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Hospitals Demonstrate Commitment to Quality Improvement October 2012. Quality improvement can be viewed as a five-step process. Chart 1: Five Steps to Improving Quality. Source: Analysis by Avalere Health and American Hospital Association. - PowerPoint PPT Presentation
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Research and analysis by Avalere Health
Hospitals Demonstrate Commitment to Quality Improvement
October 2012
Research and analysis by Avalere Health
Quality improvement can be viewed as a five-step process.
Chart 1: Five Steps to Improving Quality
Source: Analysis by Avalere Health and American Hospital Association.
Identify Target Areas for Improvement
Determine What Processes Can Be Modified to Improve
Outcomes
Develop and Execute Effective Strategies to
Improve Quality
Track Performance and Outcomes
Disseminate Results to Spur Broad Quality
Improvement
Research and analysis by Avalere Health
Health Resources
and ServicesAdministration
Health Researchand Educational
Trust
Agency forHealthcare
Research andQuality
Department of Veterans Affairs
Hospitals engage with government agencies and non-governmental bodies on quality improvement.
Centers forMedicare &
MedicaidServices
Department of Health
and Human Services
QualityImprovement
Initiatives
Centers for Disease
Control and Prevention
Source: Analysis by Avalere Health and American Hospital Association.
Chart 2: Sample of Hospital Quality Improvement Partners and Entities
Institute forHealthcare
Improvement
Disease Groups(e.g., American
Heart Association)
Premier/VHA/
Group Purchasing
Organizations
The JointCommission
NationalQualityForum
Private Payers
StatesPublic Health
Agencies
Professional Societies
Partnership for Patients
RegionalCollaboratives
Research and analysis by Avalere Health
National quality campaigns have improved hospital delivery of cardiac care.
Chart 3: Percentage of Patients Undergoing Percutaneous Coronary Interventions within 90 Minutes of Arrival at a Hospital, 2007 – 2011
Source: The Joint Commission. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2012.
2007 2008 2009 2010 2011
72%
82%87%
91% 94%
Per
cent
age
of P
atie
nts
Research and analysis by Avalere Health
Evidence-based protocols have improved quality in intensive care units (ICUs).
Chart 4: CLABSIs per 1,000 Central Line Days at Hospitals Participating in Michigan Hospital Association (MHA) Keystone: ICU, 2004 – 2009
Source: MHA Keystone Center for Patient Safety & Quality. 2010 Annual Report.
2004 2005 2006 2007 2008 2009
2.50
1.391.18 1.17
0.980.86
CLA
BS
Is p
er 1
,000
Cen
tral
Lin
e D
ays
Research and analysis by Avalere Health
Hospitals have progressed in combating hospital-acquired infections…
Source: U.S. Department of Health and Human Services. Health System Measurement Project. Central Line-Associated Bloodstream Infection Standardized Infection Ratio.Note: SIR is a ratio of the observed number of CLABSI as reported to CDC's National Healthcare Safety Network (NHSN) each year to the predicted occurrence based on the rates of infections among all facilities reporting to NHSN during the referent period (January 2006 through December 2008). SIR below 1.0 means hospitals reported fewer infections than predicted.
2006-2008 (base) 2009 20100.0
0.2
0.4
0.6
0.8
1.0
1.2
Sta
ndar
dize
d In
fect
ion
Rat
io
Chart 5: Central Line-associated Bloodstream Infection (CLABSI) Standardized Infection Ratio (SIR), 2006 – 2010
Research and analysis by Avalere Health
…and in adhering to accepted treatment protocols.
Source: U.S. Department of Health and Human Services. (2011). National Healthcare Quality Report. Washington, DC: Agency for Healthcare Research and Quality.
Chart 6: Adult Surgery Patients Who Received Appropriate Timing of Antibiotics, by Age, 2005 – 2009
2005 2006 2007 2008 200960%
65%
70%
75%
80%
85%
90%
95%
100%
Under 65
65-74
75-84
85 and Over
Per
cent
of P
atie
nts
Research and analysis by Avalere Health
Hospital efforts to curb infections have produced impressive results.
Chart 7: Percentage of On the CUSP: Stop BSI Intensive Care Units (ICUs) with Zero Percent Central Line-associated Bloodstream Infection (CLABSI) Rate
Source: Agency for Healthcare Research and Quality. CLABSI Update. http://www.ahrq.gov/qual/clabsiupdate/clabsiupdate.pdf.Note: To achieve a zero percent CLABSI rate, an ICU had to report no CLABSIs for each data point submitted during the period.
20%
30%
40%
50%
60%
70%
80%
Per
cent
of U
nits
(N
=66
0)
12 Months Before Intervention
1-3 Months Post Intervention
4-6 Months Post Intervention
7-9 Months Post Intervention
10-12 Months Post Intervention
Intervention
Research and analysis by Avalere Health
Collaboration to develop and implement multiple interventions across a system can yield quality gains.
Chart 8: Unadjusted Mortality Decline and Case-mix Index in Hospitals in the Ascension Health System, 2004 – 2010
Source: Pryor, D., et al. (April 2011). The Quality ‘Journey’ At Ascension Health: How We’ve Prevented At Least 1,500 Avoidable Deaths A Year—And Aim To Do Even Better. Health Affairs, 30(4): 604-611.
1.35
1.37
1.39
1.41
1.43
1.45
1.47
1.49
1
1.2
1.4
1.6
1.8
2
2.2
2.4
2004 2005 2006 2007 2008 2009 2010
Cas
e-m
ix I
ndex
Dea
ths
per
100
Dis
char
ges
Deaths per 100 Discharges Case-mix Index
Research and analysis by Avalere Health
Broad dissemination of quality improvement successes can improve outcomes across a hospital system.
Chart 9: System-wide Infection Counts at Legacy Health, 2008 and 2010
Source: Joyce, J., et al. (2011). Legacy Health's 'Big Aims' Initiative To Improve Patient Safety Reduced Rates Of Infection And Mortality Among Patients. Health Affairs, 30(4): 619-627.
0
10
20
30
40
50
60
70
80
90
Catheter-associated Urinary Tract Infection
Surgical-site Infection Total Infections
Dea
ths
per
100
Dis
char
ges
Baseline Performance (March 2008)
Performance at End of Study (March 2010)
Research and analysis by Avalere Health
More hospitals are adhering to accepted surgery care guidelines.
Chart 10: Rate of Adherence to Surgical Care Improvement Project (SCIP) Process Measures, Fiscal Years (FY) 2008 and 2009
Source: Centers for Medicare and Medicaid Services. Progress Toward Eliminating Healthcare-Associated Infections – September 23-24, 2010. http://www.hhs.gov/ash/initiatives/hai/actionplan/cms_scip.pdf.
80%
82%
84%
86%
88%
90%
92%
94%
96%
98%
100%
FY 2008
FY 2009
Rat
e of
Adh
eren
ce
Research and analysis by Avalere Health
Hospitals are advancing on evidence-based quality measures.
Chart 11: Percentage of Hospitals Achieving Composite Rates Greater Than 90 Percent for Accountability Measures, 2007 and 2011
Source: The Joint Commission. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2012.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Heart Attack Pneumonia Surgical Care Children's Asthma
2007
2011
Per
cent
age
of H
ospi
tals
Research and analysis by Avalere Health
Chart 12: Inpatient Deaths per 1,000 Adult Hospital Admissions with Heart Attack, by Age, 2000 – 2008
Hospitals’ quality initiatives are yielding better patient outcomes.
Source: U.S. Department of Health and Human Services. (2011). National Healthcare Quality Report. Washington, DC: Agency for Healthcare Research and Quality.
2000 2004 2005 2007 20080
20
40
60
80
100
120
140
160
De
ath
s p
er
1,0
00
Ad
mis
sio
ns
65 and over
Total
45-64
18-44
