Transcript National Pediatric Quality and Safety Collaboratives

Quality and Safety Collaborative
The Value of a State
Collaborative
Driving Forces
• Shift to Pay for Performance
• Medicaid managed care quality improvement strategy - Pay 4 Quality
• Potentially Preventable Events (PPEs) - penalty and incentive
program
• 1115 Waiver Delivery System Reform Projects (DSRIP)
• Public reporting by government entities
-- DSHS Hospital-Acquired Infections (HAI) reports
-- Texas Healthcare Information Council (THCIC) published outcome reports
• Resource Constraints and Common Needs
-- Learn together faster
-- Pool data for stronger conclusions
-- Share best practices
-- Providers, staff and patients move around Texas
-- Viability of children’s hospitals/advocacy
2
National Pediatric
Quality and Safety
Collaboratives
• Children’s Hospital Association (CHA) Quality Transformation
Network
• Solutions for Patient Safety (SPS)
• Vermont Oxford Network (VON)
• American College of Surgeons, National Surgical Quality
Improvement Program for Pediatrics (NSQIP)
• Cystic Fibrosis Foundation Care Center Network
• National Pediatric Cardiology Quality Improvement Collaborative
(NPC QIC)
• Pediatric Rheumatology Care and Outcomes Improvement
Network (PR-COIN)
• Pediatric Anesthesia Wake Up Safe Collaborative
• Pediatric Gastroenterology Improve Care Now (ICN) Network
3
What are QI Collaboratives?
•
Quality improvement collaboratives:




•
Networks for shared learning
Translate research into practice
Discover new knowledge
Close quality gaps/improve care and outcomes
One model for systems and capabilities requirements:







Evidence informed content
Quality improvement
Project management
IT infrastructure
Data management
Analytics
Research capabilities/generation of new knowledge
Lannon Pediatrics 2013
4
CHAT Quality and
Safety Collaborative
Rationale
• Standardization of practice within an institution will
improve efficiency and effectiveness of care.
• Standardization of practice throughout the CHAT
hospitals will allow for:
-- aggregate learning;
-- economies of scale in data management; and
-- acceleration of discovery for best practices.
• Rapid cycle improvement will occur in multiple cycles.
• Data will drive improvement and demonstrate value.
5
CHAT’s Vision
Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of
Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts:
Institute for Healthcare Improvement; 2012
6
CHAT Members
Partnership of 7 non-profit Texas children’s
hospitals







Children’s Health
The Children’s Hospital of San Antonio
Cook Children’s
Covenant Children’s
Dell Children’s
Driscoll Children’s
Texas Children’s
7
Timeline & History
2010 - CHAT Quality Steering Team Established
2012 - CHAT Asthma Collaborative Started
2/2016 - Texas Regional SPS Collaborative Started
6/2016 - CHAT Asthma Collaborative Completed
7/2016 - CHAT Bronchiolitis and Sepsis Collaboratives
Started
Est. 6/2018 - CHAT Bronchiolitis and Sepsis Collaboratives
Complete
8
CHAT Quality and Safety
Collaborative journey
2017-2018
2016
2016
2012
Phase I:
Asthma
collaborativeproof of concept
Phase IIb:
Incorporate
SPS safety
Phase IIa:
collaborative
Expand diseasespecific
collaboratives
(bronchiolitis &
sepsis)
Phase III:
Utilize
outcomes to
demonstrate
value, model
for pediatric
payment
and
healthcare
reform
Project Selection &
Prioritization
• High volume patient visits
• High cost cases
• High degree of variation (with opportunity for
standardization of care through evidence based
practice, existing national initiatives, etc.)
• High risk for patient harm
10
CHAT: Asthma Quality
Collaborative
Goals and Objectives
Overarching goal: to improve quality and safety of care
in CHAT hospitals
• Development and adoption of evidence-based pathways for ED
and inpatient management
• Formation of an intervention bundle for patient care
• Identification of disease-related and financial performance
measures
• Data collection, analysis, and reports to drive iterative rapid cycle
improvement
• Proof of concept for state collaborative model
11
Taskforce Deliverables
Implementation Taskforce
o Implementation key driver diagram
o Intervention bundle (ED and IP/OBS)
o Asthma best practice matrix
o ED and IP/OBS discharge checklist
Education Taskforce
o Education key driver diagram
o Education primer
o Pre and post assessments
o Additional data primers (YouTube videos)
Metric Taskforce
o Identification of metrics (ED and IP)
Culture Taskforce
o Strategies to enhance the promotion of quality improvement-related
culture among CHAT hospitals
o Talking points for the collaborative
o Information about CHAT for brief media snippets and for legislators
Asthma Outcomes
Deliverables:
• Emergency Medicine Algorithm
• Inpatient Algorithm
• Reflects continuum of care from initial ED evaluation
through discharge from inpatient unit
Collaborative reduced:
• 14 day readmission rate by a relative 58%
• 6 month readmission rate by a relative 70%
• Decreased Average Length of Stay (ALOS)
• Decreased overall costs for most participating hospitals
13
Current Initiatives
Disease-specific
• Bronchiolitis management improvement project
• Sepsis recognition and management improvement project
Safety
• Texas Regional Solutions for Patient Safety
14
Aim Statements
Global AIM: Achieve the Institute for Healthcare Improvement’s Triple AIM for children
in Texas: Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and Reducing the per capita cost of health care.
Strategic AIM1: Lead and facilitate process and outcomes improvement for diseasespecific quality collaboratives to achieve the Triple AIM elements.
Strategic AIM2: Lead and collaborate with safety initiatives, like Solutions for Patient
Safety, to eliminate preventable harm.
Strategic AIM3: Leverage collaborative learning and outcomes to partner with state
and national agencies and payors for …
Specific AIMs:
•
Reduce cost of pediatric healthcare (PPEs & Asthma) - July 2018
•
Reduce waste in pediatric healthcare (Bronchiolitis) - July 2018
•
Improve outcomes/ morbidity & mortality for pediatric patients (Sepsis) - July
2018
•
Align definitions for state reports and collaborative efforts - July 2019
•
Improve safety in pediatric healthcare (SPS) - Establish Texas Regional SPS
structure & process Jan. 2017; outcome eliminate harm
15
Questions?
823 Congress Avenue, Suite 1500, Austin, Texas 78701 l (512) 320-0910 l www.ChildHealthTX.org