|
Partnership
Projects
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.
On the CUSP: STOP BSI
The success of MHA Keystone: Intensive Care Unit (ICU)
attracted the attention of the federal government and, in February
2009, the On the CUSP: Stop BSI project launched in 10 states. In
fall 2009, as a result of support from the AHRQ and a private
foundation, hospitals from all 50 states, the District of Columbia
and Puerto Rico were given the opportunity to participate in the
program.
In
September 2011, roughly 1,055 hospitals from 45 states, the District
of Columbia and Puerto Rico were enrolled in the effort. On the
CUSP: Stop BSI aims to reduce the average rate of CLABSIs from the
national average (five infections per 1,000 catheter days) by 80
percent using the MHA
Keystone: ICU
model.
On
the CUSP: Stop BSI is scheduled to continue through September 2012
and has already shown measurable success nationwide.
In
September, the AHRQ released a report showing a 33 percent reduction
in CLABSIs among adult ICUs from more than 750 participating
hospitals.
CLABSI rates dropped from an average of 1.87 infections per 1,000
central-line days to an average of 1.25 infections per 1,000
central-line days in participating units.
The MHA Keystone Center, the Johns Hopkins University Quality and
Safety Research Group and the HRET work together to provide
participating hospitals with the necessary tools and training to
reduce these infections in hospital ICUs. Participating hospitals,
in an effort to improve the patient safety culture, are implementing
a checklist to ensure compliance with safety practices and integrate
enhanced communication, teamwork and leadership.
For more information, please visit
http://www.onthecuspstophai.org/stop-bsi.
[Back to Top]
On the CUSP: STOP CA-UTI
Catheter-associated urinary tract infections (CA-UTIs) — many of
which are preventable — account for 35 percent of all
hospital-associated infections (HAIs) and result in approximately
8,200 deaths and an estimated $565 million in excess costs each year
nationally.
On
the CUSP: Stop CA-UTI aims to reduce CA-UTI rates in participating
intensive care units and other clinical units by an average of 25
percent over two years using the MHA
Keystone: HAI
model.
The
initiative began with 12 participating states and, in fall 2011,
launched a third cohort.
The
initiative is led by the HRET through a contract with the AHRQ and
in partnership with the Johns Hopkins University Quality and Safety
Research Group, the MHA Keystone Center, and investigators from the
University of Michigan Health System, Ann Arbor.
For
more information, please visit
http://www.onthecuspstophai.org/stop-cauti.
[Back to Top]
Michigan
STate Action on Avoidable Rehospitalizations (MI STA*AR)
Through MI STA*AR, Michigan hospitals, together with community
partners, are voluntarily addressing the issues of care coordination
and communication among hospitals, patients and doctors that result
in avoidable rehospitalizations. The initiative aims to reduce by 30
percent the number of patients who experience avoidable
rehospitalizations within 30 days of discharge and to increase
patient and family satisfaction with transitions and coordination of
care. Sixty-five Michigan hospitals participate in this initiative,
which is scheduled to continue through 2013.
In
October 2012, health care reform will impose Medicare reimbursement
penalties for certain rehospitalizations. Hospitals will not only be
penalized for rehospitalizations to their own institution, but also
when their former patients are rehospitalized in other facilities.
In
July 2011, participating hospitals were provided the most complete
report, to date, of hospital-specific rehospitalizations — patients
readmitted to their hospital or to another hospital — and statewide
rehospitalization rates.
To
prepare for the changes brought about by health care reform,
participating hospitals have formed teams of physicians, community
groups, post-acute-care providers and others to reduce unplanned,
related rehospitalizations. The MI STA*AR steering committee has
succeeded in aligning payer-led incentives, assisting with the
creation of a standardized definition of rehospitalizations,
creating a localized approach to address the unique needs of a
larger city, and empowering program participants with data and
information representing more than 90 percent of the insured lives
in Michigan. In addition, participants recently began to pilot a
universal transfer form for consistency during transitions in care
and participated in regional meetings throughout the fall.
MI
STA*AR is co-led by the MHA Keystone Center and MPRO, Michigan’s
quality improvement organization, with support from the IHI.
[Back to Top]
MHA
Keystone: ICU — The “Business Case for Quality”
Since 2003, MHA Keystone: ICU has been successful in
achieving its goals of improving the culture of safety in hospitals
and reducing VAP and CLABSIs in ICUs.
Because of these achievements, six hospitals that have participated
in MHA Keystone: ICU since its inception were selected for a
study conducted by the MHA Keystone Center and the Johns Hopkins
University Bloomberg School of Public Health. The study used
cost-benefit analysis to compare the costs of implementing an MHA
Keystone: ICU improvement initiative with the generated
financial savings.
The analysis focused on prevented cases of BSIs and VAP in ICUs and
determined dollars saved and the potential revenues generated due to
the increased availability of ICU beds. To assess avoided costs, the
research team analyzed hospital cost-accounting data. In addition,
interviews were conducted to better understand the time that ICU
staffs spend on ICU-related care and, further, used a method known
as activity-based costing to assign dollar amounts to team
activities.
Lifesaving and cost-saving benefits of MHA
Keystone: ICU
were highlighted in the “Business Case for Quality,” released in the
September/October issue of the
American Journal of Medical Quality.
Six hospitals that have participated in MHA
Keystone: ICU
since its inception were selected for the study, which used
cost-benefit analysis to compare the costs of implementing the
improvement initiative with the generated financial savings. The
hospitals included large, medium, small and rural hospitals with a
mix of staffing arrangements.
The study determined that participating MHA
Keystone: ICU
hospitals prevent between 3.4 and 7.2 CLABSI deaths annually and
receive a 10-to-1 return on investment for implementation.
On
average, 29.9 CLABSIs and 18 cases of VAP were averted for the six
participating hospitals, totaling 47.9 averted infections. CLABSIs
are also associated with additional hospital costs that range from
more than $12,000 to about $56,000 per case. Using conservative
estimates for averted costs of $36,500 per CLABSI and $10,000 per
VAP, an average hospital would not only save lives by implementing
an MHA
Keystone: ICU
intervention, but save approximately $1.1 million in costs per year.
The participating hospitals were St. Joseph Mercy Hospital, Ann
Arbor; Beaumont Hospital-Troy; Beaumont Hospital-Royal Oak;
Allegiance Health, Jackson; Mid - Michigan Medical Center-Midland;
and Spectrum Health Gerber Memorial, Fremont.
[Back to Top]
MHA
Keystone: AHRQ HAI Project (complete)
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.
[Back to Top]
| 
