MHA Keystone Center

The MHA Keystone Center is participating in Partnership Projects with a number of stakeholders in innovative efforts to implement evidence-based best practice, both nationally and at the state level. Below are summaries for each project.

The success of MHA Keystone: ICU garnered the attention of the federal government, and in February 2009, the MHA Keystone: ICU model expanded to 10 additional states — California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania, Texas and Washington — to help prevent bloodstream infections (BSI). The participants were chosen by HRET based on their capability and infrastructure to implement the safety protocols being used in the project. In addition, the chosen states provide a broad geographic representation. The new 10-state project aims to reduce the average rate of CLABSIs in hospitals by 80 percent.

The MHA Keystone Center, Johns Hopkins University Quality and Research Group and HRET will work together to provide participating hospitals with the necessary tools and training to reduce these infections in hospital ICUs. Participating hospitals will implement a checklist to ensure compliance with safety practices and integrate enhanced communication, teamwork and leadership to improve patient safety culture.

The Health Research and Educational Trust, through a contract with the Agency for Healthcare Research and Quality (AHRQ), and in partnership with the Johns Hopkins University Quality and Safety Research Group and the MHA Keystone Center for Patient Safety & Quality, will implement a nationwide patient safety program in hospital intensive care units (ICU) proven to dramatically reduce central line-associated bloodstream infections (CLABSI) and improve cultures of safety.

The project will replicate the success achieved by Michigan hospitals that have implemented the Comprehensive Unit-Based Safety Program (CUSP) and other targeted patient safety interventions. Lead organizations will work with quality improvement organizations, public health agencies, state hospital associations, and at least 10 participating hospitals from each of the states. The states will join the project in three waves, or “cohorts.”

As important as the clinical intervention to prevent bloodstream infections, the work of improving the culture of safety is a significant goal to build capacity for future improvement at the state level. The project will include a regionally diverse group of hospitals that will have received training and are implementing the CUSP/CLABSI patient safety program. The project is being led by John Combes, MD, principal investigator, and Peter Pronovost, MD, PhD, co-principal investigator.

The MHA Keystone Center will serve as a nexus for the participating hospitals and ICU teams to disseminate findings and support conference calls. In addition, the MHA Keystone Center will serve as the data repository for the project.

¹FLEXTRA kits are flexible training kits that include tools such as CDs, DVDs, evaluations, and other teaching and learning aides as an effective way of quickly conveying abstract information.

[Back to Top]

Hospital readmissions, or rehospitalizations, have gained significant attention in the discussion surrounding national health care reform. According to The New England Journal of Medicine, Michigan has a Medicare fee-for-service rehospitalization rate of 19.4 percent (national rates range from about 13 percent to more than 21 percent).¹ While some of these rehospitalizations are planned and appropriate, reducing avoidable rehospitalizations will not only improve patient satisfaction, but may also lower health care costs.

In June 2009, the MHA Keystone Center partnered with MPRO (Michigan’s quality improvement organization) to launch the STate Action on Avoidable Rehospitalizations (STAAR) initiative. The goal of STAAR is to reduce 30-day rehospitalization rates by 30 percent and increase patient and family satisfaction with transitions and coordination of care. Ten independent Michigan hospitals and select hospitals within five Michigan health systems were chosen to participate in a three-state health care collaborative to reduce rehospitalizations.

The criteria used to select the participating hospitals was based on regional representation; representation by rural/urban, teaching/nonteaching; critical access hospitals; ethnic diversity in hospital service area; representation by independent and system hospitals; willingness to recruit post-acute care partners (long-term care, home health, etc.); and willingness and capacity to collect data.

Interventions include enhanced patient communication and timely follow-up after hospital discharge that will reduce unplanned, related rehospitalizations — which are rehospitalizations that are not expected/scheduled, but whose reason is clinically related to the initial admission.

To ensure success across the health care continuum, a voluntary steering committee has been convened that includes representatives of Aging Services of Michigan, BCBSM, the Health Care Association of Michigan, the Institute for Healthcare Improvement, Medicaid Program Operations and Quality Assurance, the Michigan Association of Health Plans, the Michigan Critical Access Hospital Quality Network, the Michigan Department of Community Health, the Michigan Home Health Association, the Michigan Hospice and Palliative Care Organization, the Michigan Osteopathic Association, the Michigan State Medical Society and the University of Michigan Health System, Ann Arbor.

Massachusetts and Washington join Michigan as the states selected for the program. To foster peer-to-peer learning, the STAAR initiative will also exchange best-practice information with Care Transitions, a pilot project in 14 regions across the nation (including Lansing, Michigan) to reduce avoidable rehospitalizations through improved care coordination. Ultimately, the goal is to apply what is learned from these two programs to statewide and regional efforts.

¹Jencks SF, Williams MV, Coleman EA. N Engl J Med 360:1418, April 2, 2009 Special Article

Since 2003, MHA Keystone: ICU has been successfully improving the culture of safety and reducing VAP and CLABSIs in hospital ICUs. Six hospitals that have participated in MHA Keystone: ICU since its inception have been selected for a study being conducted by the MHA Keystone Center and the Johns Hopkins University Bloomberg School of Public Health. The study will use cost-benefit analysis to compare the costs of implementing an MHA Keystone: ICU improvement initiative with the generated financial savings.

The analysis will focus on prevented cases of bloodstream infections and VAP in ICUs and will determine not only the costs saved, but also the potential revenues generated due to the increased availability of ICU beds. To assess avoided costs, the research team will analyze hospital cost-accounting data. In addition to analyzing data, interviews are being conducted to better understand the time that ICU staffs spend on ICU-related care and will further use a method known as Activity-Based Costing to assign dollar amounts to team activities.

The majority of hospital site visits are complete and the next phase, data collection, is currently under way. An individual cost-benefit analysis report will be produced for the participating hospitals, as well as a combined analysis that will assist all hospitals that are participating, or considering participating, in MHA Keystone: ICU.

Those six hospitals participating in the “Business Case for Quality” follow-up project are St. Joseph Mercy Hospital, Ann Arbor; Beaumont Hospital-Troy; Beaumont Hospital-Royal Oak; Allegiance Health, Jackson; MidMichigan Medical Center-Midland; and Gerber Memorial Health Services, Fremont.

Background: In September 2007, the Agency for Healthcare Research and Quality (AHRQ) identified the potential for a national project to help reduce HAIs. The MHA Keystone Center, the American Hospital Association (AHA), Health Research & Educational Trust (HRET), and hospitals and academic centers across the country were selected to participate in the project.

An orientation program was developed for the prevention of HAIs in ICUs based on the success of the MHA Keystone: ICU collaborative. However, following further review by the federal Office of Management and Budget, all participating organizations were required to alter their original project plans. The MHA Keystone Center’s final plan was refocused to identify and distribute the findings of the MHA Keystone: ICU collaborative to other participating hospitals across the nation.

Results: Four Michigan hospitals, representing a cross section of Michigan community hospitals, worked with the MHA Keystone Center and HRET to develop case studies that would share the findings and experiences of implementing infection prevention measures and safety culture improvements in their facilities for the past five years. The case studies revealed the critical nature of engaged executive leadership, committed physician and nursing staff, and strong, evidence-based interventions. The case studies also identified early barriers; however, through enhanced executive leadership support, the barriers were minimized.

Future: The case studies will be used for future publication to spread the understanding of how a statewide improvement effort can be effective. The MHA Keystone Center will also use the information gained from the in-depth examination and incorporate it in the expansion of the ICU project across the United States.