Kentucky AHA/HRET Hospital Engagement Network

Kentucky AHA/HRET Hospital Engagement Network

Charisse Coulombe, MS, MBA, CPHQ; Senior Director, HENHospital Engagement Network

Health Research & Educational TrustAmerican Hospital Association

Hospital Leadership

Clinicians & 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

• 1,600 + hospitals

Hospital Engagement Network

Partnership for Patients

The 40/20 Goal

• Keep patients from getting injured or sickerReduce 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 requiringre-hospitalization within 30 days of discharge

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Where We’ve Been: November, 2012

StateADE

OutcomeCAUTI

OutcomeCLABSI

OutcomeFall

OutcomeHAPU

OutcomeEED

Process*

OB Outcome

**SSI

OutcomeVTE

OutcomeVAP

OutcomeReadmit Outcome # Hospitals***

Number of Hospitals

Submitting Data on 6 or More Topics

Data Submitted on

6 or More Topics (%)

Number of Hospitals

Submitting on all of their Applicable

TopicsAK 64% 100% 100% 82% 64% 17% 33% 83% 73% 83% 91% 11 10 91% 4AL 31% 86% 82% 45% 7% 70% 80% 79% 0% 74% 100% 29 15 52% 0AR 24% 83% 72% 78% 39% 58% 46% 88% 27% 68% 80% 41 28 68% 0AZ 35% 95% 90% 90% 35% 73% 67% 79% 25% 79% 95% 20 18 90% 1CA 7% 78% 92% 42% 32% 38% 8% 93% 7% 70% 39% 158 69 44% 4CO 78% 73% 100% 73% 100% 0% 100% 91% 84% 56% 69% 51 47 92% 13CT 100% 100% 100% 100% 100% 0% 16% 100% 0% 4% 100% 27 27 100% 0DC 0% 100% 100% 33% 0% 67% 33% 67% 33% 67% 100% 3 2 67% 0FL 93% 90% 92% 95% 95% 47% 49% 82% 92% 96% 88% 73 68 93% 36ID 50% 100% 100% 75% 38% 14% 43% 100% 38% 100% 100% 8 5 63% 1IL 100% 100% 100% 100% 100% 25% 100% 100% 100% 100% 100% 55 55 100% 55IN 27% 98% 98% 94% 72% 79% 69% 98% 66% 95% 88% 97 97 100% 18KS 1% 46% 63% 68% 26% 80% 49% 30% 14% 3% 55% 92 15 16% 3KY 19% 99% 97% 95% 91% 47% 50% 75% 35% 86% 64% 77 68 88% 1LA 78% 97% 96% 95% 89% 77% 60% 86% 68% 98% 89% 73 68 93% 37MA 10% 81% 57% 57% 33% 33% 28% 67% 19% 57% 76% 21 12 57% 0MO 99% 99% 100% 100% 99% 78% 100% 73% 99% 100% 98% 81 80 99% 59MS 42% 81% 86% 65% 42% 23% 31% 67% 38% 57% 92% 26 15 58% 3MT 50% 73% 86% 58% 81% 15% 62% 69% 65% 36% 96% 26 18 69% 10ND 67% 60% 67% 90% 60% 33% 0% 33% 57% 33% 70% 30 14 47% 13NE 100% 100% 100% 100% 100% 56% 26% 94% 97% 100% 100% 34 34 100% 11NH 5% 100% 100% 43% 38% 94% 19% 100% 100% 81% 100% 21 21 100% 0NM 15% 100% 100% 95% 10% 53% 40% 94% 10% 100% 100% 20 16 80% 1OK 14% 71% 90% 93% 40% 97% 10% 91% 24% 92% 81% 58 36 62% 6OR 90% 94% 100% 71% 61% 93% 86% 96% 13% 76% 100% 31 31 100% 2PR 12% 88% 92% 90% 44% 36% 64% 69% 8% 80% 60% 50 44 88% 0RI 100% 91% 100% 18% 0% 100% 9% 82% 0% 55% 64% 11 5 45% 0SD 85% 100% 100% 100% 100% 80% 100% 95% 88% 100% 100% 33 32 97% 23WI 10% 56% 40% 46% 28% 21% 41% 44% 29% 38% 70% 105 22 21% 2WV 34% 90% 89% 76% 55% 100% 100% 91% 14% 76% 97% 29 25 86% 1WY 0% 0% 100% 100% 100% 0% 100% 0% 81% 0% 0% 16 0 0% 0AHA/HRET HEN43% 83% 87% 77% 61% 51% 52% 79% 45% 73% 77% 1407 997 71% 304

% of Hospitals Submitting Outcomes Data by Topic TotalData Submission as of February 11, 2013

HEN Progress to DateEEDs/OB ADVERSE EVENTS•449 - Number of hospitals with hard stop policies •42% - Average percent reduction (from baseline to months 9 through 12) in elective births < 39 weeks admitted to NICU for 286 hospitals•38% - Average percent reduction (from baseline through month 12) in EED > =37 weeks and <39 weeks for 271 hospitals•$40.8 m - Estimated projected cost savings for avoided NICU admissions for 2012 CAUTIs•15 percent reduction in CAUTIs since 2011 for 290 hospitals•27 CAUTIs prevented each month•$325,000 estimated projected costs avoided by end of 2012

CLABSIs•28% percent reduction of CLABSIs for 302 hospitals •5 CLABSIs prevented each month•$4 m estimated projected costs for avoided CLABSIs by end of 2012

HEN Progress to DateADEs•32% - Average percent reduction (from baseline through month 12) in excessive anticoagulation in inpatients with warfarin treatment for 80 hospitals•$1.32 m Estimated projected cost savings for avoided ADEs in 2012

FALLS WITH OR WITHOUT INJURY•4% - Average percent reduction (from baseline through month 12) in falls with or without injury for 550 hospitals•$19.0 m Estimated projected cost savings for avoided falls in 2012

PRESSURE ULCERS•2% - Percent reduction (from baseline through month 12) in percent of patients with at least one Stage II or greater pressure ulcer for 152 hospitals•$1.7 m Estimated cost savings for avoided pressure ulcers in 2012 (annualized)

SSIs•<1.2% Average surgical site infection rate (within 30 days following procedure) for over 500 hospitals in months 1 through 12

HEN Progress to DateVTEs•11% Average percent reduction (from month 1 to month 12) in potentially preventable VTE rate for 88 hospitals•$11.7 m - Estimated projected cost savings for avoided VTEs in 2012 (annualized)

VAPs•<1.23 Average ventilator-associated pneumonia rate in the ICU (per 1,000 device days) for 390 hospitals in months 1 through 12

READMISSIONS•16% Average percent reduction (from baseline to month 12) in 30 Day All- Cause Readmission rate for 420 hospitals•24 - Average number of fewer readmissions per month, per hospital for 351 hospitals (from baseline to November 2012)•$80.9 m Estimated projected cost savings for avoided readmissions in November 2012

CMS Goals

• 40% reduction in all harm topics• 20% reduction in readmission• Have 60% or more hospitals (in HEN/state)

submitting data in all applicable topics and attaining reduction goals for potential renewal in 2014

CMS Commitments• At least 70 percent of AHA HEN birthing hospitals will implement hard-

stop policies or have an EED rate less than 3 percent by April 1st of 2013; 80% as of 5/31/13: AHA/HRET HEN currently at 63% as of 2/18/13; KY currently at 47% as of 2/18/13

• 100 percent of AHA HEN hospitals will be submitting data on at least six HACs by January 31st of 2013: AHA/HRET HEN currently at 71% as of 2/25/13; KY currently at 88% as of 2/25/13 (68/77)

• Make transparent the hospitals part of the HRET HEN on the HRET website: AHA/HRET HEN has posted the names of all of the HEN hospitals by state.

• Make transparent all hospitals working on 10 HACs on the HRET HEN website: AHA/HRET HEN has posted the names of all of the CMS HEN hospitals by HEN that are working on the 10 HACs (or all that are applicable). There are currently 292 hospitals that fit this criterion. Kentucky has 1 hospital: Fleming County Hospital

• Doubling the number of hospitals showing a 20 percent improvement in readmission; AHA/HRET currently at 124 hospitals as of 2/8/13;

Kentucky Summary TableTopic Most Popular

Outcome Measure

Avg # Hospitals Reporting

Total Eligible Hospitals

Percent Reporting

Baseline Q4 2012 or last 3 monitoring months

Percent Reduction

ADE Excessive Anticoagulation

9 77 12% 5% 8% N/A

CAUTI CAUTI Rate - ICU

40 77 52% 1.58 1.33 28%

CLABSI CLABSI Rate - ICU

40 68 59% 1.13 1.26 N/A

EED TJC EED 13 34 38%

OB *

Falls Falls with or without injury

29 77 38% 3.47 3.46 0.28%

Pressure Ulcer

Stage III or IV 46 77 60% 0.06 0.00 100%

* KY hospitals submitting 13 different OB measures

Kentucky Summary TableTopic Measure Avg #

Hospitals Reporting

Total Eligible Hospitals

Percent Reporting

Baseline Q4 2012 or last 3 monitoring months

Percent Reduction

Readmission 30 Day All Cause

22 77 28% 12.34% 10.07% 18.38%

SSI SSI Rate within 30 Days of Procedure

37 67 55% 1.83 2.69 N/A

VAP VAP Rate - ICU

21 66 32% 3.89 0.19 95%

VTE Post Op PE/DVT

18 77 23% 1.85 2.80 N/A

Kentucky’s Progress to DateADE

Kentucky’s Progress to DateCAUTI

0.00

0.50

1.00

1.50

2.00

2.50

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

Cath

eter-

Ass

ocia

ted

Uri

nary

Tra

ct In

fecti

ons

Rat

e in

ICU

(CD

C N

HSN

)ra

te p

er 1

,000

cat

hete

r da

ys

Catheter-Associated Urinary Tract Infections Rate (per 1000 Catheter Days)- ICU (CDC NHSN)- Kentucky

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12N 8 44 43 44 44 44 44 43 45 45 41 39 32

Rate 1.58 0.79 2.04 1.15 1.42 1.50 1.62 1.21 1.58 0.92 1.22 1.06 1.12

AHA/HRET HEN Progress to Date

CLABSI

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Central Line Associated Bloodstream Infection Rate- ICU(per 1000 Central Line Days)- AHA HRET HEN

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12N 617 644 641 648 646 646 650 665 665 671 563 547 494Rate 1.10 1.18 1.13 1.11 1.11 1.03 0.96 1.20 1.12 1.21 0.85 1.19 1.04

Kentucky’s Progress to DateCLABSI

0.00

0.50

1.00

1.50

2.00

2.50

CLAB

SI R

ate

per 1

000

Cent

ral L

ine

Days

Central Line Associated Bloodstream Infection Rate- ICU(per 1000 Central Line Days)- Kentucky

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12N 12 44 42 44 44 44 44 43 45 45 41 39 32Rate 1.13 2.04 1.12 2.00 1.46 1.43 0.95 1.42 1.51 1.76 1.13 1.85 0.66


Falls


Rate 3.19 3.15 2.96 3.03 2.97 2.97 3.03 3.00 3.05 3.17 2.93 3.08 2.97

Kentucky’s Progress to DateFalls


Rate 3.47 3.26 3.45 2.69 3.12 3.18 3.63 3.31 4.07 4.26 3.54 3.44 3.4


Early Elective Delivery

0.00%

4.00%

8.00%

12.00%

16.00%

20.00%

Baseline Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12

n=268 n=261 n=256 n=267 n=265 n=265 n=299 n=329 n=327 n=333 n=309 n=296 n=255

Perc

ent

of E

ED a

t =>

37 a

nd <

39 W

eeks

Percent of Early Elective Deliveries at Gestational Age Greater than/Equal to 37 and Less than 39 Weeks

Percent of EED at => 37 and <39 Weeks Rate Trend Line

Kentucky’s Progress to DateEarly Elective Deliveries


Rate 21.79% 13.57% 17.97% 15.63% 16.33% 15.57% 14.20% 14.41% 11.08% 8.30% 13.15% 11.78% 18.95%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

Perc

ent

of E

ED a

t =>

37 a

nd <

39 W

eeks

Percent of Early Elective Deliveries at Gestational Age Greater than/Equal to 37 and Less than 39 Weeks- Kentucky


Pressure Ulcers

Kentucky’s Progress to DatePressure Ulcers

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12N 46 46 47 46 46 47 46 46 47

Rate 0.06 0.13 0.00 0.21 0.12 0.00 0.00 0.14 0.00

AHA/HRET HEN Progress to DateReadmissions

Kentucky’s Progress to DateReadmissions


Rate 12.34% 10.17% 10.06% 12.09% 11.51% 11.09% 13.04% 10.66% 10.51% 12.07% 11.04% 10.66% 7.37%


SSI

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12Perc

ent o

f Sur

gica

l Pati

ents

with

an

Surg

ical

Site

In

fecti

on W

ithin

30

Day

s A

fter

Pro

cedu

re

Surgical Site Infection Rate (Within 30 Days After Procedure) (CDC NHSN)- AHA/HRET HEN

Kentucky’s Progress to DateSSI


Rate 1.83% 2.40% 3.08% 3.24% 2.57% 1.96% 2.19% 5.71% 2.79% 3.47% 3.18% 3.33% 1.49%


VAP

Kentucky’s Progress to DateVAP


Rate 3.89 3.22 3.68 4.62 1.79 3.63 2.87 0.91 1.54 3.41 2.59 1.78 1.12


VTE

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12N 75 53 53 55 53 53 91 89 90 97

Rate 4.74 11.9 10.72 12.21 11.52 11.12 9.65 10.29 10.49 11.38

Kentucky’s Progress to DateVTE

Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12N 3 16 16 16 16 16 16 17 17 17

Rate 1.85 1.46 2.52 3.18 1.61 3.62 1.44 1.95 4.26 2.09

Results to Date

• CMS understands that all of the hospitals are making rapid improvement in multiple areas

• The results at both the HEN and Kentucky levels are showing improvement and areas that need focus

• For areas of focus - Talk to your teams, see what other improvements can be tested and what will work for your hospital/culture to improve patient safety and quality of care– Participate on webinars, LISTSERVs, networking events

• For areas showing improvement – ensure that your processes are hard wired and the culture has shifted to allow for this improvement to be sustained long after the HEN project is completed

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Next Milestones for the HEN Project

• Continue to focus on improvement strategies to help hospitals reduce harm and prevent readmissions

• Work with hospitals to expand their improvement work across all (applicable) topics (2->5->All)

• Work with hospitals to continue to input data into the CDS and evaluate improvement to date– Confer rights via CDC NHSN

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Thank You!

• AHA/HRET HEN is proud of the accomplishments that have occurred to date and continue to look forward to accelerating the improvement across all topics!

• We are here to support KHA and you in any way possible– General Email: [email protected]– Data Specific Questions: [email protected]

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mailto:[email protected]

mailto:[email protected]

Kentucky AHA/HRET Hospital Engagement Network

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