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  • From the last couple of slides I know you saw what I saw. There is room for improvements and “read the slide:
  • Transcript

    • 1. Edna Rensing, RN, MSHA, CPHQ
    • 2. Discuss Today <ul><li>Quality in perspective </li></ul><ul><li>The year in review </li></ul><ul><li>Where we go from here </li></ul>
    • 3. <ul><li>Quality: In accordance with VA‐RHP core principles, performance and quality improvement must be central to all rural health care services. Thus, the VA‐RHP must provide recommendations that support and promote an increased awareness of and dedication to performance and quality improvement. </li></ul><ul><li>D.1. Establish the Virginia Rural Health Performance and Quality Advisory Council. </li></ul><ul><li>D.2. Create a database that supports the identification of health inequities and approaches for measuring progress against baseline measures. </li></ul><ul><li>D.3. Host a statewide Rural Health Quality Summit. </li></ul><ul><li>D.4. Establish a plan to improve transitions in care (e.g., from hospital to home). </li></ul><ul><li>D.5. Create a database that supports rural‐relevant and meaningful indicators and increased transparency of quality data. </li></ul><ul><li>D.6. Increase the number of health promotion/disease prevention programs through grants to rural communities. </li></ul><ul><li>D.7. Develop common quality measures for program assessment and outcomes. </li></ul>
    • 4. Quality Perspective? <ul><li>Internal infrastructure or readiness to implement changes </li></ul><ul><li>External or needs of the people in the community </li></ul><ul><ul><li>Survey or needs assessment </li></ul></ul>
    • 5. Surveys and Data are Available <ul><li>Internal infrastructure or readiness to implement changes </li></ul><ul><li>Leapfrog - www.leapfroggroup.org </li></ul><ul><li>Agency for Healthcare Research and Quality (AHRQ) </li></ul><ul><ul><li>Hospital survey of staff perception of patient safety </li></ul></ul><ul><ul><li>Nursing home survey of staff perception of patient safety </li></ul></ul><ul><li>Hospital Leadership Quality Assessment Tool (HLQAT) </li></ul><ul><li>American Hospital Association (AHA) survey </li></ul><ul><li>External or needs of the people in the community </li></ul><ul><li>Leapfrog </li></ul><ul><li>CMS – hospital, home health (HH) and nursing home (NH)compare </li></ul><ul><ul><li>www.hospitalcompare.hhs.gov </li></ul></ul><ul><ul><li>www.medicare.gov/NHCompare </li></ul></ul><ul><ul><li>www.medicare.gov/HHCompare </li></ul></ul><ul><li>Virginia Health Information - www. vhi .org </li></ul><ul><li>Virginia Department of Health – Central line associated bloodstream infections </li></ul><ul><li>Data Portal </li></ul>
    • 6. Internal infrastructure or readiness to implement changes
    • 7. <ul><li>Computerized Physician Order Entry system (CPOE) </li></ul><ul><li>ICU Staffing with intensivists </li></ul><ul><li>High Risk Treatments </li></ul><ul><li>Leapfrog Safe Practices Score –17 key procedures to reduce preventable medical mistakes are put into place.  </li></ul><ul><ul><li>Nationwide - 2oo rural hospitals completed Leapfrog survey. Question applicability to Virginia rural - small number of Virginia rural hospitals report </li></ul></ul><ul><ul><ul><li>Safe        %Fully </li></ul></ul></ul><ul><ul><ul><li>Practice   Met       Description </li></ul></ul></ul><ul><ul><ul><li>  SP1      13.0%    Leadership Structures and System </li></ul></ul></ul><ul><ul><ul><li>  SP2      25.0%   Culture Measurement for Performance </li></ul></ul></ul><ul><ul><ul><li>  SP3      15.0%   Teamwork Training & Skill Building </li></ul></ul></ul><ul><ul><ul><li>  SP4      31.5%    Identification & Mitigation of Risk & Hazards </li></ul></ul></ul><ul><ul><ul><li>  SP5      13.5%    Informed Consent </li></ul></ul></ul><ul><ul><ul><li>  SP6      13.0%    Life Sustaining Treatments </li></ul></ul></ul><ul><ul><ul><li>  SP9      22.0%   Nursing Workforce </li></ul></ul></ul><ul><ul><ul><li>  SP12     28.5%    Communication of Critical Information </li></ul></ul></ul><ul><ul><ul><li>  SP14     28.5%    Labeling of Diagnostic Studies </li></ul></ul></ul><ul><ul><ul><li>  SP15     18.0%    Discharge Systems </li></ul></ul></ul><ul><ul><ul><li>  SP17     34.5%    Medication Reconciliation </li></ul></ul></ul><ul><ul><ul><li>  SP19    43.5%    Hand Hygiene </li></ul></ul></ul><ul><ul><ul><li>  SP21    40.5%    Central Venous Catheter Related Bloodstream Infections </li></ul></ul></ul><ul><ul><ul><li>  SP23    48.5%    Prevention of Aspiration & Ventilator Associated Pneumonia </li></ul></ul></ul><ul><ul><ul><li>  SP25    25.5%    Catheter-Associated Urinary Tract Infection Prevention </li></ul></ul></ul><ul><ul><ul><li>  SP28    35.5%    DVT/VTE Prevention </li></ul></ul></ul><ul><ul><ul><li>  SP29    16.5%    Anticoagulation Therapy    </li></ul></ul></ul>Leapfrog
    • 8. AHRQ – Hospital survey Safety Culture Composites Hospitals (22) Rural (9) Urban (13) Mean Median Mean Median Mean Median Overall Perceptions of Safety 64% 64% 67% 67% 62% 61% Frequency of Events Reported 64% 64% 65% 68% 63% 63% Supervisor/Manager Expectations & Actions Promoting Patient Safety 77% 77% 79% 80% 75% 76% Organizational Learning--Continuous Improvement 75% 76% 77% 77% 73% 72% Teamwork Within Units 82% 82% 81% 80% 82% 82% Communication Openness 64% 63% 64% 66% 63% 63% Feedback & Communication About Error 66% 66% 68% 69% 65% 64% Nonpunitive Response to Error 43% 44% 46% 44% 41% 43% Staffing 53% 52% 56% 55% 51% 49% Hospital Management Support for Patient Safety 73% 72% 75% 77% 72% 71% Teamwork Across Hospital Units 56% 56% 58% 57% 55% 55% Hospital Handoffs & Transitions 40% 39% 41% 39% 39% 36%
    • 9. This tool was created at the University of Nebraska Medical Center as part of an AHRQ-funded Partnerships in Implementing Patient Safety Grant (AHRQ Grant 1 U18 HS015822-01). NOTE: This tool was developed in Microsoft Office Excel 2007 and is available at www.unmc.edu/rural/patient-safety.
    • 10.  
    • 11. What stands out? <ul><li>In lowest three for hospitals and nursing homes </li></ul><ul><ul><li>Nonpunitive response </li></ul></ul><ul><ul><li>Staffing </li></ul></ul><ul><ul><li>Handoffs </li></ul></ul><ul><li>Followed closely by </li></ul><ul><ul><li>Teamwork and communication </li></ul></ul><ul><li>Similar to Leapfrog results </li></ul>
    • 12. HLQAT & AHA Surveys <ul><li>HLQAT </li></ul><ul><ul><li>Hospitals completed surveys 1/31/2010 </li></ul></ul><ul><ul><li>No data yet </li></ul></ul><ul><li>AHA survey </li></ul><ul><ul><li>Data collection period was extended </li></ul></ul>
    • 13. <ul><li>Quality: In accordance with VA‐RHP core principles, performance and quality improvement must be central to all rural health care services. Thus, the VA‐RHP must provide recommendations that support and promote an increased awareness of and dedication to performance and quality improvement. </li></ul><ul><li>D.1. Establish the Virginia Rural Health Performance and Quality Advisory Council. </li></ul><ul><li>D.2. Create a database that supports the identification of health inequities and approaches for measuring progress against baseline measures. </li></ul><ul><li>√ D.3. Host a statewide Rural Health Quality Summit. </li></ul><ul><li>D.4. Establish a plan to improve transitions in care (e.g., from hospital to home). </li></ul><ul><li>D.5. Create a database that supports rural‐relevant and meaningful indicators and increased transparency of quality data. </li></ul><ul><li>D.6. Increase the number of health promotion/disease prevention programs through grants to rural communities. </li></ul><ul><li>D.7. Develop common quality measures for program assessment and outcomes. </li></ul>
    • 14. D.3. Host a statewide Rural Health Quality Summit <ul><li>Recommended funding of travel grants to allow hospitals to attend conferences related to quality improvement techniques, culture change and team building/communications. </li></ul><ul><ul><li>VIPC&S </li></ul></ul><ul><ul><li>VHQC’s October conference </li></ul></ul><ul><ul><ul><li>TeamSTEPPS </li></ul></ul></ul><ul><ul><ul><li>Root Cause Analysis and other QI techniques </li></ul></ul></ul><ul><ul><li>Virginia Business Coalition on Health </li></ul></ul>
    • 15. External or needs of the people in the community
    • 16. CMS Hospital, HH & NH Compare <ul><li>Hospital </li></ul><ul><ul><li>Heart attack, heart failure, pneumonia, surgical care </li></ul></ul><ul><ul><li>Readmission rates </li></ul></ul><ul><ul><li>Patient Satisfaction </li></ul></ul><ul><ul><li>And more </li></ul></ul><ul><li>Nursing homes </li></ul><ul><ul><li>Star rating based on health inspections, staffing, quality measures and more </li></ul></ul><ul><li>Home Health </li></ul><ul><ul><li>Activities of daily living, readmissions, and more </li></ul></ul>
    • 17. <ul><li>Computerized Physician Order Entry system (CPOE) </li></ul><ul><li>ICU Staffing with intensivists </li></ul><ul><li>High Risk Treatments </li></ul><ul><li>Leapfrog Safe Practices Score –17 key procedures to reduce preventable medical mistakes are put into place.  </li></ul><ul><ul><li>Nationwide - 2oo rural hospitals completed Leapfrog survey. Question applicability to Virginia rural - small number of Virginia rural hospitals report </li></ul></ul><ul><ul><ul><li>Safe        %Fully </li></ul></ul></ul><ul><ul><ul><li>Practice   Met       Description </li></ul></ul></ul><ul><ul><ul><li>  SP1      13.0%    Leadership Structures and System </li></ul></ul></ul><ul><ul><ul><li>  SP2      25.0%   Culture Measurement for Performance </li></ul></ul></ul><ul><ul><ul><li>  SP3      15.0%   Teamwork Training & Skill Building </li></ul></ul></ul><ul><ul><ul><li>  SP4      31.5%    Identification & Mitigation of Risk & Hazards </li></ul></ul></ul><ul><ul><ul><li>  SP5      13.5%    Informed Consent </li></ul></ul></ul><ul><ul><ul><li>  SP6      13.0%    Life Sustaining Treatments </li></ul></ul></ul><ul><ul><ul><li>  SP9      22.0%   Nursing Workforce </li></ul></ul></ul><ul><ul><ul><li>  SP12     28.5%    Communication of Critical Information </li></ul></ul></ul><ul><ul><ul><li>  SP14     28.5%    Labeling of Diagnostic Studies </li></ul></ul></ul><ul><ul><ul><li>  SP15     18.0%    Discharge Systems </li></ul></ul></ul><ul><ul><ul><li>  SP17     34.5%    Medication Reconciliation </li></ul></ul></ul><ul><ul><ul><li>  SP19    43.5%    Hand Hygiene </li></ul></ul></ul><ul><ul><ul><li>  SP21    40.5%    Central Venous Catheter Related Bloodstream Infections </li></ul></ul></ul><ul><ul><ul><li>  SP23    48.5%    Prevention of Aspiration & Ventilator Associated Pneumonia </li></ul></ul></ul><ul><ul><ul><li>  SP25    25.5%    Catheter-Associated Urinary Tract Infection Prevention </li></ul></ul></ul><ul><ul><ul><li>  SP28    35.5%    DVT/VTE Prevention </li></ul></ul></ul><ul><ul><ul><li>  SP29    16.5%    Anticoagulation Therapy    </li></ul></ul></ul>Leapfrog
    • 18. Data exists <ul><li>Virginia Health Information - www. vhi .org </li></ul><ul><li>Virginia Department of Health – Central line associated bloodstream infections </li></ul><ul><li>Data Portal </li></ul>
    • 19. Projects Exist <ul><li>Care transitions </li></ul><ul><li>Get With the Guidelines (GWTG) </li></ul><ul><li>Use of telemedicine </li></ul><ul><li>Comprehensive Unit-based Safety Program/Central Line- Associated Blood Stream Infection (CUSP/CLABSI) </li></ul><ul><li>MRSA, pressure ulcer, physical restraint reduction </li></ul>
    • 20. <ul><li>Quality: In accordance with VA‐RHP core principles, performance and quality improvement must be central to all rural health care services. Thus, the VA‐RHP must provide recommendations that support and promote an increased awareness of and dedication to performance and quality improvement. </li></ul><ul><li>√ D.1. Establish the Virginia Rural Health Performance and Quality Advisory Council. </li></ul><ul><li>D.2. Create a database that supports the identification of health inequities and approaches for measuring progress against baseline measures. </li></ul><ul><li>D.3. Host a statewide Rural Health Quality Summit. </li></ul><ul><li>D.4. Establish a plan to improve transitions in care (e.g., from hospital to home). </li></ul><ul><li>D.5. Create a database that supports rural‐relevant and meaningful indicators and increased transparency of quality data. </li></ul><ul><li>D.6. Increase the number of health promotion/disease prevention programs through grants to rural communities. </li></ul><ul><li>D.7. Develop common quality measures for program assessment and outcomes. </li></ul>
    • 21. Expanding Membership <ul><li>American Heart Association/American Stroke Association </li></ul><ul><li>Anthem Blue Cross and Blue Shield </li></ul><ul><li>Telemedicine – VTN and NNMPT </li></ul><ul><li>Hospitals </li></ul><ul><li>Virginia Department of Health </li></ul><ul><li>Business Coalition </li></ul><ul><li>Physicians </li></ul><ul><li>Pharmacists </li></ul><ul><li>Welcome others in the community </li></ul>
    • 22. Where we go from here <ul><li>Begin the planning at a meeting this evening </li></ul><ul><li>Internal and external </li></ul>

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