Kentucky AHA/HRET Hospital Engagement Network

Charisse Coulombe, MS, MBA, CPHQ; Senior Director, HEN Hospital Engagement Network Health Research & Educational Trust American Hospital Association

Hospital Engagement Network

• • 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 Leadership Clinicians & Front Line Staff (Teams) THE PATIENT

Partnership for Patients

The 40/20 Goal

•

Keep patients from getting injured or sicker

Reduce 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 requiring re-hospitalization within 30 days of discharge 3

Where We’ve Been: November, 2012 4

DC FL ID IL IN KS KY LA

State

AK AL AR AZ CA CO CT MA MO MS MT ND NE NH NM OK OR PR RI SD WI WV WY

Data Submission as of February 11, 2013

% of Hospitals Submitting Outcomes Data by Topic Total ADE Outcome

64% 31% 24% 35% 7% 78% 100% 0% 93% 50% 100% 27% 1% 19% 78% 10% 99% 42% 50% 67% 100% 5% 15% 14% 90% 12% 100% 85% 10% 34% 0%

CAUTI Outcome

100% 86% 83% 95% 78% 73% 100% 100% 90% 100% 100% 98% 46% 99% 97% 81% 99% 81% 73% 60% 100% 100% 100% 71% 94% 88% 91% 100% 56% 90% 0%

83% Fall Outcome

82% 45% 78% 90% 42% 73% 100% 33% 95% 75% 100% 94% 68% 95% 95% 57% 100% 65% 58% 90% 100% 43% 95% 93% 71% 90% 18% 100% 46% 76% 100%

77% CLABSI Outcome

100% 82% 72% 90% 92% 100% 100% 100% 92% 100% 100% 98% 63% 97% 96% 57% 100% 86% 86% 67% 100% 100% 100% 90% 100% 92% 100% 100% 40% 89% 100%

87% EED Process*

17% 70% 58% 73% 38% 0% 0% 67% 47% 14% 25% 79% 80% 47% 77% 33% 78% 23% 15% 33% 56% 94% 53% 97% 93% 36% 100% 80% 21% 100% 0%

51% HAPU Outcome

64% 7% 39% 35% 32% 100% 100% 0% 95% 38% 100% 72% 26% 91% 89% 33% 99% 42% 81% 60% 100% 38% 10% 40% 61% 44% 0% 100% 28% 55% 100%

61% SSI Outcome

83% 79% 88% 79% 93% 91% 100% 67% 82% 100% 100% 98% 30% 75% 86% 67% 73% 67% 69% 33% 94% 100% 94% 91% 96% 69% 82% 95% 44% 91% 0%

79% OB Outcome **

33% 80% 46% 67% 8% 100% 16% 33% 49% 43% 100% 69% 49% 50% 60% 28% 100% 31% 62% 0% 26% 19% 40% 10% 86% 64% 9% 100% 41% 100% 100%

52% VTE Outcome

73% 0% 27% 25% 7% 84% 0% 33% 92% 38% 100% 66% 14% 35% 68% 19% 99% 38% 65% 57% 97% 100% 10% 24% 13% 8% 0% 88% 29% 14% 81%

45% VAP Outcome

83% 74% 68% 79% 70% 56% 4% 67% 96% 100% 100% 95% 3% 86% 98% 57% 100% 57% 36% 33% 100% 81% 100% 92% 76% 80% 55% 100% 38% 76% 0%

73%

89% 76% 98% 92% 96% 70% 100% 100% 100% 81% 100% 60% 64% 100% 70% 97% 0%

77% Readmit Outcome # Hospitals***

91% 100% 11 29 80% 95% 39% 69% 41 20 158 51 100% 100% 88% 100% 100% 88% 55% 64% 27 3 73 8 55 97 92 77 73 21 81 26 26 30 34 21 20 58 31 50 11 33 105 29 16

1407 Number of Hospitals Submitting Data on 6 or More Topics

10 15 28 18 69 47 27 2 68 5 55 97 15 68 68 12 80 15 18 32 22 25 0

997

14 34 21 16 36 31 44 5

Number of Hospitals Data Submitted on Submitting on all of their 6 or More Topics (%) Applicable Topics

91% 52% 68% 90% 44% 92% 100% 67% 4 0 0 1 4 13 0 0 93% 63% 100% 100% 16% 88% 93% 57% 99% 58% 69% 47% 100% 100% 80% 62% 100% 88% 45% 97% 21% 86% 0%

71%

2 0 0 23 2 1 0

304

36 1 55 18 3 1 37 0 59 3 10 13 11 0 1 6

HEN Progress to Date

• • • • • • •

EEDs/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 Date

• •

ADEs

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 Date

• •

VTEs

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 Table

Topic Most Popular Outcome Measure

ADE CAUTI CLABSI EED OB Excessive Anticoagulation CAUTI Rate ICU CLABSI Rate ICU TJC EED * Falls Pressure Ulcer Falls with or without injury Stage III or IV 9 40 40 13 29 46

Avg # Hospitals Reporting Total Eligible Hospitals Percent Reporting Baseline

77 12% 5%

Q4 2012 or last 3 monitoring months

8% 77 68 34 77 77 52% 59% 38% 38% 60% 1.58

1.13

3.47

0.06

1.33

1.26

3.46

0.00

Percent Reduction

N/A 28% N/A 0.28% 100% * KY hospitals submitting 13 different OB measures

Topic Measure

Readmission SSI VAP VTE 30 Day All Cause SSI Rate within 30 Days of Procedure VAP Rate ICU Post Op PE/DVT 37 21 18

Kentucky Summary Table

Avg # Hospitals Reporting Total Eligible Hospitals Percent Reporting Baseline

22 77 28% 12.34%

Q4 2012 or last 3 monitoring months

10.07%

Percent Reduction

18.38% 67 66 77 55% 32% 23% 1.83

3.89

1.85

2.69

0.19

2.80

N/A 95% N/A

Kentucky’s Progress to Date ADE

Kentucky’s Progress to Date CAUTI

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

2.50

2.00

1.50

1.00

0.50

N Rate 0.00

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

Baseline

8 1.58

Jan-12

44 0.79

Feb-12

43 2.04

Mar-12

44 1.15

Apr-12

44 1.42

May-12

44 1.50

Jun-12

44 1.62

Jul-12

43 1.21

Aug-12

45 1.58

Sep-12

45 0.92

Oct-12

41 1.22

Nov-12

39 1.06

Dec-12

32 1.12

AHA/HRET HEN Progress to Date CLABSI

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

1.40

1.20

1.00

0.80

0.60

0.40

0.20

0.00

N Rate

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

617 644 641 648 646 646 650 665 665 671 563 547 494 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

2.50

2.00

1.50

1.00

0.50

0.00

Kentucky’s Progress to Date CLABSI

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

N Rate

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

12 1.13

44 2.04

42 1.12

44 2.00

44 1.46

44 1.43

44 0.95

43 1.42

45 1.51

45 1.76

41 1.13

39 1.85

32 0.66

AHA/HRET HEN Progress to Date Falls

N Rate

Baseline

547 3.19

Jan-12

530 3.15

Feb-12

530 2.96

Mar-12

539 3.03

Apr-12

533 2.97

May-12

540 2.97

Jun-12

586 3.03

Jul-12

610 3.00

Aug-12

627 3.05

Sep-12

644 3.17

Oct-12

586 2.93

Nov-12

544 3.08

Dec-12

479 2.97

Kentucky’s Progress to Date Falls

N Rate

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

27 3.47

27 3.26

27 3.45

27 2.69

27 3.12

27 3.18

28 3.63

28 3.31

28 4.07

28 4.26

28 3.54

28 3.44

26 3.4

AHA/HRET HEN Progress to Date Early Elective Delivery

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

20.00% 16.00% 12.00% 8.00% 4.00% 0.00% Baseline n=268 Month 1 n=261 Month 2 n=256 Month 3 n=267 Month 4 n=265 Month 5 n=265 Month 6 n=299 Month 7 n=329 Percent of EED at => 37 and <39 Weeks Month 8 n=327 Month 9 Month 10 Month 11 Month 12 n=333 n=309 n=296 n=255 Rate Trend Line

25.00%

Kentucky’s Progress to Date Early Elective Deliveries

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

20.00% 15.00% 10.00% 5.00% N Rate 0.00% 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

Baseline

12 21.79%

Jan-12

12 13.57%

Feb-12

12 17.97%

Mar-12

13 15.63%

Apr-12

12 16.33%

May-12

12 15.57%

Jun-12

14 14.20%

Jul-12

13 14.41%

Aug-12

13 11.08%

Sep-12

15 8.30%

Oct-12

15 13.15%

Nov-12

14 11.78%

Dec-12

11 18.95%

AHA/HRET HEN Progress to Date Pressure Ulcers

Kentucky’s Progress to Date Pressure Ulcers

N Rate

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12

46 0.06

46 0.13

47 0.00

46 0.21

46 0.12

47 0.00

46 0.00

46 0.14

47 0.00

AHA/HRET HEN Progress to Date Readmissions

Kentucky’s Progress to Date Readmissions

N

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

18 19 19 22 20 21 24 23 23 27 23 23 19 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%

AHA/HRET HEN Progress to Date SSI

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

1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 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

Kentucky’s Progress to Date SSI

N Rate

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

4 1.83% 38 2.40% 37 38 37 37 35 37 37 39 33 31 25 3.08% 3.24% 2.57% 1.96% 2.19% 5.71% 2.79% 3.47% 3.18% 3.33% 1.49%

AHA/HRET HEN Progress to Date VAP

Kentucky’s Progress to Date VAP

N Rate

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

5 3.89

17 3.22

18 3.68

18 4.62

20 1.79

19 3.63

19 2.87

20 0.91

21 1.54

20 3.41

22 2.59

19 1.78

13 1.12

AHA/HRET HEN Progress to Date VTE

N Rate

Baseline

75 4.74

Jan-12

53 11.9

Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12

53 10.72

55 12.21

53 11.52

53 11.12

91 9.65

89 90 10.29 10.49

97 11.38

Kentucky’s Progress to Date VTE

N Rate

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

3 1.85

16 1.46

16 2.52

16 3.18

16 1.61

16 3.62

16 1.44

17 1.95

17 4.26

17 2.09

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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

32

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

33

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]