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The Quality Improvement Support Collaborative: Working together!. Leslie Schultz, PhD, CPHQ, Director, Premier Healthcare Informatics. Why a Support Collaborative?. Challenge. Front line healthcare workers see themselves as relatively unsupported in their efforts to improve care.

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The quality improvement support collaborative working together l.jpg

The Quality Improvement Support Collaborative:Working together!

Leslie Schultz, PhD, CPHQ,

Director, Premier Healthcare Informatics



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Challenge

  • Front line healthcare workers see themselves as relatively unsupported in their efforts to improve care.

  • Meanwhile, a number of organizations see themselves as supporting improvement and seek to be more supportive.


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Response

In December 2001, CMS, IHI, Premier and VHA met to find ways of working together; in January 2002 they joined with JCAHO and NCQA to form the Quality Improvement Support Collaborative (QISC).


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Goals

  • Conduct pilot collaborative projects to support specific improvement goals.

  • Collaborate in providing information to support improvement.

  • Reduce the burden of data collection and quality improvement.

  • Make frontline providers more aware of ways in which QISC organizations and others can support them.


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Pilot Collaborative Improvement Support Projects

  • Heart attack and heart failure

  • Inpatient settings

  • Maryland and Louisiana (two States where QIOs,VHA and Premier were interested and capable).


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Information & Web Sites

  • CMS, IHI, AHRQ, Premier, VHA, JCAHO and NCQA run or are building web sites to support improvement.

  • To date -- few efforts to link support of improvement information.

  • The QISC organizations committed to collaborating to make web sites easier for frontline workers to use.


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Reduce Burden

  • CMS and JCAHO have converged their measures (a hospital collecting Oryx (JCAHO) measures can use them directly to participate in QIO (CMS) improvement efforts; CMS tools collect Oryx data.

  • All QISC organizations support the National Quality Forum effort to identify and endorse national measure sets for multiple settings.


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Awareness

  • Most hospitals are (vividly) aware of Oryx requirements!

  • They may be less aware of the existence of either regional or national programs supporting improvement activities.


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The QISC Pilots

Louisiana

Maryland


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Louisiana QISC

  • Background & Environment

    • 118 Acute Care Hospitals in Louisiana

    • ~70% JCAHO accredited and working on one or more core measure projects

    • NO legislative mandate on quality reporting

    • high utilization (Medicare expenditure) per hospital bed


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LA QISC: Goals of collaborative

  • Improve the quality of cardiac care provided to citizens of Louisiana.

  • Provide hospitals an opportunity to give input on national measures, given near inevitability of public reporting.

  • Contribute to an understanding of the real data burden involved in creating a public data set.


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LA QISC Challenges

  • Recruitment

    • requires individual soliciting - getting the right mix of players

    • hospitals concerned about added “burden”

  • Public reporting

    • working through the cycle of fear


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MD QISC: Challenge of the Local Environment

  • Public reporting already in place-administrative data and chart data

  • Regulated environment-MHCC, HSCRC, Office of Health Care Quality, JCAHO, Delmarva

  • Decreasing profitability

  • Increasing demand for accountability

  • Increasing resistance from hospitals for unfunded mandates


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Quality Improvement Overload

  • Get With the Guidelines

  • Guidelines Applied in Practice

  • National Registry for Myocardial Infarction

  • Crusade Registry

  • CMS 7th SOW (Delmarva)

  • And more…


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MD QISC: Goals of collaborative

  • Coordination: One coordinated project for chosen topic area

  • Burden: Commitment to use of existing data where possible and link to Core Measures

  • Linkage: Focus QI efforts on publicly reported measures

  • Executive Involvement: steering group composed of senior leadership

  • Cost/Benefit: Involvement of state rate setting agency


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Status of Pilots

  • LA QISC:

    • recruited “work group” from interested hospitals to provide input and direction in the planning of the collaborative;

    • first work group meeting scheduled for Feb. ‘03

    • first full collaborative group meeting anticipated in May ‘03

  • MD QISC:

    • recruited “steering committee” from interested hospitals to provide input to the type and nature of assistance the QISC could provide;

    • convening two work groups: a data management group and a “paying for quality” group


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Challenges for the Pilots!

  • Multiple quality agendas with pride of ownership

  • Too many cooks

  • Competitive environment

  • Uncertainty of what else “they” will dream up

  • Ability to maintain focus and momentum

  • Engagement of senior leadership and Board


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Questions???

Leslie Schultz, PhD, CPHQ,

Director, Premier Healthcare Informatics 704.733.5209

[email protected]


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