its citizens
contact information
ƒ Rick Foster, MD
Senior Vice President, Quality
Improvement and Patient Safety, SCHA
[email protected]
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6/21/2011
Integrated Health Model
• Holistic view of the member, seamless experience
• Proactive Outreach
• Guide to Quality providers & facilities
Health
Advocate Team
Health & Wellness
Coaching
Outreach
Gaps in Care
Acute & Specialty
Care
Coordination
Web Portal
Email
CMR Team
Decision
Support
Chronic Condition
Management
EAP/Behavioral
Health Support
Work/Life Assistance
Lifestyle Change
Programs
Honeywell Confidential
Improving Outcomes - Medical Decision Support
2078 unique members since April 2004 – Dec 2008:
76% Survey Response Rate
Reported an improved quality of life or comfort
80%
68%
Improved wellness or treatment compliance
54%
Improved physical health
Drives Customer
Satisfaction
Switched to treatment considered to be
“best practice”
35%
23%
Discontinued unnecessary or questionable treatment
22%
Changed doctors or sought a 2nd and/or 3rd opinion
and
Drives Savings
15%
2%
0
Eliminated or minimized side effects of treatment
Identified an incorrect diagnosis
10
20
30
40
50
60
70
80
90
Proven ROI on MDS program
26
Honeywell Confidential
13
6/21/2011
Facility Performance in the Phoenix Market - MSK
Variability in both cost and quality among Phoenix hospitals provides opportunity to
drive traffic to higher quality and lower cost facilities
- Average cost allowed for APR weight ranges from $8,367 to $15,363
- Readmit rates <=30 days range from 3.57% to 5.79% and relative length of stay to expected varies
from .95 to 1.22.
Days
LOS
Expected LOS
LOS To Expected
Readmit<=30 Days
Readmit Factor
Avg APR WT
Market Comparison Avg Wt
Avg Allowed per Admit
Sum of APR WTS
Allowed per APR WT
Relative Cost Weight Factor
Hospital Name
Arrowhead Hospital
Banner Desert Medical Center
Banner Good Samaritan Med Ctr
John C Lincoln Hosp-North Mountain
Scottsdale Healthcare Osborn
Scottsdale Healthcare Shea
St Josephs Hospital And Med Ctr
Admits
- Hip replacement ranges from $8,262 to $10,607 (28.4%)
- Cervical spinal fusions range from $8,633 to $16,827 (almost double)
179
212
228
259
679
112
329
579
678
702
871
1,878
356
1,083
3.23
3.20
3.08
3.36
2.77
3.18
3.29
3.34
2.99
3.20
3.02
3.15
3.33
2.69
0.97
1.07
0.96
1.11
0.88
0.95
1.22
4.47%
4.72%
5.70%
5.79%
3.98%
3.57%
4.56%
1.07
1.13
1.37
1.39
0.95
0.86
1.09
1.76
1.80
1.82
1.73
1.82
1.85
2.11
0.97
1.00
1.01
0.96
1.00
1.02
1.17
$14,715
$20,633
$20,652
$24,418
$16,599
$16,666
$32,390
314.81
381.55
414.73
448.14
1232.58
207.49
693.65
$8,367
$11,464
$11,354
$14,112
$9,144
$8,996
$15,363
0.84
1.16
1.15
1.42
0.92
0.91
1.55
Definitions:
Expected LOS and LOS to Expected – refer to appendix for detail
Readmit Factor = Hospitals MSK readmit % / Markets MSK readmit %
Average APR WT = Total MSK APR-DRG weights for the hospital / Total MSK Admits
Market Comparison Average Wt = Average of Hospitals MSK APR-DRG weights / Average of Markets APR-DRG weights
Allowed per APR WT = Allowed Amount / Sum of APR Wts
Relative Cost Weight Factor = Hospitals Case Mix Adj. Allowed / Markets Case Mix Adjusted Allowed
Source: VDA Region Southwest COM 100131for hips, knees and spine
27
Honeywell Confidential
Opportunities
9 Hospital and doctor quality data are readily accessible
9 Quality outcome data for treatments is accumulated in a
statistically significant way so best practices can be distilled,
disseminated, and accessed
9 Medical decision support systems are available to all
9 Quality outcomes are rewarded rather than usage
9 Doctors, nurses, diagnosticians, pharmaceuticals are brought
together to coordinate the best outcome for the patient
9 Chronic disease prevention and management is addressed
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Honeywell Confidential
14
6/21/2011
Ascension Health FY09 System-wide Statistics
Discharges
696,206
Available beds
17,928
Number of births
76,268
Total surgical visits
544,400
Home health visits
554,664
Clinic visits
1,748,421
Emergency visits
2,317,004
Physician office visits
5,112,392
Total outpatient visits
17,702,630
Associates
113,000
29
Setting The Goal – December 2003
Healthcare
That Is Safe
2003
30
Defined by our
Clinical Excellence
Goal:
The care we deliver will
be safe and effective. We
commit to having
excellent clinical care
with no preventable
injuries or deaths in five
years (by July 2008).
30
15
6/21/2011
Unadjusted Mortality Declines
FY04-FY10
1.48
2.20
1.4687
2.14
2.15
1.46
2.10
1.4492
2.10
2.00
1.42
2.00
1.4145
1.4
1.95
1.91
1.3868
1.90
1.3970
1.91
1.92
1.3869
1.88
Case Mix Index
Mortality per 100 Discharges
1.44
2.05
1.38
1.3734
1.85
1.36
1.80
1.34
1.75
1.32
1.70
3ly '0
(Ju
04
FY
4)
e '0
Jun
4ly '0
(Ju
05
FY
e
Jun
)
'05
(Ju
06
FY
5
ly '0
)
'06
ne
- Ju
)
)
)
)
'08
'07
'09
'10
ne
ne
ne
ne
- Ju
- Ju
- Ju
- Ju
'07
'08
'06
'09
uly
uly
uly
uly
J
J
J
J
(
(
(
(
07
08
09
10
FY
FY
FY
FY
Observed Mortality Rate
Case Mix Index
FY10 – O/E = .749, >5000 lives saved, unadjusted results – 1,587 fewer deaths compared to baseline 31
Our Journey to Zero –FY10 Results
National Average
25%
43%
57%
65%
Birth
Trauma
89%
94%
Neonatal
Mortality Pressure
Ulcers
74%
VAP
Blood
Stream
Infections
Mortality
Falls
with
Serious
injuries
Measurement of Ascension Health Performance 07/01/09 - 6/30/10. National estimates are the latest available in the
literature and other sources of data (data collection methodologies may not be identical). Birth Trauma & Neonatal
Mortality -2005, Facility-Acquired Pressure Ulcers – 2004 data; Falls with Serious Injury 1985 – 1999 data; Central Line Blood Stream Infection & VentilatorAssociated Pneumonia – 2006 -2008 data, Mortality 2009 data.
32
16
6/21/2011
What’s Next and Lessons Learned
• Healing without Harm by 2014
– Become a High Reliability Organization.
– 40% additional reduction in serious safety events.
• Lessons learned
–
–
–
–
–
–
–
–
Great change is possible.
Don’t accept the status quo.
Clear and discrete focus.
Leadership and governance commitment.
Define and measure outcomes
Transparency speeds and improves performance
Caregivers must support and actively participate
Improved quality results = improved financial results
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