Past Projects
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Hospital Improvement Innovation Network (HIIN)

HCIF is pleased to be a partner to the Hospital & Healthsystem Association of Pennsylvania (HAP) in the Partnership for Patients Hospital Improvement Innovation Network (HIIN) aimed at reducing readmissions and hospital-acquired conditions.  HCIF is involved in the following three programs:

Readmissions

HCIF has co-led two HAP HIIN programs focusing on the reduction of readmissions. Beginning in 2016, a palliative care program aimed at reducing high volume readmissions among patients with a serious or advanced illness was launched entitled, Plan on it! A Palliative Care Collaborative. This program engaged  local and national experts in the delivery of an innovative educational curriculum, organizational best practices, and fostered the exchange of experiences, strategies, and tools among organizations. Pennsylvania Order for Life Sustaining Treatment (POLST) training was offered to develop the skills to facilitate goals of care discussions for individuals with advanced illnesses wishing to define their preferences for care.

The second program, a Behavioral Health Comorbidity in Readmissions pilot project, was initiated in 2018 to reduce readmissions for chronic obstructive pulmonary disease, sepsis, and heart failure patients with behavioral health comorbidities. The program consisted of a clinical advisory group providing guidance, one-on-one coaching calls with participating hospitals, physician office hours, and measurement of interventions deployed by clinicians to treat and reduce readmissions of patients with behavioral health conditions. Reduction in readmissions continues to be a HAP HIIN priority. 

Diagnostic Error

HCIF and the Pennsylvania Patient Safety Authority have partnered in a groundbreaking program that will address radiologic diagnostic errors in the emergency department.  Diagnostic errors represent a complex and understudied area of patient safety with countless opportunities for improvement. Studies have shown diagnostic error rates in the emergency department (ED) as high as 12% and in visual specialties, such as radiology, around 5%.  In the first year of the program, a diverse group of stakeholders will be convened to establish standardized performance measures, approaches, and tools for addressing these errors.  In the second year, hospitals will use rapid-cycle improvement to pilot and demonstrate the usability of the tools and reliability of the established measures and approaches.

CT Radiation Safety

HCIF and ECRI Institute, a leading authority in imaging technology and radiation safety, will work with hospitals to optimize and manage radiation doses with the goal of preventing undue exposure.  While computerized tomography (CT) can be a life-saving tool for diagnosing illnesses and injuries, it is the largest single contributor of radiation dose delivering 100-400 times the radiation than a conventional x-ray.  In this two-year program, hospital improvement teams will collect and report CT dose data, identify potential areas of overuse or inappropriate use, establish CT protocols that ensure optimization of radiation doses, provide education and training to medical and technical staff, implement dose control tools and strategies, monitor progress, and provide on-going feedback to staff.

Contact:

Pam Braun, Vice President, Clinical Improvement
pbraun@hcifonline.org

Montgomery County Hospital Partnership

In 2013, HealthSpark Foundation began convening leadership from Montgomery County health systems, federally qualified health centers, behavioral health providers, and the Montgomery County Department of Health and Human Services. Through the Montgomery County Hospital Partnership, leaders explored their response to the Affordable Care Act’s mandates for nonprofit hospitals to assess and address unmet community health needs. To support the Partnership, HealthSpark Foundation engaged the Health Care Improvement Foundation (HCIF) in 2015 to design and facilitate processes for visioning and selection of at least one strategy that several or all hospitals could agree to work on together. Over the course of meetings facilitated by HCIF, the Partnership prioritized collectively addressing behavioral health needs in the County. 

Key Activities

To understand better the scope and nature of these needs, HCIF conducted analyses of emergency department (ED) utilization data in the County for 2016-2017. Results revealed the high prevalence of depression and anxiety diagnoses among ED patients, as well as the high frequency with which these conditions were comorbid with chronic conditions such as hypertension. The Partnership then considered several specific opportunities for collective action in light of these findings. 

With the goal of pursuing a coordinated, multi-institutional strategy targeting behavioral health issues upstream, the Partnership ultimately identified behavioral health integration in primary care as an opportunity and shared priority in 2018. Accordingly, HCIF established a learning collaborative designed to support Montgomery County-based primary care practices in integrating behavioral health services such as screenings, assessments, short-term therapy, and consultations. The main programming for the collaborative consisted of four half-day learning events over 12 months. 

The behavioral health integration learning collaborative facilitated sharing of best practices, as well as local resources, successful strategies, and lessons learned. Topics covered during the learning events included models of behavioral health integration; patient, staff, and provider engagement; approaches to metrics and quality assurance; and regulatory and financial barriers to integration. The collaborative concluded in September 2019 with an overview of statewide and County-level opportunities for members to continue pursuing these topics collectively.  

Contact: 

Susan Choi, Senior Director, Population Health

schoi@hcifonline.org

Pennsylvania Health Care Quality Alliance (PHCQA)

A multi-stakeholder alliance of hospitals, physicians, health insurers, purchasers and government, the PHCQA is dedicated to promoting responsible public reporting of health care information.  Our aim is to provide reliable, quality data that supports and encourages the delivery of high quality and high value care to patients and their families in the Commonwealth of Pennsylvania.  We believe that by sharing aggregated quality performance data openly through public reporting on the Internet, we can provide valuable, objective information for all patients and purchasers.  On our website, PAHealthCareQuality.org, you can find and compare information about quality of care and patient experience at over 175 hospitals.  

 

Improving Safety of Computerized Prescriber Order Entry through Event-based Testing (CPOE)
 

The CPOE collaborative, funded by the Cardinal Health Foundation and the Partnership for Patient Care, was a one-year collaborative ending in November 2016 that aimed to improve the utilization of hospital CPOE systems so that they provide the maximum safety benefit for patients.  Over the course of the collaborative, the Institute for Safe Medication Practices (ISMP) evaluated the CPOE systems of six participating hospitals for their adequacy in detecting and preventing serious prescribing orders.  Using test scripts developed by ISMP, hospital CPOE systems were challenged with orders known to have caused harm or fatalities.  In doing so, hospital teams learned about their system limitations and vulnerabilities, such as inactivated maximum dose warnings, missing duplicate therapy alerts, the need for decision support for specific populations (such as pregnancy/lactation) and high risk drugs.  ISMP experts provided participating hospitals with specific recommendations for ways to optimize their medication systems and prevent future harm.

Goals:

1. To evaluate the level of medication safety afforded by clinical decision support (CDS) of CPOE systems in regional hospitals

2. To identify opportunities to improve medication safety through modifications to CDS and current practices around the use of the organization’s CPOE system

Contact:

Pam Braun, Vice President, Clinical Improvement

pbraun@hcifonline.org

OB Adverse Events Collaborative
Through Partnership for Patients, the Centers for Medicare and Medicaid Services (CMS) contracted with 26 state and national organizations to create hospital engagement networks (HENs).  These networks promote the use of strategies that foster a culture of safety and offer opportunities for hospitals to participate in projects to reduce adverse events, as well as prevent complications and readmissions. Through Partnership for Patients HEN funding from 2012 – 2016, hospitals across Pennsylvania worked together to establish Pennsylvania’s first obstetric improvement collaborative aimed at reducing maternal adverse events.  HCIF was a subcontractor to the Hospital & Healthsystem Association of Pennsylvania, a HEN.

The program curriculum reflected national quality and safety priorities which have been shown to contribute to maternal and neonatal morbidity and mortality.  Programming consisted of in-person meetings, webinars, networking calls and individualized coaching with project teams.  Activities were designed to yield organizational improvement, sustain results, build physician engagement and accountability, provide intensive support to lower performers, leverage results to drive improvement, foster transparency and trust among hospital providers, establish formal channels for dissemination of best practices, integrate safety culture tools and approaches, engage senior leaders, engage patients and families as partners in their care, and address disparities.

Key Successes and Outcomes:

1. 64% reduction in non-medically indicated early elective deliveries

2. A drop from 13.1% to 1.7% in the rate of severe morbidity in women with pre-eclampsia, eclampsia or pre-eclampsia superimposed on pre-existing hypertension

3. A drop from 16.4% to 4.1% in the rate of severe morbidity in women with maternal hemorrhage

4. 31% reduction in the rate of OB trauma related to vaginal deliveries with an instrument – achieving the lowest rate over a 6-year period during the final reporting month

5. 26% reduction in the rate of OB trauma related to vaginal deliveries without an instrument – achieving the lowest rate over a 6-year period during the final reporting month

Although the collaborative concluded in September 2016, Pennsylvania hospitals are well positioned to continue this important work though the relationships they developed, the strategies they implemented, and the resources and tools they shared with one another.

Contact:

Pam Braun, Vice President, Clinical Improvement

pbraun@hcifonline.org

The PAVE Project: Reducing Readmissions
 

In order to assist hospitals to improve care transitions and reduce readmissions, HCIF launched in May 2010 the PAVE Project (Preventing Avoidable Episodes: Smoothing the Way for Better Transitions), an 18-month regional collaborative to engage health care providers and community-based service organizations across the continuum of care.  Fifty-three organizations, including hospitals and health systems, non-acute providers, and community organizations, collaborated on the PAVE Project.  In order to accelerate the adoption of evidence-based strategies, encourage multi-organizational innovations and experimentation, and develop at least one strategy or achievement with significant regional impact, three workgroups were created:  Medication Management, Personal Health Record, and Care Transitions.

Goals:

1. Reduce readmission rates by 10% over the course of the 18-month project

2. Improve transitions of care from one provider to the next for patients being discharged

3. Increase patient and family engagement in the management of the patient’s health care plan

4. Engage providers and health care professionals within the entire continuum of care

Key Successes and Outcomes:

1. After two years, readmission rates improved from 12.2% to 10.7%.

2. Workgroup members developed various passports to set standards, enable communication, and improve transitions of care among providers.

a. Hospital Care Transitions Passport– A document with contact information for key departments involved in care transitions at the hospitals, as well as a description of the hospital’s care transitions process, in order to improve communication between hospitals and other providers across the continuum of care.

b. Hospital Discharge Passport – A set of standards that incorporates all of the critical components of an effective care transition at the time of hospital discharge.

c. Medication Passport – A set of standards that incorporates all of the critical components of an effective, clear, and concise medication reconciliation and transfer form.

d. Payor Passport – A document with payor contact information to be used by hospital utilization management, emergency department and discharge planning staff as a way to improve communication between hospitals and insurers.

3. Facilities implemented numerous interventions and strategies, including but not limited to:

a. Implementing screening tools to identify inpatients at high-risk for readmission

b. Improving processes to educate patients about their condition

c. Utilizing transition coaches or nurses that follow up with patients after discharge to address issues, answer questions, etc.

d. Providing patients with checklists and reminders

e. Sending discharge summaries to a patient’s primary care physician

Contact:

Pam Braun, Vice President, Clinical Improvement

pbraun@hcifonline.org