Strategic Initiative 4.0: Quality & Safety
Support member hospitals in achieving or exceeding public indicators and best practice benchmarks in quality of care and patient safety through educational opportunities, sharing of data, interpretation of data to the media.
Overview
Better Health Greater Cleveland is one of 17 national projects sponsored by the Robert Wood Johnson Foundation (RWJF) through its Aligning Forces for Quality (AF4Q) program. The strategic goals are to lift the overall quality of healthcare in targeted communities, reduce racial and ethnic disparities, and provide models for national reform. In 2007, MetroHealth Medical Center, was awarded funds to support a local program that focuses on improving the quality of care for patients with selected chronic diseases who receive ambulatory care from 11 primary care provider sites and 10 hospital facilities in Cuyahoga County. In 2008,
The Center for Health Affairs became directly involved with Better Health Greater Cleveland by spearheading a nurse‐led three‐year grant program (Transitions of Care Collaborative [TOCC]) sponsored by RWJF. The strategic goals of TOCC are to focus on reducing unnecessary hospital readmissions and improve discharge practices for patients diagnosed with stroke, coronary artery disease, heart failure and diabetes. Over the past two years, the TOCC has developed a program network among hospital case managers at the 10 participating hospitals to better understand and identify the gaps in the patient discharge process that may lead to unnecessary hospital readmissions. As a result, three pilot projects have been developed at two of the participating hospitals to address several of these gaps and identify best practices to better coordinate patient discharge and overall improve the quality of patient care.
Core Value
Implementing programs that improve care and lower the risk of re‐hospitalization for patients in Northeast Ohio diagnosed with chronic diseases is a key objective for hospitals and healthcareproviders. As the Centers for Medicare and Medicaid Services (CMS)implements changes in hospital reimbursement that directly link payment with patient outcomes and re‐hospitalizations, having an established community effort through Better Health Greater Cleveland
Deliverables
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4.1.1 Best Practices: The TOCC project continues through 2011 with its main focus on tracking the outcomes of the pilot programs established in 2010 and is working towards collecting baseline admission-readmission data in the four chronic diseases identified in the project. A best practices conference for hospitals and other interested healthcare providers will be held in April 2011 to share the program and pilot outcomes.
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4.1.2 Expanded Participation: The TOCC project, given continued funding, will continue its efforts under a new RWJF program, the Hospital Quality Network (HQN). The HQN is open only to hospitals within the AF4Q communities and has three individual rogram entry points: hospital readmissions, emergency department throughput, and language services. Local hospitals may elect to participate in any or all of these initiatives but the local interest in the Greater Cleveland area has been to focus reducing heart failure readmissions by 25 percent over the next two years along with adding diabetes (reduction of 15 percent readmissions) and hypertension. Ten of The Center’s member hospitals have already committed to HQN participation with another three to four hospital commitments anticipated.
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4.1.3 Develop readmission tracking capacity: Collecting patient readmission data in the areas impacted by CMS Medicare reimbursement changes (FY2013) on excess readmissions (heart failure, pneumonia, acute myocardial infarction) is an area that can be evaluated for inclusion as part of The Center’s monthly Volume Statistics report. More closely aligning patient outcomes with the delivery of care and changes in reimbursement are key avenues to improving care and making sure hospitals are reimbursed adequately for the care they provide.
Overview
The Quality Collaborative is a shared venture that seeks to improve quality of care delivered in various regions throughout the state. Collaborative initiatives already exist in the Greater Dayton area, Central Ohio, the Greater Cincinnati area, and Northeast Ohio. The Northeast Ohio collaborative currently includes 35 hospitals from the membership of the Akron Regional Hospital Association. As a champion for quality care delivery in Northeast Ohio, The Center for Health Affairs plans to engage in the Northeast Ohio Quality Collaborative to allow its membership the opportunity to improve the quality of care delivered in the Greater Cleveland area. Participation in this initiative is currently in the planning phase.
Core Value
The Quality Improvement Collaborative has already shown the potential to improve the quality of care. In Northeast Ohio, for instance, an initiative focused on the performance of pneumonia care resulted in significant improvement — with an additional 20 percent of patients receiving recommended pneumonia care just over two years after the project began. The existing collaborative is currently evaluating opportunities to reduce 30‐day readmission rates for heart failure patients. The Center for Health Affairs is poised to make a significant contribution to this effort with its experience with the Better Health Greater Cleveland Transitions of Care Collaborative, a Robert Wood Johnson Foundation grant‐based initiative pinpointing strategies and making headway in methods to reduce avoidable readmissions. Regional adoption of best practices can serve to improve care for the many communities of Northeast Ohio. The Center for Health Affairs’ participation in the collaborative will be mutually beneficial, as The Center’s members both learn about others and share their own best practices with the regional and state hospital community.
Deliverables