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Virginia Hospital & Healthcare Association

North Carolina-Virginia Hospital Engagement Network

2013 NoCVA HEN Final Report

Overview of the Partnership for Patients

In April 2011 the federal government, in order to help improve the quality, safety, and affordability of health care for all Americans, launched the Partnership for Patients. The Partnership for Patients, under the direction of the U.S. Center for Medicare & Medicaid Innovation, brings together leaders of major hospitals, employers, physicians, nurses and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable and less costly.

The two goals of the Partnership are to, by the end of 2013:

  • Decrease preventable hospital-acquired conditions by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.

  • Decrease all hospital readmissions by 20% compared to 2010. Achieving this goal 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.

Achieving these goals has the potential to save up to $35 billion across the health care system, including up to $10 billion in Medicare savings, over the next three years. Over the next 10 years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.

As part of the Partnership for Patients, $218 million was awarded to 26 state, regional, national or hospital system organizations to be Hospital Engagement Networks (HENs). These organizations will help identify solutions already working to reduce healthcare-acquired conditions, and work to spread them to other hospitals and health care providers.

HENs will develop learning collaboratives for hospitals and provide a wide array of initiatives and activities to improve patient safety. They will be required to conduct intensive training programs to teach and support hospitals in making patient care safer, provide technical assistance to hospitals so that they can achieve quality measurement goals and establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.

Although the Partnership for Patients focuses on reducing all harm, CMS has identified 10 initial areas of focus for the HENs:

  • Adverse drug events

  • Catheter-associated urinary tract infections

  • Central line-associated bloodstream infections

  • Injuries from falls and immobility

  • Obstetrical adverse events

  • Pressure ulcers

  • Surgical site infections

  • Venous thromboembolism

  • Ventilator-associated pneumonia

  • Preventable readmissions

Overview of the NoCVA HEN

The NoCVA HEN will be led as a joint effort between VHHA and the North Carolina Hospital Association (NCHA). VHHA is thrilled to have NCHA as our partner in this venture. Many of you have joined VHHA in the past to work on statewide VHHA-led quality improvement initiatives. The quality improvement capacity for our HEN is greatly enhanced by our partnership with NCHA, as NCHA has had many years of experience in successfully leading and managing statewide quality improvement initiatives through its North Carolina Quality Center (NCQC). By working together, we will be able to tackle these crucial issues from a regional perspective and share resources in a way that maximizes efficiency.

Many key features help to differentiate the NoCVA HEN:

  • By including hospitals only in Virginia and North Carolina, a local focus will predominate, especially given that VHHA and NCHA have long track records and understand many of the unique issues facing Virginia and North Carolina hospitals.

  • To date, 47% of Virginia hospitals and 52% of North Carolina hospitals have joined the NoCVA HEN (see list). This impressive level of involvement will allow us to significantly improve health care across the region. By having large numbers of hospitals within a contained region working on similar activities, the likelihood of sustaining these initiatives into the future is maximized within the region.

  • The NoCVA HEN will partner with other statewide organizations that focus on quality improvement and patient safety. In Virginia, these organizations include the Virginia Health Quality Center (the state quality improvement organization), the Medical Society of Virginia and the Virginia Nurses Association. Furthermore, we will ensure that other statewide organizations are included in the process, such as the Virginia Health Care Association, the Virginia Organization of Nurse Executives, AARP-Virginia and the Virginia Department of Health. By doing so, not only will we ensure that resources within these organizations are leveraged, but also that activities within each of these organizations align seamlessly with the NoCVA HEN activities. The goal will be to prevent confusion and excessive hospital cost that stems from overlap of requirements placed on hospitals by these multiple organizations.

  • The NoCVA HEN is partnering with Healthcare Team Training (HTT) for the obstetrical adverse events initiative. HTT has been the major implementation contractor for TeamSTEPPS® – Strategies and Tools to Enhance Performance and Patient Safety in civilian and military health care systems. TeamSTEPPS has successfully led several multi-hospital obstetrical adverse event prevention initiatives around the U.S.

  • Regional, state and/or local meetings will be held for each initiative, allowing a unique focus on local issues and interactions. By having these meetings within driving distance to hospitals, costs will be minimized for individual hospitals and multiple hospital staff will be able to attend.

  • Recognizing that many hospitals already are engaged at varying stages in the NoCVA HEN initiatives, the programs for each initiative have been designed to allow hospitals to enter into an initiative at the most appropriate time in the process so that hospitals won’t need to repeat their past activities to be involved in NoCVA’s activities moving forward.

  • Data collection will involve using NCHA’s already secure and confidential data entry portal. In as many cases as possible, data metrics were chosen that are already being collected by hospitals. If this was not possible, metrics were chosen, whenever possible, that are easily collected using existing electronic data.

  • As for all other HENs, programmatic content and tools will be derived from CMS’s National Content Developer, an organization specifically funded to provide necessary materials to the HENs. The NoCVA HEN will be able to supplement much of this content with tools that have been created as part of prior North Carolina and Virginia quality improvement initiatives.

  • The NoCVA HEN readmission initiative will have a highly localized component. We believe readmissions truly represent a community issue and will require stakeholder involvement beyond just hospitals to create meaningful and sustainable improvements. VHHA is uniquely positioned in Virginia to bring appropriate community stakeholders to the table on this issue.

In order to accomplish our goals, all of the 10 initiatives will have certain features in common: data collection, in-person learning sessions, comprehensive toolkits, regularly scheduled teleconferences/webinars and Just Culture/TeamSTEPPS® integration. Beyond these similarities, each of the 10 initiatives has been categorized based on the level of additional activity, as follows:

  • Educational Program (VAP) – an Educational Program does not involve any level of activity beyond that mentioned above.

  • Campaign (CAUTI) – in addition to the above activities, a Campaign involves the creation of a unique web site and a leadership team to establish campaign goals.

  • Learning Network (Adverse Drug Events, Falls with injury and Pressure Ulcers) – in addition to the above activities, Learning Networks involve a dedicated interactive web site and list serv.

  • Collaborative (CLABSI, Obstetrical Adverse Events, Readmissions, SSI, and VTE) – in addition to the above activities, Collaboratives involve more detailed data feedback, an expert panel, a dedicated interactive web site and list serv, prework, project timelines with milestones, a patient safety culture survey and regular interaction between NoCVA and individual hospitals.

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