5 million lives campaign hospital intervention status survey results

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.