QIOs Capitalize On Collaborative Model For Improving Patient Care

Preventing Post-Surgical Infections : Heart Care
Diabetes Management : Increasing Immunizations

Quality Improvement Organizations (QIOs) are in the forefront of a new national effort to improve quality of care through learning collaboratives that promote the exchange of information and joint problem solving, provide guidance on effective evidence-based care delivery systems, and disseminate intelligence learned through innovative demonstration projects.

Collaboratives typically involve bringing together health care providers to share information on how to improve care in specific treatment areas. Leaders facilitate meetings for the introduction of technical and clinical information needed to implement evidence-based care interventions. Many collaboratives encourage ongoing long-term communication for reporting and discussion of successes and barriers.

QIOs are leading a number of national collaboratives with health care providers and are participating in more than 100 local collaboratives in states around the nation aimed at rapidly improving care for diabetes, heart failure, and heart attacks—as well as reducing surgical infections and increasing immunizations.

QIO collaboratives already underway range from the national Surgical Infection Prevention collaborative to local collaboratives addressing heart care, immunizations and diabetes management. Some examples of QIO-led collaboratives:

Preventing Post-Surgical Infections

• Qualis Health, in partnership with the Institute for Healthcare Improvement, is running a collaborative of QIO and hospital staff from across the country designed to prevent surgical infections. Under the initiative, each QIO selects one hospital in their state or territory to partner on identifying opportunities to prevent surgical infections by rapidly testing and implementing quality improvement cycles. The collaborative will convene an Outcomes Congress in April 2003 to share successes and develop a charter on preventing surgical infections that will include an ideal system of care and a set of process and outcome measures for surgical infections. The collaborative already has benefited more than 10,000 patients as hospitals have adopted ways to improve administration of antibiotics to surgical patients. Contact Evan Stults, 206-364-9700.

• National Surgical Infection Prevention Collaborative Drawing on lessons learned in the Qualis Health-led collaborative, QIOs in every state are implementing collaboratives to reduce the incidence of surgical site infections. Contact: Michelle Clark, 405-840-2891.

Heart Care

• Stratis Health, the Minnesota QIO, has partnered with the state Office of Rural Health to develop a collaborative project for Minnesota’s Critical Access Hospitals focused on heart failure and atrial fibrillation. The collaborative featured in-person workshops and conference calls during which participants shared experiences using the QIO’s evidence-based strategies for improving treatment of patients with heart failure and atrial fibrillation., as well as developing an infrastructure for CAHs to network and learn from other’s successes and challenges. As a result of the collaborative, every CAH demonstrated improvement on at least one clinical indictor for heart failure or atrial fibrillation. For more info, Jennifer Lundblad, 952-854-3306.

• The Alabama Quality Assurance Foundation, the Alabama QIO, collaborated with 20 hospitals and cardiovascular surgery teams to significantly improve the care of patients undergoing coronary artery bypass grafting (CABG) surgery. Through innovative interventions, such as allowing members of one hospital’s heart surgery team to visit another hospital’s team and compare steps in the processes of care, the collaboration helped increase the percentage of patients who had breathing tubes removed within six hours after surgery from 9% to 41.2%; the use of internal mammary artery grafts from 73% to 84%, and aspirin use at discharge from 88% to 92%. These improvements were associated with significant reductions in risk-adjusted mortality in the state. For more info, Bill Hawkins, 205-970-1600.

• Primaris worked with five hospital emergency departments to improve the treatment of patients with heart attacks following an error that resulted in a patient’s death. After a traditional quality improvement approach failed to produce improvement, the Missouri QIO established the collaborative and required participants to administer aspirin within 20 minutes of a patient’s arrival. Following meetings and conference calls, timely aspirin administration occurred 92% of the time, compared to 14% prior to the collaborative, and the average amount of time it took for emergency room staff to administer the medication dropped from 33 minutes to 14 minutes. For more info, Deborah Finley, 573-893-7900.

• Qualis Health conducted the Washington State Cardiovascular Collaborative with acute care teams to reduce errors in the treatment of cardiovascular conditions. Through learning sessions focused on implementing system changes from the Robert Wood Johnson Foundation’s Improving Chronic Illness Care program, participants rapidly changed clinical care systems to reduce errors in getting the right medications to the right patients. For more info, Evan Stults, 206-364-9700.

• The Georgia Medical Care Foundation, the Georgia QIO, is collaborating with 11 rural hospitals in the state to develop intervention tools to care for post-operative patients with heart failure. These hospitals are testing and measuring practice innovations, and then sharing experiences with other partners to accelerate implementation of best practices. The group also has designed a new form to improve the rate of consistent and complete discharge instructions for patients with heart failure. Contact Lee Millman, 404-982-0411.

• The TMF Health Quality Institute is launching a statewide IHI-style collaborative to improve hospital care for treatment of heart failure and pneumonia. The collaborative will help hospitals identify and rapidly implement changes to improve performance on joint CMS-JCAHO quality indicators for CHF and pneumonia. Contact Minnie Malone, 512-327-7159.

Diabetes Management

• North Dakota Health Care Review, Inc. collaborates with clinics that provide care to more than 60% of the state's diabetic population. Five years of implementing system improvements, such as a diabetes care flow sheet, have led to increased office visits, annual hemoglobin A1c rates, eye exams, urinalysis, and measurement of microalbumins. The North Dakota QIO also has developed a widely used diabetes care tracking system that facilitates tracking of diabetics and includes a patient reminder system for routine diabetes care checks. For more info, Barbara Groutt, 701-852-4231.

• Qualis Health is working on its third outpatient diabetes collaborative with the Washington State Department of Health and 28 clinics across the state. The program trains doctors to redesign medical practices to improve management of diabetes and lays the groundwork for delivering better care for other chronic diseases. Participating clinics choose different process and outcomes measures to focus on and share successes in regular learning sessions. The collaborative has produced measurable improvements in the rate of foot exams, blood sugar testing, and in levels of LDL cholesterol in patients with diabetes. For more info, Evan Stults, 206-364-9700.

• Primaris, the Missouri QIO, partnered with community health centers, the state health department, and the Missouri Primary Care Association to develop a collaborative focused on improving diabetes self-management among patients visiting physician offices. The collaboration resulted in increases of documented patient self-management goals and the number of patients receiving two, hemoglobin A1c tests in the last 12 months. For more info, Deborah Finley, 573-893-7900.

Increasing Immunizations

• The Colorado Foundation for Medical Care, the Colorado QIO, has designed and implemented a Pharmacy Collaborative to determine whether hospital pharmacists can achieve universal inpatient pneumococcal immunizations in six large metropolitan hospitals. Each hospital used a different approach to immunize a target population, while ensuring that hospital staff capture patients’ immunization status at admission and appropriate patients receive vaccinations. CFMC will launch the collaborative statewide in 2003 and will include nursing staff to encourage greater coordination between pharmacists and nurses, who play a critical role in screening and administering vaccines. For more info, Kam Valentine, 303-695-3300.

• The Georgia Foundation for Medical Care has worked with 11 rural hospitals to improve influenza and pneumonia vaccination rates for all patients. To improve rates, collaborators have developed an admission assessment of the patient’s immunization status; an immunization order form; a standard discharge instruction sheet integrated into all hospital discharge forms; and a set of procedures regarding immunizations. For more info, Lee Millman, 404-982-0411.