VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION HOSPITAL ENGAGEMENT NETWORK BETSY COLE ARCHER, MS, BB (ASCP) DIRECTOR, PERFORMANCE IMPROVEMENT CENTER FOR HEALTHCARE EXCELLENCE
ABOUT ME Master of Science, Virginia Commonwealth Director, Performance Improvement University Multiple initiatives that support our vision Transfusion Medicine Hospital Acquired Infections Manager, Quality and Patient Safety Preventable readmissions Large health system in Virginia (Richmond and Reducing hospital costs through quality improvement Hampton Roads) Strengthening hospital performance in penalty Ambulatory Care -> Imaging centers, radiation programs oncology, urgent care centers, etc. Making healthcare safer for Virginians
VHHA - WHO ARE WE? Virginia Hospital & Healthcare Association Alliance of 107 hospitals and 26 health systems The Center for Healthcare Excellence Improve healthcare by assisting members to achieve top-tier performance in quality, safety, & service
VHHA VISION Through the power of collaboration, the association will be the recognized driving force behind making Virginia the healthiest state in the nation by 2020.
VHHA MISSION Working with our members and other stakeholders, the association is to transform Virginia’s health care system to achieve top tier performance in safety, quality, value, service and population health. The association’s leadership is focused on: principled, innovative and effective advocacy; promoting initiatives that improve health care safety, quality, value and service; and, aligning forces among health care and business entities to advance health and economic opportunity for all Virginians.
HOW WILL WE ACHIEVE OUR AIM?
COMMITMENT FROM STAKEHOLDERS Hospital commitment Patient & Family Engagement Voice of the patient and family is essential! Strategic State Partners Virginia Department of Health QIN/QIO National Support American Hospital Association
EXTERNAL FUNDING… Center for Medicare & Medicaid Services (CMS)
AHA/HRET & VHHA HOSPITAL ENGAGEMENT NETWORK HEN 2.0 SEPTEMBER 2015 - 2016
SO WHAT IS A HEN ANYWAY? • Improvement collaborative • Best-practice incubator • Community of peers • Learning cohort • Quality improvement (QI) • Clinical content • Standardized measures and accelerated timeframes
WHY JOIN A COLLABORATIVE? Best deployed when there is a gap between accepted best practice and current practice Collaboratives allow participants to: Spread evidence-based best practices Shared learning via virtual events Monitor outcomes through data Rapid Cycle Improvement (PDSA) Achieve ambitious project goals…
HEN 2.0 PROJECT GOALS Adverse Event Areas • • Adverse Drug Events (ADE) Injuries from Falls Reduce Harm by 40% • Central Line-Associated • Catheter-Associated Urinary Reduce Preventable Readmissions by 20% Blood Stream Infections Tract Infection (CAUTI) (CLABSI) …by September 23, 2016 • • Ventilator Associated Events Venous Thromboembolism (VAP) (VTE) 3 operational metric categories: • • Pressure Ulcers (PrU) Surgical Site Infections Patient and family engagement • Obstetrical (OB) Harm and • Early Elective Deliveries Readmissions Health care disparities (EED) Engaging leadership and governance • Clostridium difficile (C. diff.), • Airway Safety including antibiotic stewardship • Culture of Safety, fully 12 • integrates patient safety with Severe Sepsis and Septic Shock worker safety
HOW WILL WE IMPROVE? IMPROVEMENT STRATEGIES
VHHA HEN Elizabeth City, NC 36 hospitals committed
HOW DO WE KNOW THERE’S A NEED TO IMPROVE? Perform Collect needs baseline assessment data Develop Perform change gap analysis package
IMPROVEMENT STRATEGIES Education plan: emphasize implementation and doing work instead of planning to do work Site Visits – Gemba walk! Peer to Peer Learning: IHI Model for Improvement Measurement System Our Members! Access to experts What have you tried? Listserv & website What worked? Change packages! What were your barriers? What can your network team help you to overcome?
CONNECTING TO RESOURCES Webinars for each topic from national advisors Facilitation of networking and shared learning VHHA In-person events with Subject Matter Experts Coaching calls Regular interaction to keep pace with goals
HOW WILL WE KNOW CHANGE IS AN IMPROVEMENT? MEASUREMENT SYSTEM
USING DATA… Encyclopedia of Measures Baseline data collected for each measure Monthly monitoring data Real-time improvement Database allows for graphs, benchmarking, comparisons, and relative reductions
RESULTS NATIONAL AND VIRGINIA HEN RESULTS
WHAT DOES THE AHA/HRET HEN 2.0 PROJECT LOOK LIKE? 1,500+ hospitals across 33 states and one region Spanning 5 time zones (PR to AK)
HEN 2.0 – HOSPITAL CHARACTERISTICS
FINAL AHA/HRET HEN 2.0 RESULTS TOTAL HARMS PREVENTED AND COST SAVINGS 23
Hospitals (%) HEN 1 HEN 2.0 Baseline Apr – Jun Relative Core Harm Topic / Measure Reporting Data Ending Performance Improvement 2 Rate 2016 Rate at Baseline 1 Benchmark 4 Rate 3 OB Harm: Vaginal deliveries without 719 (94%) 21.56 10.91 -49% 19.53 N/A instrument Early Elective Deliveries (EED) 722 (94%) 4.02 2.24 -44% 4.89 2.00 PrU: Pressure Ulcer Rate (Stage 3+) 1137 (88%) 1.60 0.91 -43% 1.21 1.49 VTE: Post-Operative Venous 911 (93%) 4.51 2.99 -34% 4.35 N/A Thromboembolism (VTE) SSI: Surgical site infection rate, all 907 (93%) 2.01 1.59 -21% N/A N/A procedures reported VAE: Infection-Related Ventilator- 776 (92%) 1.40 1.20 -14% 1.52 N/A Associated Condition (IVAC) Rate ADE: Adverse drug events, all ADEs 1,005 (78%) 1.63 1.44 -12% N/A N/A reported CLABSI:Central line-associated blood stream infections per 1,000 1,007 (98%) 1.00 0.89 -11% N/A 0.21 central line days Falls: Falls w/Injury 1,230 (96%) 0.64 0.60 -5% 0.64 0.50 Readmissions: All-cause, 30-day 1,225 (95%) 8.51 8.14 -4% 8.78 N/A readmissions CAUTI: Catheter-associated urinary tract infections per 1,000 catheter 1,260 (98%) 1.02 0.98 -4% N/A 0.27 days 1 The percent reporting represents the number of hospitals reporting baseline data divided by the number of hospitals expected to report data for the topic and/or measure. For example, non-OB hospitals are not expected to report data on EED or OB Harm. FINAL AHA/HRET HEN 2.0 RESULTS 2 Relative improvement calculates baseline compared to the most recent available three-month rate (Apr – Jun 2016). 3 Most current available three-month rate at the end of HEN 1. 24 4 HEN 2.0 performance benchmarks as released by the Evaluation Contractor September 132016 (PfPPEC_Benchmarks_Sept_2016.xlsx)
VIRGINIA HEN BY NUMBERS 36 • Active Virginia participants 24 • VHHA-provided educational programs • In-person learning sessions • Readmissions & C. difficile 4 • Sepsis • HRO pre-summit event • Patient & Family Engagement 10 • Virtual Shared Learning Events
VIRGINIA HEN RESULTS Harms Prevented by Month 400 368 Number of Harms Prevented 350 311 300 258 237 229 250 199 194 200 130 150 100 50 - Oct Nov Dec Jan Feb Mar Apr May Monitoring Month Number of Harms Prevented Total Harms Prevented: 1,851 Total Cost Savings: $16,585,917
VIRGINIA RESULTS BY TOPIC STATE AGGREGATE TOPIC-LEVEL ACHIEVEMENT NOTE: A topic is considered met if the relative reduction is 17.6% or better (12% or better for readmissions) Baseline Rate Most Current Q Rate Relative Baseline Data May Data (Mar - May 2016) reduction Submission Submission ADE 1.67 1.97 18.2% 81% 58% CAUTI 1.17 1.05 -10.1% 97% 100% 0.93 0.75 -19.2% 97% 100% CLABSI 2.72 1.25 -54.0% 96% 96% EED Falls 0.50 0.54 6.7% 97% 83% 23.45 6.93 -70.4% 96% 44% OB Harm 11.96 0.53 -95.6% 106% 52% PrU (1) Read 3.72 4.15 11.7% 97% 8% SSI 2.07 1.95 -5.5% 94% 103% 6.08 5.35 -12.1% 97% 100% VAE 8.28 4.36 -47.3% 97% 46% VTE CDI 0.74 0.88 19.1% 97% 100% 65.77 64.40 -2.1% 11% 8% SEPSIS We still have work to do!
HOSPITAL ACHIEVEMENTS Number of Hospitals Achieving ≥ 40% Reduction of Harm (20% for Readmissions) Number of Hospitals Meeting Goal 30 26 22 21 21 21 21 20 20 10 8 NOTE: Hospital-level achievement is assessed comparing aggregate data (October 2015 – August 2016) from baseline
THE POWER OF STORIES…
NEXT STEPS HEN UNDERGOES A TRANSFORMATION!
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