The Upper Peninsula Trustee Forum. Senior Vice President Quality and Patient Safety Michigan Health & Hospital Association

Transcription

1 Safe Care. Always. The Upper Peninsula Trustee Forum March 25, 2011 Sam R. Wt Watson Senior Vice President Quality and Patient Safety Michigan Health & Hospital Association

2 How will your hospital harm a patient today? 2

3 Healthcare Quality There are serious problems in quality Between the health hcare we have and the care we could have lies not just a gap but a chasm. The problems come from poor systems not bad people In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expectsand deserves. We can fix it but it will require changes The degree to which health services for individuals and populations p increase the likelihood of desired health outcomes... 3

4 IOM Crossing the Quality Chasm Six Aims Safety Effectiveness Patient centeredness Timeliness Efficiency Equity 4

5 Federal Reform 5

6 The Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act (PPACA) was signed into law March 23. It was amended by the Health Care & Education Affordability Reconciliation Act, which was signed into law March 30. Result: Provides coverage to 32 million uninsured people by Costs an estimated $940 billion over 10 years ( ).

7 Hospitals Shared Responsibility $155 billion over 10 years mainly is achieved through: Reduce hospital updates Medicare/Medicaid DSH payment reductions Hospital readmissions i policy Hospital acquired conditions But hospitals will experience reduced uncompensated care and additional revenue/payment for the newly insured.

8 Reforming the Delivery System Creates new ways to tie payments to quality improvement. Accountable Care Organizations i Bundling Pilots CMS Center for Innovation Value Based Purchasing Geographic Variation Medical Homes Gain sharing Medical Liability Demonstrations Health information/data will play an integral role in Health information/data will play an integral role in each of these strategies.

9 Encouraging Quality and Safety The law encourages quality and safety by: Establishing a national quality improvement strategy. Creating a public private institute to analyze the comparative effectiveness of treatments. Creating a patient safety research center to promote best practices. Taking steps to pay for quality rather than volume.

10 Hospital acquired conditions 2012 Secretary reports to Congress on state of current hospitalacquired conditions program. Consider expansion to other facilities: LTCHs, IRFs, SNFs, ASCs and hospitaloutpatient outpatient departments Hospitals in top (worst) quartile receive 1% less on Medicare reimbursement. Report on Hospital Compare website after hospitals review and correct information.

11 Hospital Readmissions Decreased Medicare payments begin 2013 for hospitals with higher than expected readmission rates. 30 day readmissions measured for: Heart attack Heart failure Pneumonia 2015 Secretary may expand list to COPD, cardiac and vascular surgical procedures, others

12 Patient Safety Research Center Center for Quality Improvement and Patient Safety w/i AHRQ Research to identify best practices for quality improvement and health care system redesign Improve patient safety, promote successful adoption of best practices, build capacity to lead quality and safety efforts Technical assistance grants to entities to assist providers in adopting best practices identified through Center research.

13 The Ultimate Goal CLINICAL QUALITY + SERVICE = VALUE COST 13

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15 MHA Quality and Accountability Agenda No Preventable Harm 15

16 System Factors Impact Safety Institutional Hospital Departmental Factors Work Environment Team Factors Individual Provider Task Factors Patient Characteristics Adopted from Vincent

17 Rank Order of Error Reduction Strategies Forcing functions and constraints Automation and computerization Standardization and protocols Checklists and double check systems Rules and policies Education / Information Be more careful, be vigilant

18 MHA Patient Safety Organization Responsibilities of a Patient Safety Organization Collect data and work with providers to analyze the information Best practices Evidence based care Preserve confidentiality & security of the patient safety work product Data be used to improve patient safety only Encourage a culture of patient safety If you want to change behavior you need to change the culture Have qualified patient safety personnel and licensed clinicians on staff Improve patient safety and the quality of health care delivery Reporting errors alone will not improve patient safety 18

19 MHA PSO Activities and Timeline 2008 MHA Board Authorizes 3 year assessment Standardize Patient Alert Wristbands 2008 PA 541 PSO peer review/ Report 2009 Federal Certification 2010 DataCollection and Reporting 2009 Member Advisory Group 2009 Member Education 2009 Member Enrollment Clinical Advisory Panel 2010 First Annual Report

20 MHA Keystone Center Visioni Michigan hospitals will lead the nation in patient safety and quality improvement practices Mission i To expedite the translation of patient safety and quality improvement evidence into practice 20

21 Reduce Complexity Increase Reliability Identify interventions associated with improved outcomes in specified population Select strongest interventions and convert to behaviors Develop measures (either process or outcome) Ensure patients reliably receive evidence 21

22 Patient Safety Human Error Challenges Medicine Views Errors as Failings Which Deserve Blame Fault wepunish people for making mistakes Train and Blame Mentality L. Leape NursingEmphasizes Rules wheremedicine Emphasizes Knowledge Corrective Actions Focus on Individual 22

23 The application of evidence.

24 More than simply a checklist 24

25 A Culture of Safety 25

26 Challenger Report The unrelenting pressure to meet the demands of an accelerating flight schedule might have been adequately handled by NASA if it had insisted upon the exactingly thorough procedures thatwere its hallmark during the Apollo program Between that period and 1986, however, the program became ineffective. This loss of effectiveness seriously degraded the checks and balances essential for maintaining flight safety. 26

27 MHA Keystone Center Michigan Collaboratives Collaborative Participating Hospitals Keystone: ICU 77 Keystone: Hospital Associated Infection 120 Keystone: Surgery 104 Keystone: Obstetrics 60 Keystone: Gift of Life 76 Keystone: Emergency Department t 71 MI STA*AR (Rehospitalization Project) 27

28 Science of Safety 1. Evaluate culture of safety 2. Educate staff on science of safety 3. Identify defects 4. Assign executive to partner with a unit 5. Learn from one defect per month and implement teamwork tools J Patient Safety 2005; Jt Comm J Qual Saf. 2004;30(2): Evaluate culture 28

29 MHA Keystone Collaboriaitves Keystone: ICU 1,830 lives saved More than 140,700 excess hospital days avoided More than $271 million in health care dollars saved Keystone: Hospital Associated Infection 25% reduction in the use of urinary catheters in 16 hospitals 3,000 less patients at risk for UTI More than 1,000 unnecessary hospital days and More than $1 million in avoided costs If all Michigan hospitals up to $13 M in savings 29

30 Improved ICU Infection Rates Median and Mean CRBSI Rate Median and Mean VAP Rate Baseline Intervention Time (months) Median CRBSI Rate Mean CRBSI Rate Pronovost NEJM 2006: Pronovost BMJ 2010: Sawyer CCM2010 Berenholtz ICHE 2011

31 Michigan ICU Safety Climate Improvement Effect of CUSP on Safety Climate % "Needs Improvem ment" * Pre vs. Post Intervention Pre-CUSP (2004) Post-CUSP (2006) * Needs Improvement - Safety Climate Score <60% CCM in press

32 Teamwork Climate Across Michigan ICUs No BSI = 5 months or more w/ zero No BSI 21% No BSI 31% No BSI 44% The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care Attribution: J. Bryan Sexton

33 Relationship of Care Coordination to HCAHPS Likelihood to Recommend HCAHPS Item HCAHPS Item HCAHPS Item Results from 246,135 patients at 1,293 facilities Press Ganey

34 Impact of Statewide Quality Improvement Initiative on Hospital Mortality Impact of Michigan Keystone Project on Hospital Mortality Adjusted Odds Ratio Pre implementation (12 months: Oct 02 Sept 03) Project Initiation (5 months: Oct 03 Feb 04) Implementation (12 months: Mar 04 Feb 05) Post implementation (12 months: Mar 05 Feb 06) Post implementation (12 months: Mar 06 Dec 06) Study Group Adjusted OR Comparison Group Adjust OR Lipitz: BMJ in press

35 MHA Keystone Collaboratives Keystone: ER Using LEAN to reduce variation and waste in the emergency department. Sepsis and Early Goal Directed Therapy Keystone: Obstetrics 39 week induction Pitocin Protocol Second Stage Labor 35

36 % Elective Inductions < 39 wks n = 20, Change of 14.99% to 5.68% (Jan/Feb to Oct/Nov) Significant (p =.008) Percent change 62.1%

37 % Elective Cesarean Births < 39 wks n =5, Change of 20.07% to 6.35% (Jan/Feb to Oct/Nov) g ( / / ) Significant (p =.003) Percent change 69.23%

38 National 30 Day Rehospitalization Rates 38

39 MI STate Action on Avoidable Rehospitalizations Reduce state wide 30 day rehospitalization rates by Variation across 30% Rehospitalization Michigan Increase patient and family satisfaction with transitions in care and with coordination of care Coordinate existing state and national quality improvement activities iti Provide examples in which providers have dramatically improved care transitions and reduced rehospitalizations

40 MI STate Action on Avoidable Rehospitalizations Funded by the Commonwealth Fund under the Institute for Healthcare Improvement Co lead by MHA and MPRO First phase: 27 hospitals implementing hospital focused interventions and starting cross continuum meetings. Payers organized to produce data reports for phase one hospitals on readmission rates. June 7 MHA and MPRO hosted a policy summit in Dearborn on payment and rehospitalizations. The summit attendees included providers, payers, government and employers. Commonwealth Fund will produce a policy paper as a result of that summit. Planning for broader expansion of MI STA*AR in Spring 2011

41 MHA Keystone National Collaboratives AHRQ funded national project to prevent infections Bloodstreaminfection 47states underway atpresent present. HRET engaged in enrollment of remaining states. Partners in project include HRET, JHU and MHA. Urinary tract Infection beginning with 10 states. Lead by MHA with U of M and St. Johns Hospital and Medical Center. 41

42 Transparency and Accountability Remain VOLUNTARY No MANDATORY reporting of data

43 MI Hospital Inform Quality

44 MI Hospital Inform Price

45 QUESTIONS / DISCUSSION? Sam Watson Senior Vice President Michigan Health & Hospital Association 6215 W. St. Joseph Hwy Lansing, MI