Quality Update for December 14, 2006

IHI Launches 5 Million Lives Campaign – Aims to Prevent Harm in U.S. Hospitals JAMA Study Says Hospital Performance Measures Have Limited Value as an Indicator of Quality AHQA Annual Meeting Update! “Making a Difference” Trials for Nationwide Health Information Network Forthcoming Tipsheet on Diabetes-related Coverage Changes Note: The next issue of Quality Update will be published in the second week of January. IHI Launches 5 Million Lives Campaign – Aims to Prevent Harm in U.S. Hospitals Prevent five million incidences of harm by December 8, 2008 – that is the goal of the Institute for Healthcare Improvement’s (IHI) new national campaign to improve the health care system. President and CEO Donald Berwick, MD, MPP, launched the 5 Million Lives Campaign – an extension of the successful 100,000 Lives Campaign, which concluded in June -- at the organization’s 18th National Forum in Orlando. The new Campaign, which is sponsored principally by America ’s Blue Cross and Blue Shield health plans, will rely on the Node network to support hospitals in implementing interventions designed to reduce harm. The 5 Millions Lives Campaign represents the single “largest improvement effort in patient safety in American health care history” said Dr. Berwick. Strengthening the Node network (which includes geographic, system, and affinity nodes) is a priority of the new Campaign. Describing the node network as an unprecedented national infrastructure for change that is one of the three great successes of the 100,000 Lives Campaign, “can be a new way to change at a national scale,” said Dr. Berwick. Thirty-three QIOs across the country are leading geographic Nodes – and many others are key participants in Nodes led by other organizations or coalitions. “We are grateful that IHI has listened well and worked hard to align its interventions with QIO work under the Medicare health care quality improvement program, specifically the SCIP and heart failure interventions,” said David Schulke, AHQA EVP. “The 9 th Statement of Work could further reinforce this kind of cooperation, if the QIO role in discharge planning and post-hospital care is included as a Medicare priority.” In his announcement of the new Campaign, Dr. Berwick singled out a number of organizations that are working across the country to improve patient safety, including “the amazing quality improvement organizations which have been central to the 100,000 Lives Campaign, and their association, AHQA.” While the Campaign intends to enroll even more hospitals (4,000 is the goal) and continue helping them improve care, IHI also plans to more actively engage patients and families as well as hospital boards of directors with the hope of driving demand for higher quality care. Back to top 5 Million Lives “The goal of protecting patients from five million incidents of medical harm in two years is ambitious, but patients and families deserve no less,” said Campaign Manager and IHI Vice President Joe McCannon . “There’s a lot of harm in the U.S. hospital system and were going to try to do our part to reduce it in a two year period.” IHI estimates that 15 million incidents of medical harm occur in U.S. hospitals each year. This estimate of overall national harm is based on IHI’s extensive experience in studying injury rates in hospitals, which reveals that between 40 and 50 incidents of harm occur for every 100 hospital admissions. With 37 million admissions in the United States each year (according to the AHA’s National Hospital Survey for 2005), this equates to approximately 15 million harm events annually - or 40,000 incidents of harm in U.S. hospitals every day. IHI defines “medical harm” as unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization, or results in death. Hospitals participating in the Campaign are challenged to adopt up to 12 of the following interventions – six of which were included in the 100,000 Lives Campaign and six of which are new: New interventions targeted at harm Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) infection ...by reliably implementing scientifically proven infection control practices throughout the hospital Reduce harm from high-alert medications ...starting with a focus on anticoagulants, sedatives, narcotics, and insulin Reduce surgical complications ...by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)  Prevent pressure ulcers ...by reliably using science-based guidelines for prevention of this serious and common complication Deliver reliable, evidence - based care for congestive heart failure …to reduce readmissions Get Boards on board …by defining and spreading new and leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating the improvement of care The six ongoing priorities from the 100,000 Lives Campaign Deploy Rapid Response Teams …at the first sign of patient decline – and before a catastrophic cardiac or respiratory event. Deliver reliable, evidence - based care for acute myocardial infarction … to prevent deaths from heart attack. Prevent adverse drug events …by reconciling patient medications at every transition point in care. Prevent central line infections …by implementing a series of interdependent, scientifically grounded steps. Prevent surgical site infections …by following a series of steps, including reliable, timely administration of correct perioperative antibiotics. Prevent ventilator-associated pneumonia … by implementing a series of interdependent, scientifically grounded steps. There is no cost for hospitals to join the 5 Million Lives Campaign but they must adopt at least one intervention and are expected to regularly report hospital profile and mortality data. All 3,100 hospitals that participated in the 100,000 Lives Campaign are automatically enrolled in the new Campaign. Materials and tools to support all 12 interventions are available on the IHI website, www.ihi.org. How to Guides: http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=2#InterventionMaterials Schedule of upcoming calls: http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=7 Back to top JAMA Study Says Hospital Performance Measures Have Limited Value as an Indicator of Quality A study in the December 13 issue of JAMA reiterates recently published findings identifying the limitations of current hospital performance measures. The study focused on measures posted for public use on Hospital Compare, and sought to determine their utility in assessing overall quality of care in US hospitals. Researchers Rachel M. Werner, MD, PhD, of the Philadelphia Veterans Affairs Medical Center and Eric T. Bradlow, PhD, of the University of Pennsylvania conducted a study to determine whether data from the Hospital Compare website correlated with and were predictive of hospitals’ risk-adjusted death rates. The researchers analyzed data between Jan. 1 and Dec. 31, 2004 , for heart attack, heart failure, and pneumonia at acute care hospitals. Ten process performance measures were compared with hospital risk-adjusted death rates, which were measured using Medicare Part A claims data. A total of 3,657 acute care hospitals were included in the study. Across all heart attack performance measures, the absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile vs. those performing in the 75th percentile was 0.005 for inpatient death, 0.006 for 30-day death, and 0.012 for death at 1-year. For the heart failure performance measures, the absolute death reduction was smaller, ranging from 0.001 for inpatient death to 0.002 for 1-year death. For the pneumonia performance measures, the absolute reduction in death ranged from 0.001 for 30-day death to 0.005 for inpatient death. “Our study suggests that in the case of hospital performance, the CMS’s current set of performance measures are not tightly linked to patient outcomes. These findings should not undermine current efforts to improve health care quality through performance measurement and reporting. However, attention should be focused on finding measures of health care quality that are more tightly linked to patient outcomes,” the authors conclude. “This is not evidence that the measures don’t matter - from a population perspective lives are saved by improving performance on the hospital measures,” said Dale Bratzler, DO, MPH, QIOSC Medical Director at the Oklahoma Foundation for Medical Quality and former AHQA President. “CMS will begin reporting risk-adjusted measures of mortality for AMI and HF next year (pneumonia to follow) and these new measures will begin to provide a more complete picture of hospital quality,” continued Bratzler. Using Measures for P4P? In an accompanying commentary, Susan Horn, PhD, of the Institute for Clinical Outcomes Research in Salt Lake City notes, “The results of this study raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals. If performance measures are not strongly associated with better outcomes, why should clinicians and health care centers be required to collect and submit the data, and why would payers and consumers want to act on them?” Dr. Horn suggests using measures developed through randomized controlled trials and comprehensive observational studies. “We have to be realistic that there are not too many processes of care that have randomized trial evidence linking them to improved outcomes so we are quite limited in what we can measure,” cautioned Dr. Bratzler. Adding new measures to the mix doesn’t provide an unmitigated benefit either, he said. As new measures are added, the burden associated with the measurement itself becomes an issue, as Dr. Horn has also suggested. AHQA EVP David Schulke noted, “In one sense, these new findings are not all that new, inasmuch as they confirm findings published in JAMA in 1996. But the press attention this report has received shows how far we’ve come as a nation in paying attention to quality measurement. Even more important is the recent work on the next generation of measures done by Harlan Krumholz and colleagues at CMS with QIO program funding, which was published in Circulation in April. They’ve tested claims-based mortality measures for heart attack and heart failure care which hospitals are going to be working with shortly. Christine Bechtel , AHQA Vice President for Government Affairs said, “W e have to start data collection somewhere. This is why we need health IT – to build the infrastructure for more robust collection that we can begin to use for outcomes measurement.” Read an abstract of the article at: http://jama.ama-assn.org/cgi/content/abstract/296/22/2694 Back to top AHQA Annual Meeting Update! “Making a Difference” New Orleans – Habitat for Humanity! Meeting participants that are interested in assisting with the rebuilding of New Orleans can contact the New Orleans Habitat for Humanity. New Orleans Area Habitat for Humanity is a volunteer-driven organization. Working side-by-side with the families that will live in the house, volunteers help a family realize their dream of home ownership. There is an ongoing need for volunteers. All volunteers must be age 16 years and over.  Please visit the Habitat for Humanity website for more information and signing up http://www.habitat-nola.org/volunteer/. Showcase Your Organization’s Support… and Double Your Visibility! Opportunities exist for organizations to gain exclusive exposure by supporting selected events and products during the AHQA 2007 Annual Meeting. A number of pre-designed support options are outlined in the Prospectus, http://www.ahqa.org/pub/uploads/2007ExhibPro.pdf. Support packages can be designed to maximize exposure and visibility for your organization. For information, contact Jacqueline Osborne at josborne@ahqa.org or 202-331-5790 ext. 1575. More Partners Assist AHQA in getting the Word Out! The following organizations are strategic partners for the 2007 AHQA Annual Meeting: American Association of Colleges of Pharmacy (AACP) American College of Physicians (ACP) American College of Physicians Foundation American Health Information Management Association (AHIMA) American Society of Health-System Pharmacists (ASHP) HiMSS National Alliance of State Pharmacy Association (NASPA) National Association for Home Care & Hospice (NAHC) Opportunities remain for local stakeholder organizations, membership associations, business coalitions, and even QIOs to become strategic partners of the 2007 AHQA Annual Meeting. For information, contact Jacqueline Osborne at josborne@ahqa.org or 202-331-5790 ext. 1575. Registration Update! Early bird registration has been extended! Discounted registration rates for the 2007 AHQA Annual Meeting, to be held February 13-15, at the New Orleans Marriott in New Orleans , Louisiana , will be available until Friday, December 22, 2006 . Please note the last day for changes and cancellations is January 27 th. Visit www.ahqa.org to register. For information and questions, contact Amanda Scott at ascott@ahqa.org or 202-331-5790 ext. 1567. Hotel Reminder: Hotel r eservations at the New Orleans Marriott will only be accepted via the AHQA registration process through Monday, January 8, 2007 . Sleeping rooms are assigned as each participant or exhibitor registers for the conference. Participants will not be allowed to make hotel reservations directly with the New Orleans Marriott. Hotel confirmations will be sent to participants by AHQA. Each room reservation must be confirmed and guaranteed with a valid credit card on the AHQA registration form - http://www.ahqa.org/pub/inside/158_1107_5520.cfm Back to top Trials for Nationwide Health Information Network Forthcoming HHS’ Office of the National Coordinator for Health Information Technology recently announced that the department will support trial implementations for the Nationwide Health Information Network (NHIN) next year.   In the coming months, HHS will announce details of the procurement process for the trial implementations. Proposals will be solicited in spring 2007. The trial implementations are a key step toward meeting the President’s vision of using information technology to make patient information available to providers and consumers, regardless of geographic location. “By bringing together the significant expertise and work achieved this year by the current efforts with state and local health information exchanges, we can begin to construct the ‘network of networks’ that will form the basis of the Nationwide Health Information Network,” said Interim National Coordinator for Health Information Technology Dr. Robert Kolodner. Prototype Architectures Earlier this year four consortia of health care and health information technology organizations contracted with HHS to develop “prototype architectures,” including developing functional requirements, security approaches, and identifying needed standards for creating secure health information exchange in different health care markets. In January 2007, the four consortia will present their findings at the American Health Information Community and the third NHIN forum in Washington, D.C. NHIN will release a summary report capturing key findings from 2006 in early 2007.  Back to top Tipsheet on Diabetes-related Coverage Changes The Centers for Medicare & Medicaid Services recently published a partner tipsheet outlining changes to Medicare’s coverage for diabetes-related coverage. Starting January 1, 2007, more coverage for services that affect Medicare beneficiaries with diabetes will be available. Specifically, Medicare will: Increase payment to doctors for the most frequently billed face-to-face doctor/patient service, which includes referring eligible patients to existing preventive services like diabetes outpatient self-management training and medical nutrition therapy. Include diabetes outpatient self-management training and medical nutrition therapy services in the Federally Qualified Health Center benefit to reach beneficiaries in more rural and underserved areas. Adding abdominal aortic aneurysm screening to the “Welcome to Medicare” physical exam and exclude colorectal cancer screening procedures from the Part B deductible. The tipsheet includes a chart of all diabetes-related coverage under Medicare along with the beneficiary’s cost. Read the tipsheet at: http://www.aoa.gov/Medicare/news/media/PartnerTipSheet-11274-P0DiabetesUpdates11-22-06.pdf Back to top

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