PneumoniaAdvisoryGroupNorthCarolinaHospitalAssociation

Thursday,June8th,201710:30AM– 12PM

WelcomeMeetingObjectives:• LevelsetontheimportanceofcollaborationandpartnershiparoundcommunityacquiredpneumoniainNCtocollectivelyimpactreductioninpneumoniamortalityandreadmissionrates.

• ShareNCHABoardofTrusteesrecentlyapproved2-yearpneumoniaqualitygoalandthePneumoniaPnockoutCampaign.

• Seekalignmentofwork,assessmentofcurrentandpastimprovementworkaroundpneumonia.

• Gaincommitmentandlevelofengagementaroundpneumoniaimprovementwork.

Agenda:• Welcome,ReviewObjectives&MeetingAgenda• LevelSet&CurrentState:CommunityAcquiredPneumonia• PneumoniaProgramming&PneumoniaPnockoutCampaign• ModeratedDiscussion:

• Alignmentwithwork(assessmentofcurrent&pastimprovementefforts)• EngagementOpportunities

• WrapUpandNextSteps• Lunch12PM– 12:30PM

2017QualityGoalImproving30-dayPneumoniaMortalityandReadmissionRates

StatewideCrossContinuumInitiative

PrioritizingPneumonia

Sources:CMSdata,RAI,PDS+

Variationincomparablecosts

Greatest Opportunity

IdentifyingOpportunitiesforImprovement:Pneumonia

• Step1:ReviewCMSdataviaDatagenReports(NCHAprovidesDatagenreportstoeachhospital)

Step 2: Evaluate opportunity according to criteria for transformation: ü Aligned with CMS priorities? Publically reported?ü Among top 10 causes of death in NC? ü Identified variation in RAI performance statewide?ü NC performing worse than hospitals nationwide?ü Hospitals interested in improving in this area?

PneumoniaMortalitybyCounty

Number label indicates total cases by county in 2016. Color indicates performance compared to national benchmark on mortality – red is worse, green is better.

PoorperformanceonCMSPneumoniaMortalityandReadmissions

NumberofHospitalsPerformingWorsethantheNationalAverageonCMSPneumoniaMeasures

Benchmark HPHSReadmissions

NCReadmissions(NationalRank

28of50)

HPHSMortality

NCMortality(NationalRank

49of50)

ComparedtoNationalAverage 7 47 13 71ComparedtoNationalTopQuartile 13 70 16 92ComparedtoNationalTop10% 18 89 17 98ComparedtoNCaverage 7 42 8 44TotalHospitalsReporting 19 100 19 100

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0.2

0.4

0.6

0.8

1

ComparedtoNationalAverage

ComparedtoNationalTopQuartile

ComparedtoNationalTop10%

ComparedtoNCaverage

PercentofHospitalsPerformingWorsethanBenchmarks

HPHSReadmissions NCReadmissions(NationalRank28of50)

HPHSMortality NCMortality(NationalRank49of50)

Admitted through Emergency Department

PneumoniaPatientCharacteristicsHad Surgery

PDS+ data source, drill-down possible to patient encounter-level

PneumoniaMortalitybyAge,2015

TrackingChangeoverTimeforRAIHospitals

Between 2014-2016, • Fewer hospitals in middle

quartiles; • More in lowest quartile.• NC is currently 49 out of 50

states on pneumonia mortality.

• Range in pneumonia mortality has increased since 2012. Among RAI hospitals, lowest in 1% of hospitals; highest in top 95% of hospitals nationally.

• Variation indicates opportunity for improvement

DefiningandTargetingOpportunities

PneumoniaReadmission

andMortalityRate

QualityData

PatientActivation

CostofCare

CrossContinuumOpportunities

IMPACT• Adoptthe2017QualityGoalofreducingPneumonia(PNE)MortalityRateover2yearstobringNCtothenationalaverage;andreducingPNEReadmissionratetobringNCtothetop25th percentileofhospitalsnationally.

•1000NCLivesImpacted- ReducingPneumoniaMortalityby7.5%

• 950ReadmissionsPrevented• $8,835,000- Saved

MeasuringSuccess- Outcomes• EachHealthSystem/IndependentHospitalwillreceivequarterly/semi- annually

• CMSClaimsData- (6-9monthLag)• CurrentMortalityRateandPNEReadmissionRatesE/ORatios• CommunityPrevalenceRate• SocialDeterminantImpact• CostVariationandROI

• RAIParticipants(24hospitals)• DRGlevelcostvariation

• ADTParticipants• PNELOS• PointofOrigin• Disposition• 30- daymigrationtables

“ItAlwaysSeemsImpossibleUntilItisDone”NelsonMandela

PerformanceImprovementStrategy• PneumoniaAdvisoryGroup&Workgroups

• StatewideCollaborationandPartnerships• GuideStatewideStrategyaroundreducingpneumoniamortalityandreadmissionrates• Developprogrammingandcontentforpneumoniawork

• PneumoniaPnockoutCampaign• PledgefromallNChospitalsandhealthcaresystems• Identifyonetotwoopportunitiestoimprovebasedontheirinternalperformanceontheidentifiedmeasures• Communitypartnersandpost-acutecareproviderswillbeinvitedtoparticipate• ConveneLocalandNationalExpertsforLearning• PeertoPeerSharing• CrossContinuumForum• Coalitionfocusedwithcommunitypartners

• FocusedCollaborative• CoachingandFacilitation• FocusedGoalsandmeasurement

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ockout neumonaP Pneumonia Pnockout CampaignInMarch2017,theNCHABoardofTrusteesapprovedatwo-yearQualityGoaltoreducepneumonia(PNE)mortalityandreadmissionratestoputNorthCarolinaatandbelowthenationalaverage.Specifically,thegoalisto:

•Reduce thePNEmortalityrateby7.5%tothenationalaverageover2years•Reduce PNEreadmissionsby5.4%over2yearstotargettop25%quartile

TheBoard’sapprovalofthisgoalsignifiesanorganizationalcommitmenttoguidethisworkandacalltoNCHA’s130memberhospitalsandhealthsystemsstatewidetoactivelyparticipate.

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ockout neumonaPPneumoniaPnockoutCampaign

CAMPAIGNPARTICIPATIONParticipatinghospitalsandhealthsystemswillbeaskedtoidentifyonetotwoopportunitiestoimprovebasedontheirinternalperformanceontheidentifiedmeasures.Communitypartnersandpost-acutecareproviderswillbeinvitedtoparticipatewithhospitalsandhealthsystems.

Eachorganizationwillcommittoleaditsimprovementefforts.

NCHAQualityCenterstaff,withguidancefromanAdvisoryCouncil,willprovideparticipatingteamswithtechnicalsupport,educationandbestpracticelearning/sharing.NCHAwillprovidedatatomemberorganizationstosupportthisworkandwillcoordinateapubliceducationcampaign,includingmediaandcollateralmaterials.

PNEUMONIAFACTS

• NorthCarolinaisranked49of50states foritspneumoniamortalityrate,with73%ofhospitalsbelowtheCMSnationalbenchmark.

• MorethanhalfofallN.C.hospitalsareabovethenationalbenchmarkfor30-daypneumoniareadmissionrates.

• Pneumoniaismostoftenacquiredinthecommunity,outsideofthehospitalsetting.

• CDCrecommendspneumococcalvaccinationforalladults65yearsorolder.Accordingto2015datafromtheBehavioralRiskFactorSurveillanceSystem,73.6%ofNorthCaroliniansover65yearsoldreportthattheyhavebeenvaccinated,slightlyabovetheU.S.average.

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ockout neumonaPPneumoniaPnockoutCampaign

Opportunities• ParticipateasanNCHAmemberorganizationorpartnerintheQuality

Goal.• Provideeducation,informationaspartofthelearningcollaborative.• Supportpubliceducation/outreacheffortsoutsidethehospitalsetting.• Committofunding/underwritingtowardthecampaign.

TIMELINE

May/June: NCHAQualityCenterstaffintroducesgoaltomemberhospitalsandhealthsystemsandprospectivepartnerorganizations

July: KickoffatNCHASummerMembershipMeeting(July19-21)Aug-Sept: EnrollmentcontinuesOct: LearningandActionNetwork/PubliccampaignbeginsNov: WorldPneumoniaDayisNovember12

ModeratedGroupDiscussion:Alignmentwithwork,assessmentofcurrent&pastimprovementefforts

• Stateyournameandorganization;• Sharethoughtsonyourorganization'salignmentwiththiswork,whatareyourneeds/goalsaroundthiswork?

• Howcanwepartnerandcollaboratetogetherforcollectiveimpact?

EngagementOpportunities

PneumoniaPrograms

PublicCampaign

PostAcuteCare Hospital Endorseand

Sponsor

AdvisoryGroup

WrapUp&NextSteps

• ThankYou

• AdvisoryGroupPledge• WorkgroupSelection

• NextAdvisoryGroupMeeting• July11th,10:30AM– 12PM,12PM– 12:30PMLunch