IHI 5 Million Lives Campaign Hospital Intervention Status Survey

1
IHI 5 Million Lives CampaignHospital
Intervention Status Survey
Protecting 5 Million Lives From Harm Patient
Safety Symposium
Preliminary Findings From a HAP Member
Survey March 6, 2007
2
Pennsylvania IHI Node PartnersEarly Spring 2005

• Hospital Healthsystem Association of PA (HAP)
• Quality Insights of Pennsylvania (QIP)
• The Pennsylvania Patient Safety Authority
• VHA Pennsylvania
• VHA East Coast
• Health Care Improvement Foundation (HCIF) of the
  Delaware Valley Health Council (DVHC) of HAP
• Hospital Council of Western Pennsylvania (HCWP)

3

• IHI Campaign Kickoff June 2005
• VHA Pennsylvania
• VHA East Coast
• Rapid Response Team Presentation
• Best Practices and Educational Program

4
Pennsylvania IHI Hospital, Legislative Media
Education ForumSeptember 2005

• Pennsylvania Node Partners
• Selected IHI Participating Hospitals
• IHI National Campaign Team
• Hosted a panel discussion for hospital staff,
  state legislators, legislative staff, and state
  agencies.
• Provided an understanding of the 100K Lives
  Campaign, the Campaign interventions, and efforts
  taking place within participating hospitals.

5
IHI National Bus Tour Stops at

• Abington Hospital
• Childrens Hospital of Philadelphia

6
Accomplishments

• Using existing expertise and established
  programs, each of the Pennsylvania Node Partners,
  contributed to one of several programs around
  each of the six interventions through 2005, and
  into the spring of 2006.

7

• VHA VHA East Coast
• Rapid Response Teams
• Preventing Adverse Drug Events / Medication
  Reconciliation
• HAP, HCIF and HCWP
• Prevention of Central Line Associated Blood
  Stream Infections
• Prevention of Ventilator Associated Pneumonias
•    
• QIP
• Evidenced Based Care for Acute Myocardial
  Infarction
• Prevention of Surgical Site Infections

8
Pennsylvania IHI Node Partner Campaign
UpdateJanuary 2006

• State bulletin highlighting hospital success
  stories around the Campaign interventions.
• http//www.haponline.org/quality/safety/100k/

9

• Statewide Honor Roll of fully committed
  Pennsylvania hospitals, Mentor Hospitals, and
  hospitals that served as faculty for IHI
  sponsored programs.

10
Pennsylvanias IHI MilestoneCelebration State
CapitolJune 14, 2006
Presentation of Pennsylvania hospital success
stories to legislative staff in

• House Health Human Services Committee
• Senate Public Health Welfare Committee

11
Other Opportunities for Collaborationfrom PA
Node Partnership

• HAP Patient Safety Symposium
• over 400 participants
• each partner organization was represented and
  actively involved in the event
• Partnership for Patient Care Program
• HCIF, Independence Blue Cross, and ECRI
• Failure mode effects analysis on infection topics
  

12
PA Hospital Participation in IHI Campaign
128 Pennsylvania Hospitals
110 Pennsylvania Hospitals

• Source HAP Member Surveys, Summer 2005 and March
  2007

13
Which of the existing IHI 100K Lives measures are
quality/patient safety priorities at your
hospital?
of responding hospitals

• Source HAP Member Surveys, Summer 2005 and March
  2007 (CEO Opinion)

14
Which of the new IHI 5 Million Lives measures are
quality/patient safety priorities at your
hospital?
of responding hospitals

• Source HAP Member Surveys, Summer 2005 and March
  2007 (CEO Opinion)

15
Perspectives onPatient Safety Quality
Priorities
Differences
Source HAP Member Surveys, March 2007
16
Priority Ranking of IHI Measures
High Priority
Low Priority
No Activity

• Source HAP Member Survey, March 2007
• (Quality Directors Opinions)

17
Implementation Status Then NowRapid Response
Teams
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

18
Implementation Status Then NowEvidence-Based
AMI Care
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

19
Pennsylvania Patients Receiving Appropriate Care

• Limited to providers submitting to the QIO Data
  Warehouse.
• Source QIO Clinical Data Warehouse, PPS
  Providers Only, discharge dates 1-1-06 through
  6-30-06

20
Percent of AMI Patients Who Received Recommended
Hospital Care
Ranked 23rd nationwide
Ranked 31st nationwide
Recommended hospital care for AMI includes
administrations of aspirin and beta-blocker
within 24 hours of hospital arrival and at
discharge, receiving prescription of angiotensin
converting enzyme (ACE) inhibitor or an ARB at
discharge for patients with left ventricular
systolic dysfunction (LVSD), and giving smoking
cessation counseling for smoking patients.
Source CMS Hospital Compare
21
AMI Care in Pennsylvania Hospitals
Source AHRQ National Healthcare Quality Report,
2006
22
AMI Care in Pennsylvania Hospitals
Not applicable
Source AHRQ National Healthcare Quality Report,
2006
23
AMI Care In Pennsylvania(ACM AMI Measures)

• Limited to providers submitting to the QIO Data
  Warehouse.
• Source QIO Clinical Data Warehouse, PPS
  Providers Only, discharge dates 1-1-06 through
  6-30-06

24
Implementation Status Then NowPreventing
Surgical Site Infections
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

25
Percent of Adult Surgery Patients Who Received
Appropriate Timing of Antibiotics
Ranked 40th nationwide
Appropriate timing of antibiotics includes
receiving preventative antibiotic(s) 1 hour
before incision, and discontinuing the
antibiotics within 24 hours after surgery end
time.
Source CMS Hospital Compare
26
SCIP Care In Pennsylvania(ACM SCIP Measures)

• Limited to providers submitting to the QIO Data
  Warehouse.
• Source QIO Clinical Data Warehouse, PPS
  Providers Only, discharge dates 1-1-06 through
  6-30-06

27
Implementation of New MeasuresImproving Care for
Patients with Congestive Heart Failure
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

28
Percent of Heart Failure Patients Who Received
Recommended Hospital Care
Ranked 20th nationwide
Ranked 30th nationwide
Recommended hospital care for heart failure
receiving evaluation of left ventricular ejection
fraction, and prescription of angiotensin
converting enzyme (ACE) inhibitor at discharge
for patients with left ventricular systolic
dysfunction (LVSD).
Source CMS Hospital Compare
29
Heart Failure Care in Pennsylvania Hospitals
Source AHRQ National Healthcare Quality Report,
2006
30
HTF Care In Pennsylvania(ACM HTF Measures)

• Limited to providers submitting to the QIO Data
  Warehouse.
• Source QIO Clinical Data Warehouse, PPS
  Providers Only, discharge dates 1-1-06 through
  6-30-06

31
Implementation of New MeasuresReducing MRSA
Infections
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

32
Implementation Status Then NowPreventing
Ventilator-Associated Pneumonia
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

33
Implementation Status Then NowPreventing
Central Line Infections
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

34
Implementation Status Then NowPreventing
Adverse Drug Events
of responding hospitals
Implementation

• Source HAP Member Surveys, Summer 2005 and March
  2007

35
Implementation of New MeasuresPreventing
Pressure Ulcers
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

36
Implementation of New MeasuresPreventing Patient
Harm From High Alert Medications
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

37
Implementation of New MeasuresReducing Surgical
Complications
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

38
Implementation of New MeasuresGovernance
Leadership on Quality Patient Safety
of responding hospitals
Implementation

• Source HAP Member Survey, March 2007

39
Level of Technical Assistance Needed with Measures
High Level
Low Level
None Needed

• Source HAP Member Survey, March 2007

40
Areas Needing High Level of Technical
Assistance(based on of respondents)

• Preventing Adverse Drug Events 59
• ADEs _at_ Admission 40 need high level of
  assistance
• ADEs during Hospital Stay 42
• ADEs _at_ Discharge 46
• ADEs Operative 35
• Reducing Surgical Complications 35
• VTE prophylaxis 43 need high level of
  assistance
• Beta blockers 31
• Ventilator-associated
• pneumonia 26
• Reducing Surgical Site Infections 33
• Antibiotics _at_ admission 13 need high level of
  assistance
• Antibiotics discontinued 28
• Hair removal 10
• Normothermia 17
• Glucose control 28

Source HAP Member Survey, March 2007
41
Able to Sustain Improvements in IHI Measures?
Yes, not difficult
Yes, with some difficultly
Yes, but extremely difficult
No

• Source HAP Member Survey, March 2007

42
Whats Next?

• Seek to reach 100 percent participation among
  Pennsylvania hospitals.
• Focus on the challenging measures within the
  clinical measures sets associated with Medicare
  pay-for-performance heart failure, surgical
  infections, surgical complications, heart attack.
• Bring on new partner, the American Hospital
  Association and capitalize on their expertise.

43
Whats Next?

• Determine whether other partners are needed.
• Review information from survey among Pennsylvania
  Node partners to develop work plan for
  interventions.
• Seek expertise among all Pennsylvania hospitals
  on the interventions faculty, newsletter.
• Hear from all of you about whether this data
  accurately reflects your needs.