Transcript Doing Well By Doing Good - Virginians Improving Patient Care and

Founded by The Business Roundtable
Supported by the Robert Wood Johnson Foundation
2003: Improvements and Other
Changes
Francois de Brantes
May, 2003
To Err Is Human:
Building a Safer Health System
 Institute
of
Medicine
 Committee
on
Quality of Health
Care in America
The Quality Imperative
Low Back Treatment Overuse
Post Heart Attack Medications Underuse
Mammography Screening Underuse
DPMO
1,000,000


100,000
Antibiotic Overuse
 
93% good

10,000
99.4% good
44,000 - 98,000 Preventable
Hospital Deaths (IOM)
1,000
99.98% good
100
Anesthesia During Surgery

10
1
1
2
3
4
5
6
SIGMA
© 1994 Dr. Mikel J. Harry - V4.0
Breaking The Status Quo
LOW
Provider
Universe Today
Efficiency
Provider Universe
Tomorrow
HIGH
LOW
HIGH
Effectiveness of Care
Removing The Barriers ToChange

Meaningful Measures

Engage Consumers

Engage Hospitals
Three Leaps – 1st Generation

An Rx for Rx
– Computer Physician Order Entry (CPOE)
– 85% serious drug errors prevented
– Net cost savings

Practice Makes Perfect
– Evidence-based Hospital Referral (EHR)
– > 20% mortality reduction for 7 complex treatments

Sick People Need Special Care
– ICU Daytime Staffing with CCM Trained M.D.
– > 10% mortality reduction
– Net cost savings
Leap Refinements
FROM
CPOE
2004/2005
Implementation
targets
IPS
2002/2003
Implementation
targets
IPS
In development
Telemedicine
TO
2005/2006
2004/2005
Allowed
Strong emphasis on integrated Information Systems
Leap Refinements – EHR
FROM
TO
CABG
500 per year
550 for last 12 mos or as
annual avg over 24 mos
PCI
Coronary
Angioplasty
All PCIs, 400 for last 12 mos
or as annual avg over 24
mos
AAA repair
30 per year
50 for last 12 mos or as
annual avg over 24 mos
Carotid
Endarterectomy
100 per year
Eliminated
Esophageal
cancer surgery
7 per year
8 for last 12 mos or as
annual avg over 24 mos
Pancreatic cancer
surgery
Not measured
6 for last 12 mos or as
annual avg over 24 mos
R/A State-reported outcomes not allowed for VA
Leap Refinements – Process

Revised survey ready

All hospitals asked to re-submit in Q2

New results posted in Q3 & Q4

Same process on-going
M
easures – Beyond Leapfrog
31
5
NQF Group 1 ~ “ORYX”
CMS/AHA
“Pilot 10”
UCSF/
AHRQ
“Top 11”
Leapfrog
“2 + 6”
44 Unique Measures:
• 8 outcomes – infections or r/a
mortality
• 6 volumes – number of
procedures or patients
• 3 structural processes – CPOE,
ICU, discharge plans
• 27 clinical indicators –
medication admin, interventions
NQF Group 2
8
+ a number of other structural safe practices measures to create a
comprehensive overview of hospital performance.
EngageConsumers

Heart
– FACCT Toolkit
– NEJM survey results
NEJM 12-12-2002
EngageConsumers

Health
Grades
Heart
– FACCT Toolkit
– NEJM survey results
Subimo

Mind
DQ
– Web Hits
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
1st Qtr
2nd Qtr
2002
3rd Qtr
4th Qtr
SQC
EngageConsumers

Heart
– FACCT Toolkit
– NEJM survey results

Mind
– Web Hits

Wallet
– Co-pays,
co-insurance,
PBAs
Engaging Hospitals

Mind
– Thousands of press hits
– Letters from plans
Almost 60% of hospitals in
targeted regions fill out
survey…30% of all targeted
Hospitals
Engaging Hospitals

Mind
– Thousands of press hits
– Letters from plans

Wallet
– Direct
– Indirect
M
aking The BusinessCase

Determine impact of mechanisms to close
net shortfall:
– Direct $$
– Intensivist reimbursement
– Bonus payments (e.g. x + x%)
– Award
– Volume shift
Pilots
underway
now…mo
re to
come!
– Indirect $$
– Cost of capital
– Reduced liability/malpractice premiums
M
easuring Results
Counting down to Zero
“all missing” for
non-reporting
hospitals
Σ
Σ
Missing Appropriate Leaps per
Patient (n) per Hospital Stay
n
Appropriate Leaps per Patient (n)
per Hospital Stay
= % Defects
n
Make all accountable: plans, purchasers,
providers, and patients
Reducing Avoidable Deaths
Leap
CPOE CABG Angio
AAA
Endart Esoph
NICU
IPS
Observations
28,324
307
425
30
122
2
80
2,405
Defects
27,134
145
100
15
77
1
39
1,881
Leap-specific Defect 95.80% 47.20% 23.50% 50.00% 63.10% 50.00% 48.80% 78.20%
Rate
Differential Risk
0.2
9
2.8
25
1.4
99.1
43.3
18
(deaths) per 1000
Defects
Avoidable Deaths
Full Adoption
5.7
2.8
1.2
0.8
0.2
0.2
3.5
43.3
Remaining
5.4
1.3
0.3
0.4
0.1
0.1
1.7
33.9
Totals
Avoidable Deaths – full adoption
57.5
Avoidable Deaths – remaining
43.1
Weighted Defect Rate
75.00%
Modify and refine model to reflect Leap changes
… and continue the countdown to zero.
That’s one small step for all of us,
one giant leap for patient safety.