5 million lives campaign hospital intervention status survey results
TRANSCRIPT
IHI 5 Million Lives CampaignHospital Intervention Status
Survey
Preliminary Findings From a HAP Member SurveyMarch 6, 2007
Protecting 5 Million Lives From HarmPatient Safety Symposium
Pennsylvania IHI Node Partners
Early Spring 2005
•Hospital & Healthsystem Association of PA (HAP)•Quality Insights of Pennsylvania (QIP)•The Pennsylvania Patient Safety Authority •VHA Pennsylvania•VHA East Coast•Health Care Improvement Foundation (HCIF) of the
Delaware Valley Health Council (DVHC) of HAP•Hospital Council of Western Pennsylvania (HCWP)
IHI Campaign Kickoff – June 2005
– VHA Pennsylvania
– VHA East Coast
Rapid Response Team
Presentation
– Best Practices and Educational Program
Pennsylvania IHI Hospital, Legislative & Media Education
ForumSeptember 2005
Pennsylvania Node Partners Selected IHI Participating Hospitals IHI National Campaign Team
• Hosted a panel discussion for hospital staff, state legislators, legislative staff, and state agencies.
• Provided an understanding of the 100K Lives Campaign, the Campaign interventions, and efforts taking place within participating hospitals.
IHI National Bus Tour Stops at:
• Abington Hospital • Children’s Hospital of Philadelphia
Accomplishments• Using existing expertise and established programs, each
of the Pennsylvania Node Partners, contributed to one of several programs around each of the six interventions through 2005, and into the spring of 2006.
VHA & VHA East Coast– Rapid Response Teams– Preventing Adverse Drug Events /
Medication Reconciliation
HAP, HCIF and HCWP– Prevention of Central Line Associated
Blood Stream Infections– Prevention of Ventilator Associated
Pneumonias
QIP– Evidenced Based Care for Acute
Myocardial Infarction– Prevention of Surgical Site Infections
Pennsylvania IHI Node Partner Campaign Update
January 2006
• State bulletin highlighting hospital success stories around the Campaign interventions.
• http://www.haponline.org/quality/safety/100k/
Statewide Honor Roll of fully committed Pennsylvania hospitals, Mentor Hospitals, and hospitals that served as faculty for IHI sponsored programs.
Pennsylvania’s IHI MilestoneCelebration – State Capitol
June 14, 2006
• House Health & Human Services Committee
• Senate Public Health & Welfare Committee
Presentation of Pennsylvania hospital success stories to legislative staff in:
Other Opportunities for Collaboration
from PA Node Partnership HAP Patient Safety Symposium
• over 400 participants• each partner organization was represented
and actively involved in the event
Partnership for Patient Care Program
• HCIF, Independence Blue Cross, and ECRI• Failure mode effects analysis on infection
topics
PA Hospital Participation in IHI Campaign
57%
74%
0%
15%
30%
45%
60%
75%
90%
Percentage of PA hospitals currently enrolled inIHI Campaign
2005
2007
Source: HAP Member Surveys, Summer 2005 and March 2007
110 Pennsylvania Hospitals
128 Pennsylvania Hospitals
Which of the existing IHI 100K Lives measures are quality/patient safety
priorities at your hospital?
62%
74%68%
61%66%
75%84%
91%96%
90% 91% 90%
0%
20%
40%
60%
80%
100%
DeployingRapid
ResponseTeams
DeliveringEvidence-Based
Care for AMI
PreventingAdverse Drug
Events
PreventingCentral LineInfections
PreventingSurgical SiteInfections
PreventingVentilator-AssociatedPneumonia
2005 2007% of responding hospitals
Source: HAP Member Surveys, Summer 2005 and March 2007 (CEO Opinion)
Which of the new IHI 5 Million Lives measures are quality/patient safety
priorities at your hospital?
96% 94%89%
81% 85% 84%
0%
20%
40%
60%
80%
100%
Improving Carefor Patients
with CongestiveHeart Failure
ReducingMRSA
Infections
PreventingPatient Harm
From High-AlertMeds
ReducingSurgical
Complications
GovernanceLeadership
PreventingPressure Ulcers
% of responding hospitals
Source: HAP Member Surveys, Summer 2005 and March 2007 (CEO Opinion)
Perspectives onPatient Safety & Quality
Priorities
Source: HAP Member Surveys, March 2007
IHI Measure
Priority Ranking
Chief Quality Directors
CEO
Preventing Adverse Drug Events 1 1
Improving Care for Patients with CHF 2 2
Preventing Surgical Site Infections 3 4
Preventing Ventilator-Associated Pneumonia
4 6
Preventing Central Line Infections 5 7
Preventing Patient Harm from High-Alert Meds
6 8
Evidence Based Care for AMI 7 5
Reducing Surgical Complications 8 12
Preventing Pressure Ulcers 9 10
Rapid Response Teams 10 11
Reducing MRSA Infections 11 3
Governance Leadership on Quality & Patient Safety
12 9Differences
Priority Ranking of IHI Measures
Source: HAP Member Survey, March 2007(Quality Directors’ Opinions)
1.00 1.50 2.00 2.50 3.00
Governance Leadership on Quality & Patient Safety
Reducing MRSA Infections
Rapid Response Teams
Preventing Pressure Ulcers
Reducing Surgical Complications
Evidence Based Care for AMI
Preventing Patient Harm from High-Alert Meds
Preventing Central Line Infections
Preventing Ventilator-Associated Pneumonia
Preventing Surgical Site Infections
Improving Care for Patients with CHF
Preventing Adverse Drug Events
HighPriority
LowPriority
No Activity
Implementation Status: Then & NowRapid Response Teams
27%
10%
27%31%
6%
73%
6% 4%9% 9%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Implementation Status: Then & NowEvidence-Based AMI Care
76%
3%
13%8%
0%
85%
4% 6%0%
6%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Pennsylvania Patients Receiving Appropriate Care*
87% 86%
61%55%
89.6% 87.8%
69.3%62.7%
0%
20%
40%
60%
80%
100%
AMI HTF PNE SCIP
2005 2006*
* Limited to providers submitting to the QIO Data Warehouse.Source: QIO Clinical Data Warehouse, PPS Providers Only, discharge dates 1-1-06 through 6-30-06
Percent of AMI Patients Who Received Recommended Hospital Care
83.4%
82.3%
84.6%
85.3%
80.0%
81.0%
82.0%
83.0%
84.0%
85.0%
86.0%
United States Pennsylvania
2004 2005
Ranked 31st
nationwide
Ranked 23rd
nationwide
Source: CMS Hospital Compare
“Recommended hospital care for AMI” includes administrations of aspirin and beta-blocker within 24 hours of hospital arrival and at discharge, receiving prescription of angiotensin converting enzyme (ACE) inhibitor or an ARB at discharge for patients with left ventricular systolic dysfunction (LVSD), and giving smoking cessation counseling for smoking patients.
AMI Care in Pennsylvania Hospitals
92%
87% 87% 87%
68%
92%90% 89% 89%
78%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Given aspirin @admission
Aspirinprescribed @
discharge
Given beta-blocker @admission
Given beta-blocker @discharge
Pts. with LVSDprescribed ACE
inhibitor @discharge
2004 2005
Source: AHRQ National Healthcare Quality Report, 2006
AMI Care in Pennsylvania Hospitals
73%
31%
74%
25%
58%
20.0%
27.5%
35.0%
42.5%
50.0%
57.5%
65.0%
72.5%
80.0%
87.5%
Given smokingcessation advice while
hospitalized
Recieved thrombolyticmedication within 30
min. of arrival
Given percutaneouscoronary intervention
within 120 min. ofarrival
2004 2005
Source: AHRQ National Healthcare Quality Report, 2006
Not applicabl
e
AMI Care In Pennsylvania*(ACM AMI Measures)
94.8% 96.3%
80.4%
92.9% 95.8%95.9% 97.3%
83.9%
93.8% 97.3%
0%
20%
40%
60%
80%
100%
Aspirin @arrival
Aspirin @discharge
ACE or ARBfor LVSD
Beta blocker@ arrival
Beta blocker@ discharge
2005 2006*
* Limited to providers submitting to the QIO Data Warehouse.Source: QIO Clinical Data Warehouse, PPS Providers Only, discharge dates 1-1-06 through 6-30-06
Implementation Status: Then & NowPreventing Surgical Site Infections
33%
16%
35%
13%
4%
60%
8%
28%
1% 3%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Percent of Adult Surgery Patients Who Received Appropriate Timing of Antibiotics
69.1%
62.5%
56.0%
58.0%
60.0%
62.0%
64.0%
66.0%
68.0%
70.0%
72.0%
United States Pennsylvania
2005
Ranked 40th nationwide
Source: CMS Hospital Compare
“Appropriate timing of antibiotics” includes receiving preventative antibiotic(s) 1 hour before incision, and discontinuing the antibiotics within 24 hours after surgery end time.
SCIP Care In Pennsylvania*(ACM SCIP Measures)
77.7%68.8%
81.5%74.5%
0%
20%
40%
60%
80%
100%
Prophylactic antibiotic receivedwithin 1 hour prior to surgical
incision.
Prophylactic antibioticsdiscontinued within 24 hours after
surgeryl end time.
2005 2006*
* Limited to providers submitting to the QIO Data Warehouse.Source: QIO Clinical Data Warehouse, PPS Providers Only, discharge dates 1-1-06 through 6-30-06
Implementation of New MeasuresImproving Care for Patients with Congestive Heart Failure
69%
7%
15%
1%7%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Percent of Heart Failure Patients Who Received Recommended Hospital Care
76.1%74.5%
79.6%
81.5%
70.0%
72.0%
74.0%
76.0%
78.0%
80.0%
82.0%
84.0%
United States Pennsylvania
2004 2005
Ranked 30th
nationwide
Ranked 20th nationwide
Source: CMS Hospital Compare
“Recommended hospital care for heart failure” receiving evaluation of left ventricular ejection fraction, and prescription of angiotensin converting enzyme (ACE) inhibitor at discharge for patients with left ventricular systolic dysfunction (LVSD).
Heart Failure Care in Pennsylvania Hospitals
81%
68%
86%
77%
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
Pts. having evaluation of leftventricular ejection fraction
Pts. with LVSD prescribed ACEinhibitor @ discharge
2004 2005
Source: AHRQ National Healthcare Quality Report, 2006
HTF Care In Pennsylvania*(ACM HTF Measures)
92.5%
81.1%
93.7%
83.4%
0%
20%
40%
60%
80%
100%
LVF Assessment ACE or ARB for LVSD
2005 2006*
* Limited to providers submitting to the QIO Data Warehouse.Source: QIO Clinical Data Warehouse, PPS Providers Only, discharge dates 1-1-06 through 6-30-06
Implementation of New MeasuresReducing MRSA Infections
29% 28% 25%
13%6%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Implementation Status: Then & NowPreventing Ventilator-Associated Pneumonia
33%27%
32%
8%0%
72%
13% 10%
1% 4%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Implementation Status: Then & NowPreventing Central Line Infections
41%
12%
33%
12%
2%
67%
11%17%
1% 4%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Implementation Status: Then & NowPreventing Adverse Drug Events
11% 9%
47%
33%
0%
75%
10% 13%
3% 0%0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
2005 2007
% of responding hospitals
Implementation
Source: HAP Member Surveys, Summer 2005 and March 2007
Implementation of New MeasuresPreventing Pressure Ulcers
58%
13%17%
10%3%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Implementation of New MeasuresPreventing Patient Harm From High Alert Medications
54%
15%19%
6% 6%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Implementation of New MeasuresReducing Surgical Complications
36%
22%
31%
6% 6%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Implementation of New MeasuresGovernance Leadership on Quality & Patient Safety
38%
7%
23%18%
14%
0%
20%
40%
60%
80%
Hospital-Wide
Selective Incomplete DiscussionOnly
No Activity
% of responding hospitals
Implementation
Source: HAP Member Survey, March 2007
Level of Technical Assistance Needed with Measures
Source: HAP Member Survey, March 2007
1.00 1.50 2.00 2.50 3.00
Preventing Ventilator-Associated Pneumonia
Rapid Response Teams
Governance Leadership on Quality & Patient Safety
Evidence Based Care for AMI
Preventing Patient Harm from High-Alert Meds
Preventing Pressure Ulcers
Preventing Central Line Infections
Reducing MRSA Infections
Improving Care for Patients with CHF
Preventing Surgical Site Infections
Reducing Surgical Complications
Preventing Adverse Drug Events
HighLevel
LowLevel
NoneNeeded
Areas Needing High Level of Technical Assistance
(based on % of respondents)Preventing Adverse Drug Events 59%• ADEs @ Admission 40% need high level of
assistance• ADEs during Hospital Stay 42%• ADEs @ Discharge 46%• ADEs Operative 35%
Reducing Surgical Complications 35%• VTE prophylaxis 43% need high level of assistance• Beta blockers 31%• Ventilator-associated
pneumonia 26%
Reducing Surgical Site Infections 33%• Antibiotics @ admission 13% need high level of assistance• Antibiotics discontinued 28%• Hair removal 10%• Normothermia 17%• Glucose control 28%
Source: HAP Member Survey, March 2007
Able to Sustain Improvements in IHI Measures?
Source: HAP Member Survey, March 2007
1.00 1.50 2.00 2.50 3.00 3.50 4.00
Preventing Ventilator-Associated Pneumonia
Preventing Central Line Infections
Evidence Based Care for AMI
Improving Care for Patients with CHF
Preventing Patient Harm from High-Alert Meds
Preventing Surgical Site Infections
Preventing Pressure Ulcers
Rapid Response Teams
Reducing Surgical Complications
Governance Leadership on Quality & Patient Safety
Preventing Adverse Drug Events
Reducing MRSA Infections
Yes, not
difficult
Yes, with some
difficultly
Yes, but extremel
ydifficult
No
What’s Next?
• Seek to reach 100 percent participation among Pennsylvania hospitals.
• Focus on the challenging measures within the clinical measures sets associated with Medicare pay-for-performance – heart failure, surgical infections, surgical complications, heart attack.
• Bring on new partner, the American Hospital Association and capitalize on their expertise.
What’s Next?
• Determine whether other partners are needed.
• Review information from survey among Pennsylvania Node partners to develop work plan for interventions.
• Seek expertise among all Pennsylvania hospitals on the interventions – faculty, newsletter.
• Hear from all of you about whether this data accurately reflects your needs.