hiin project background, scope and goals · hiin project background, scope and goals 1. 2...
TRANSCRIPT
November 9, 2016
Charisse Coulombe, MS, MBA, CPHQ
Vice President, Clinical Quality | HRET
HIIN PROJECT BACKGROUND, SCOPE AND GOALS
1
2
• Overview of HIIN
–HEN 1.0 and HEN 2.0
–HIIN – where we are going
• Assistance you get as a HIIN hospital
– Education
– Site visits and technical assistance
– Fellowship
–CDS reports
AGENDA
3
Hospital type:
• General medical/surgical?
• Teaching?
• Rural/CAH?
HOW MANY OF YOU ARE JOINING US FROM…
4
Hospital size:
• CAH?
• Not CAH, <100 beds?
• Not CAH, 100-299 beds?
• Not CAH, 300+ beds?
HOW MANY OF YOU ARE JOINING US FROM…
5
WHAT BEST DESCRIBES YOUR EXPOSURE TO HIIN/QI WORK?
A. We are familiar with HEN and HEN 2.0 and are a high reliability organization.
B. We are familiar with HEN and HEN 2.0 and are looking to take our hospital to the next level and free education, free resources and free assistance sounded like a good idea.
C. We are not familiar with HEN and HEN 2.0 and would like to learn more.
D. We are here because someone told us we needed to attend.
6
PARTNERSHIP FOR PATIENTS
The 40/20 goal set December 2011:
Keep patients from getting injured or sicker.• Reduce preventable hospital-acquired conditions by 40 percent.
–1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years.
Help patients heal without complication.• Reduce all hospital readmissions by 20 percent.
–1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.
Hospital leadership
Clinicians and front line staff (teams)
THE PATIENT
• ACA considerable focus on quality• Created the CMS Innovation Center
• Public-private partnership• Set 40/20 goal
• Tool: Hospital Engagement Networks
• 26 contracts awarded
• Contracted with 31 state and regional hospital associations
• 1,400 + hospitals
HOSPITAL ENGAGEMENT NETWORK
8
Substantial progress thru 2014, compared to 2010 Baseline:
• 17 percent reduction in overall harm; 39 percent reduction in preventable harm.
• 87,000 lives saved.
• $19.8B in cost savings from harm avoided.
• 2.1M fewer harms over four years.
NATIONAL RESULTS ON PATIENT SAFETY
Source: Agency for Healthcare Research & Quality. “Saving Lives and Saving Money: Hospital-Acquired Conditions Update. Interim Data From National Efforts To Make Care Safer, 2010-2014.” December 1, 2015.
9
AHA/HRET ORIGINAL HEN RESULTS
Hospital leadership
Clinicians and front line staff (teams)
THE PATIENT
• ACA considerable focus on quality• Created the CMS Innovation Center
• Public-private partnership• Set 40/20 goal
• Tool: Hospital Engagement Networks
• 17 contracts awarded
• Contracted with 34 state and regional hospital associations
• 1,500 + hospitals
HOSPITAL ENGAGEMENT NETWORK 2.0
11
AHA/HRET HEN 2.0 RESULTS
12
HEN 2.0 HOSPITAL CHARACTERISTICS
13
• Achieved reduction in four topics – CAUTI, CLABSI, EED and SSI
• Going the opposite direction in four topics –ADE, falls, readmissions and VAE
• Not enough hospitals reporting data in three topics– Ob harm, PrU and VTE
KENTUCKY SPECIFIC HEN 2.0 RESULTS
Hospital leadership
Clinicians and front line staff (teams)
THE PATIENT
• Public-private partnership• Set 20/12 goal all cause harm
• Tool: HIIN• 16 contracts awarded
• Contracted with 32 state and regional hospital associations
• 1,700 + hospitals
• Center for Clinical Standards and Quality
• HIIN funded out of the Medicare Trust Fund
HOSPITAL IMPROVEMENT INNOVATION NETWORK
15
• Improvement collaborative
• Best-practice incubator
• Community of peers
• Spread and sustainability
• Learning cohort
• Quality improvement (QI)
• Clinical content
• Similar to the original HEN project (2011-2014) and HEN 2.0 (2015-2016), regarding focus and bold aims.
• Different regarding topic adjustments, standardized measures and accelerated timeframes.
HIINS: WHAT ARE THEY?
HOSPITAL IMPROVEMENT INNOVATION NETWORK
16
HIIN: WHERE WE ARE GOING
• 20 percent Overall reduction in hospital-acquired conditions (baseline 2014)
• 12 percent Reduction in 30-day readmissions (baseline 2014)
“America’s hospitals embrace the ambitious new goals CMS has proposed,” said Rick Pollack, president and CEO of the American Hospital Association (AHA). “The vast majority of the nation’s 5,000 hospitals were involved in the successful pursuit of the initial Partnership for Patients aims. Our goal is to get to zero incidents. AHA and our members intend to keep an unrelenting focus on providing better, safer care to our patients -- working in close partnership with the federal government and with each other.”
Goals:
partnershipforpatients.cms.gov
17
Two base years to reduce all-cause inpatient harm by 20 percent and readmissions by 12 percent.
1. Be in action to support your patients and their families by committing to this project.
2. Work to reduce harm across the board.
3. Learn together by sharing your hospital stories – successes and opportunities.
4. Data is the foundation of all improvement at the unit level, hospital level, state and national level.
5. Accelerate, align and amplify the work of the previous HEN projects.
BOLD AIMS FOR HIIN
18
1. Alabama
2. Arizona
3. Arkansas
4. Colorado
5. Connecticut
6. Dallas Fort-Worth
7. Delaware
8. Florida
9. Georgia
10.Idaho
11.Indiana
12.Kansas
13.Kentucky
14.Louisiana
15.Maine
16.Maryland
17.Massachusetts
18.Mississippi
19.Missouri
20.Montana
21.Nebraska
22.New Hampshire
23.New Mexico
24.North Dakota
25.Oklahoma
26.Rhode Island
27.Tennessee
28.Texas
29.Virginia
30.West Virginia
31.Wyoming
HRET HIIN STATE PARTNERS
19
THE HRET HIIN STRUCTURE
Patients
and families
Hospital teams (YOU!)
State hospital association (Kentucky Hospital Association) and Quality
Improvement Networks (QIN-QIO) teams
HRET HIIN team
20
CORE TOPICS – AIM IS 20 PERCENT REDUCTION
1. Adverse drug events (ADE)
2. Catheter-associated urinary tract infections (CAUTI)
3. C. difficile infections (C. diff)
4. Central line-associated blood stream infections (CLABSI)
5. Injuries from falls and immobility
6. Pressure ulcers (PrU)
7. Sepsis
8. Surgical site infections (SSI)
9. Venous thromboembolisms (VTE)
10. Ventilator-associated events (VAE)
11. Readmissions (12 percent reduction)
Note: patient and family engagement (PFE) and health care disparities (HCD) woven throughout all topics.
21
ALL OTHER FORMS OF HARM
1. Multi-drug resistant organisms (e.g. MRSA)*
2. Hospital patient safety culture*
3. Diagnostic error**
4. Airway safety**
5. Iatrogenic delirium**
6. Undue exposure to radiation**
7. Malnutrition in the inpatient setting**
*HRET will have a strong focus on MRSA and hospital patient safety culture throughout the project.
**HRET HIIN will provide support on the topics and encourages you to work on them, but Kentucky is not requiring these.
22
• Customized by hospitals’ needs:
– High-level and targeted.
– Didactic and interactive.
– Full-hour and condensed virtual events.
– Highly technical and practical implementation vs theory.
• Cross-cutting:
– UP
– PFE
– Disparities
• Topics will be prioritized based on our direction from CMS, you and your
project data (including a needs assessment).
• Data webinars
– Will cover how you can use project data and analytics to inform quality
improvement.
EDUCATIONAL OPPORTUNITIES
23
Readmissions - Hospital Bright Spots
Thursday, November 10 | 11:00 a.m. - 12:00 p.m. CT
Join us to learn about what’s new in the HIIN readmission reduction plan and get some specific tips that your team can use right away to jumpstart your efforts. Hear from “bright spot” hospitals about the biggest opportunities we face including; engaging patients and families, developing a learning loop and their highest leverage strategies. Many approaches can be taken to reduce readmissions, but the key is selecting interventions that address the needs your patients have.
Download the full agenda here.
Register here.
JOIN OUR UPCOMING VIRTUAL EVENTS!
http://www.hret-hiin.org/events/events.shtml
24
ADE – What if.. We Reduced Harm from ADE?
Thursday, November 17 | 11:00a.m. – 11:50a.m. CT
What would your community look like if there were less harm from excessive anticoagulation, hypoglycemia and opioids? How many patients, families and friends would we not hurt? In HEN 2.0 we made progress in reducing harm from warfarin and opioids, but fell short of our targets and know that there is additional harm waiting to be prevented.
After more than four years of concentrated and collaborative effort, we need to hear from you as to what we can do to help move the dial down. We ask for your insights as we discuss the easy and hard ways to identify and submit data. We will facilitate your sharing of successes and challenges and include insights from HRET HEN 2.0 ADE fellows.
After a brief discussion of the key strategies for reducing hypoglycemia, this event will conclude with polling questions. Your responses will help guide the development of future virtual events. We look forward to participation. In fact, we NEED it.
Download the full agenda here.
Register here.
JOIN OUR UPCOMING VIRTUAL EVENTS!
http://www.hret-hiin.org/events/events.shtml
25
LISTSERV® COLLABORATION
• Subscriber-based email group.
• Each email group covers a different topic or group of topics.
• Ideal for:
• Peer-shared learning.
• Asking questions about barriers.
• Sharing data collection opportunities.
• Clarifications about measures or inclusion/exclusion criteria.
27
RIGHT NOW, HEN 2.0 WEBSITE IS A GREAT REFERENCE
Resources:• Click on
resources• Sort by topic
www.hret-hen.org
28
• Foundational HIIN Action Leader Fellowship
– For new HIIN participants or those new to quality improvement.
• Advanced HIIN Action Leader Fellowship
– For QI-trained HIIN participants or those who have been focused on quality improvement and patient safety for more than five years.
• PFE Fellowship
– For hospital staff and patient/family advisors seeking to support PFE at their institution and guide patient and family advisors on how to support QI and patient safety efforts.
Details for each include:
• Integrated learning across topics, QI and PFE fellowships.
• Deliverables throughout the fellowship to drive pace.
• Focus on peer-to-peer learning.
• Projects will highlight individual hospital progress toward HIIN project goals.
• Supported by virtual and on-site collaboration.
QI AND PATIENT AND FAMILY ENGAGEMENT (PFE) FELLOWSHIPS
29
• Alarm fatigue
• Patient satisfaction
• Closing the referral loop
• Catheter reduction
• Rounding
• Adverse drug events
• Falls
EXAMPLES OF QI FELLOWSHIP PROJECTS FROM HEN 2.0
30
• Kentucky Hospital Association will contact you to set up a mutually agreeable date and time for them to visit and review the project, data and your organization’s goals.
• During site visits:
–You will complete an action plan with your state partner.
• What to expect:
–Focused attention, support and guidance.
–Site visits are meant to set you up for success in HIIN.
SITE VISITS
31
21 KY hospitals have taken the #123forEquity pledge
HEALTH CARE DISPARITIES
http://www.equityofcare.org/pledge/index.shtml
32
• Simple, straightforward and explainable!
• Capitalize on existing data where possible.
• Use standardized measures.
• Be responsive to unique needs.
• We have done this for 4+ years - the team has the experience and understanding to help support your hospital in gathering data.
MEASUREMENT PHILOSOPHY
33
Reports available in the Comprehensive Data System (CDS)
CDS
34
Additional reports in CDS:
• All measures
• Custom data
• Current improvement
• Relative improvement
• Ad-hoc reports
CDS interpretation guide is available here.
CDS
35
WRAP UP
Thank you for joining us on this journey to improve care!
We ask that you:
• Strive for continuous improvement.
• Learn from and collaborate with your peers to achieve the goals.
• Embrace change.
–Change is hard at first, messy in the middle and beautiful at the end.
QUESTIONS?
Thank you – we look forward to supporting you on your HIIN journey