Collaboration and national goal setting are combining to help improve care in California hospitals
More than 50 ministry hospitals are among the nearly 400 hospitals across California that are participating in Partnership for Patients, a three-year initiative to reduce hospital-acquired complications and readmissions throughout the U.S. The federal Centers for Medicare & Medicaid Services initiated the program in late 2011. Participating hospitals and health systems contract with one of 26 go-betweens, known as Hospital Engagement Networks. The networks perform much of the statistical analysis and share best practices. A few large health systems, including Dignity Health in San Francisco, serve as their own engagement networks. Dignity Health is the largest health-care system in California.
Partnership for Patients provides a uniform metric which hospitals use to measure their own progress and weigh it against the progress of others.
"In a big national initiative, everyone is striving to get better," said Nancy Pratt, a senior vice president and chief quality and safety officer at St. Joseph Health System in Irvine, Calif. She added, "With any system, things can get pushed to the back burner. With something like the Partnership (for Patients), everyone is talking about it at the same time, from hospital administration to physicians in private practice. I think it's a fantastic approach."
Barbara Pelletreau, senior vice president for patient safety at Dignity Health, said the partnership gives health systems a format to more efficiently share ways to improve care. "We have always supported health-care reform, but until recently we haven't been able to harness the size and scope of the industry to make real change happen," Pelletreau said. "We're now able to learn more quickly from others and share our results in a way that we weren't incentivized to do before."
Catherine Carson, director of quality and patient safety for the Daughters of Charity Health System of Los Altos Hills, Calif., described it as an "augmentation and a supplement to our own efforts, not the driver. But it all fits very well together."
Participating health systems are reporting improvements in care. At St. Jude Medical Center, a Covenant Health Network/St. Joseph Health hospital in Fullerton, Calif., skin breakdowns from pressure ulcers have been significantly reduced. At St. Vincent Medical Center, a Daughters of Charity hospital in Los Angeles, the rate of central line infections is falling steadily. At Providence St. Joseph Medical Center in Burbank, a Providence Health & Services hospital, urinary tract infections are down 40 percent. Across Dignity Health's 32 California hospitals, hypoglycemic events have been reduced by half.
Nationwide, about 3,700 hospitals participate in Partnership for Patients — about two-thirds of all hospitals in the United States. Participation has grown since the program began in December 2011, when not quite 3,200 hospitals were signed up.
Dr. Richard Gilfillan, director of the innovation center for CMS, praised California's health systems for enthusiastically embracing Partnership for Patients. In California, the participation rate is nearly 90 percent. "This initiative will help California hospitals improve health outcomes and reduce complications for their patients," he said.
The California Hospital Association is serving as the engagement network agent for 175 hospitals in that state. It is doing so as a subcontractor to the American Hospital Association, which is one of the 26 federally-appointed engagement agents.
The program was authorized by the Patient Protection and Affordable Care Act of 2010, and is financed through a $500 million appropriation distributed among the engagement networks.
Its two major goals are to reduce preventable hospital-acquired conditions by 40 percent and patient readmissions within 30 days of hospital discharge by 20 percent by the beginning of 2014, as compared to rates in 2010. To get there, participating hospitals review their procedures and collect and report to their engagement networks data on such things as central line infections, falls, ventilator-associated pneumonia and pressure ulcers.
Premier Inc., a health-consulting firm in Charlotte, N.C., and one of the 26 engagement networks, is evaluating data for the Daughters of Charity and St. Joseph Health among others. Providence Health & Services of Southern California is working with VHA Inc. of Irving, Texas.
"This measures apples to apples," said Dr. Priscilla Knolle, director of care coordination for the Daughters of Charity Health System. "We are able to measure the effectiveness of our interventions with a uniform tool, and I believe this helps the patients receive better care."
Knolle said the information and front-line intervention have helped the Daughters of Charity Health System to reduce its 30-day readmission rate from just below the national average and move into the top quartile of performers. She said she regularly discusses the information from Premier with hospital managers, who share the insights and information with nurses and other front-line caregivers.
Pratt of St. Joseph Health said guidance of that sort is immensely useful on the medical floors. "In dealing with urinary infections, one of the most important things is to remove catheters as soon as possible," Pratt said. "But patients need them. Having (support) for removing them in a timely basis is enormously important for improved care."