The Obama administration's campaign to reduce hospital-acquired conditions by 40% and slash readmissions by 20% by 2013 seemed at first to be a publicity ploy lacking detail.
"Look here at all the harm being done; it's urgent that we tackle this problem head on," it seems to say. But that's okay.
The Partnership for Patients initiative announcement last week came right on the heels of CMS' frightening hospital-acquired conditions disclosure. The voluminous spreadsheet revealed exactly how many of each type of eight hospital-acquired conditions had occurred at each of the nation's 3,361 hospitals. Perhaps the timing of the two events was deliberate.
But the U.S. Department of Health and Human Services hasn't yet explained much about how it intends to track success rates for these badly needed improvements. For example, it hasn't
- Provided a roadmap or instruction sheet to achieve the goals
- Explained how it intends to track success rates for these improvements
- Determined whether improvements should take place in the processes or actual outcomes and what metrics will be used
- Provided clarity on who would review the data.
"I've been told the details will come," says David Classen, MD, author of the report in Health Affairs earlier this month that revealed hospitals are injuring as many as one in three patients receiving acute care because of avoidable errors.
His study pointed out that the safety metric traditionally used by half the hospitals in the country, the Agency for Healthcare Research and Quality's Patient Safety Indicators, or PSI, missed nine in 10, which were caught by the Institute for Healthcare Improvement's Global Trigger Tool.
"This is all going to come to head, they're going to have to decide how they measure patient safety," he says.
I think that's a great idea. It's about time.
The administration promises to spend $1 billion allocated from health reform legislation on the effort, specifically to help coalitions of providers, state agencies, employers, insurance companies and others who have proven strategies for success show others how to achieve these goals. And as of Wednesday night, nearly 1000 hospitals, medical groups, and clinicians had signed a pledge to participate, as well as 256 patient advocacy groups or health plans, consumer groups and employers.
Some hospital officials are hopeful, but skeptical.
Jim Lott, executive vice president of the Hospital Association of Southern California, which represents 180 hospitals and 40% of the acute care beds in the state, says he doesn't fully understand the program or what it seeks to accomplish. He thinks perhaps the White House is feeling pressure to get something off the ground.
"I've got to believe some of this is prompted by the political activity regarding the Affordable Care Act, and the fact House Republicans want to defund all these initiatives, particularly those that give the Secretary this kind of discretion," he says. "The sooner the administration gets these types of preventive initiatives in place, the better argument they can make for their funding."
Lott says that he wishes the administration didn't feel so much pressure. "They need to slow down and find out what is the best use of that money," he said. California, he notes, already has just that kind of program already in place.
Joe McCannon, senior advisor to CMS administrator Don Berwick, MD, and the advocate who ran the Institute for Healthcare Improvement's "Protecting 5 Million Lives from Harm" campaign, explains the program this way:
Take ventilator-associated pneumonia, a hospital-acquired infection that the Partnership's research team estimates is 50% preventable, he says. The Partnership wants hospitals to reduce those cases by that amount by 2013, or about 17,500 cases.
McCannon says hospital teams learn from strategies shown to work elsewhere, such as elevating the head of a patient's bed to reduce the risk of aspiration, adjusting sedation to allow patients to follow commands, and better weaning strategies to reduce the time the patient is on the ventilator, he says.
Don't hospitals already do those things, and in spite of it VAP still occurs at alarmingly high rates? I ask.
"Look at the data from around the country," McCannon replied. "It will show you there's still enormous variation in practice; some places are able to reliably provide care that reduces the incidence of adverse events, but there are other places where that just isn't the case."
"We know that where organizations reliably introduce these best practices, they get good results. So what we're seeking to do is help them introduce these evidence-based practices and study what has worked in other places," said McCannon.
Progress will be systematically checked, McCannon says. "We'll track changes in all-cause and specific forms of harm by conducting retrospective chart audits of records from a random selection of facilities to study change in harm over time," with various interventions and through databases such as the National Healthcare Safety Network, that are already kept by either CMS or the Centers for Disease Control and Prevention.
Hospitals will be the first targets for these efforts with the aim to reduce these categories of harm:
1. Adverse drug events
2. Catheter-associated urinary tract infections
3. Central line-associated bloodstream infections
4. Injuries from falls and immobility
5. Obstetrical adverse events
6. Pressure ulcers
7. Surgical site infections
8. Ventilator-associated pneumonia
9. Venous thromboembolism
10. Nearly two dozen other hospital-acquired conditions.
The results will not be risk-adjusted because no hospital will be publicly singled out, he says. The money will be awarded to organizations that make a good case that others can learn from their strategies.
$500 million of the Partnership funds will be spent to prevent complications in patients discharged from the hospital, which would mean "more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge," according to the campaign's website.
There won't be financial incentives for actually participating, but those will come in other regulations stemming from the ACA, such as the Value-Based Purchasing program, which penalize hospitals with higher than expected rates of certain types of preventable harm.
"Our hope is that that state consortia and large systems and associations will be eligible for these funds, which will help support local learning and improvement activity," McCannon says.
If successful, the two strategies to prevent hospital-acquired conditions and readmissions could save up to $35 billion dollars including up to $10 billion in Medicare savings, over the next three years—considerably more than the $1 billion spent to make it work.
I welcome the effort. If nothing more, it will help raise awareness throughout the healthcare system that patient harm remains a growing crisis that can, and must be, reversed.