Strategies to prevent HACs, reduce cost of care, improve patient experience discussed at QUEST National Meeting

Jul 13 2010

As healthcare providers prepare for the implications of reform, the more than 200 hospitals participating in the QUEST^®: High Performing Hospitals collaborative are already achieving the goals of improving patient care and reducing costs.

“As healthcare providers, we can and should be doing a better job to reduce the incidence of readmissions - we just need to keep the individual patient as our focus.”

As a part of the annual QUEST National Meeting, participating hospitals provided evidence-based examples of proven strategies that help prevent hospital-acquired conditions (HACs) such as healthcare-associated infections (HAIs); reduce readmissions and cost of care; and improve the patient experience.

The event, which took place during Premier's Annual Breakthroughs Conference and Exhibition in the Washington, D.C., area, also featured a pair of special guest speakers.

Harlan M. Krumholz, M.D., S.M., and Harold H. Hines Jr., professor of Medicine and Epidemiology and Public Health at Yale University School of Medicine, offered insights and overall information about readmissions. Dr. Krumholz is the lead author on a recent Journal of the American Medical Association (JAMA) article that looks at the connection between hospital length of stay and readmissions for patients with heart failure. According to the study, while shorter stays may have cut costs in the near-term, they led to more readmissions and the potential for higher long-term costs.

"There is a significant need within the healthcare continuum of care to focus on transitions in care, from hospitals to non-acute settings to health homes," Dr. Krumholz stated. "As healthcare providers, we can and should be doing a better job to reduce the incidence of readmissions - we just need to keep the individual patient as our focus." Dr. Krumholz also serves as director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation (CORE) and director of the Robert Wood Johnson Clinical Scholars Program at Yale University.

Judith Eve Nelson, M.D., J.D., professor of Medicine/Pulmonary and Critical Care at the Mount Sinai School of Medicine in New York City, discussed the case for improving palliative care.

According to Nelson, the significant growth over the last decade of palliative care, and hospitals reporting it, has made this type of care a standard for hospital quality and excellence.

"Effective palliative care programs are associated with better patient care along with higher patient and family satisfaction, and they can provide valuable support to physicians and nurses," Nelson said. "There are many resources and tools available to hospitals interested in starting or enhancing an existing palliative care program, but it's these large-scale collaboratives that can be a powerful means to share practices and enhance the work of this type of care."

A voluntary project made up of more than 200 hospitals across 34 states, QUEST is designed to optimize hospital performance in five critical areas, including cost-effectiveness, evidence-based care delivery, mortality, harm reduction, and improving patient satisfaction. QUEST measures of high performance are foundational elements of reform, positioning participants for success in an environment linking pay to outcomes. Specifically, QUEST hospitals will be more likely to:

• Earn 1-2 percent Medicare incentive payments as part of the value-based purchasing program (VBP) through the reliable delivery of evidence-based care,
• Avoid up to 3 percent of Medicare payment penalties for high readmission rates,
• Avoid 2 percent Medicare payment penalty under VBP for hospital-acquired conditions (HACs),
• Avoid being fined 1 percent of payments for high rates of HACs, and
• Better manage the $197.2 billion in reimbursement cuts over the next decade.

Results from the first year of the QUEST project show that the original 157 QUEST hospitals saved an estimated total of 8,043 lives and $577 million in one year. Of the approximately 2.3 million patients treated annually in these hospitals, 24,818 additional patients received treatments that met the highest quality patient care standards when compared to baseline performance at the outset of the project.

QUEST benefits from an Advisory Panel of experts from 20 of the country's top healthcare organizations, such as the Centers for Medicare & Medicaid Services, National Quality Forum, and the Agency for Healthcare Research and Quality.

QUEST participant speakers and panelists included:

Patient Experience

• Jim Pope - President, Summa Wadsworth-Rittman Hospital & Barberton Hospital
• Gary Hamilton, BSN, RN - Nurse Manager, Renal Telemetry, Covenant Health System
• Julia Scott, MSN, RN, CCRN - Nursing Director Cardiac and Critical Care, Covenant Health System

The IHI Improvement Map

• Christina Gunther-Murphy - Hospital Portfolio Operations Manager, Institute for Healthcare Improvement
• Rose Lindsey-Giulian, RN, RHIA, PhD - Administrator of Quality, Accreditation and Infection Prevention, Baptist Memorial Health Care Corporation
• Debbie Nance, RN, BS, CPHQ - Corporate Director of Quality, Accreditation and Infection Prevention, Baptist Memorial Health Care Corporation

Reducing Mortality: Achieving Excellence through Clinical Transformation

• Anna Grant, MHA - Clinical Excellence Analyst, Quality, Bon Secours Health System Inc.

Cost of Care: Resource Utilization

• Janice Beene - Administrative Director, Quality Institute, Presbyterian Healthcare Services

Prevention of Catheter Associated Urinary Tract Infections

• Linda Green, RN, MPS, CIC - Director of Infection Prevention, Rochester General Health System

VTE Microsystem: Bruised but not Bleeding

• Monica Barrington, RPh, MPH, FASCP - Director of Healthcare Improvement, Georgetown Hospital System
• Monica Grey, RN, BHS, MHA - Quality Manager, Georgetown Hospital System

Impact of a Clostridium Difficile (CDI) Reduction Plan

• Christine Hendrickson, RN, BSHA, CIC, CWCN - Director of Infection Prevention, University of Minnesota Medical Center, Fairview

Patient Experience - HCAHPS Survey

• Paula Harless, RN - Nurse Manager of Gynecology, CAMC Women and Children's Hospital, Charleston Area Medical Center
• S. Andrew Weber, MBA - Vice President/Administrator, CAMC Women and Children's Hospital, Charleston Area Medical Center

Baldrige Panel

• Monica Ray, RN, MS, MSA - Process Leader Quality, Safety & Risk, Heartland Health
• Joan Brennan, DNP, RN - VP of Quality and Performance Excellence, Atlanticare
• Karen Koch, Pharm.D, MSHA - Director of Patient Focused Improvement Department, North Mississippi Medical Center (NMMC)

SOURCE Premier healthcare alliance