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CAH and Small, Rural Hospital Performance Improvement

NC/SC Small Rural Hospital Conference. CAH and Small, Rural Hospital Performance Improvement . November 9, 2010. NC Office of Rural Health and Community Care Matt Womble matt.womble@dhhs.nc.gov. NC Center for Rural Health Innovation and Performance Jeff Spade jspade@ncha.org.

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CAH and Small, Rural Hospital Performance Improvement

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  1. NC/SC Small Rural Hospital Conference CAH and Small, Rural Hospital Performance Improvement November 9, 2010 NC Office of Rural Health and Community Care Matt Womble matt.womble@dhhs.nc.gov NC Center for Rural Health Innovation and Performance Jeff Spade jspade@ncha.org

  2. NC Center for Rural Health Innovation and Performance NC Office of Rural Health and Community Care Rural Hospital Performance Improvement Portfolio • CMS Core Measures(inpatient & outpatient) • Board Quality Curriculum • 340B Drug Program • AHRQ Culture of Patient Safety Survey • HIT Strategic Plan • Lean Culture Transformation Collaborative • Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) • Healthcare Leadership Quality Assessment Tool (HLQAT) • Trauma, Cardiac and Stroke System Development • Pediatric Emergency Care Pilot • Community Paramedic Program • Telehealth

  3. Core Measure Improvement Collaborative • Commitment by 30 small, rural hospitals to improve core measure performance. • Working to accomplish 95% process reliability. • Partnership with NC Office of Rural Health, NCHA and CCME. • Small, rural hospitals will enroll in the Hospital Outpatient Quality Data Reporting Program by submitting data for 11 quality measures for Acute Myocardial Infarction (AMI), Chest Pain (CP), Surgery, and Imaging Efficiency Measures. • Purpose: Small, rural hospitals working together to achieve high reliability in CMS core measures. • Outcomes: Over 200% improvement in pneumonia care and more than 120% improvement in heart failure care.

  4. Core Measure Improvement Collaborative • Expectations: All CAHs participating by submitting relevant measures. • Funding Source: Assistance made possible through the NC Flex Grant. • Internet Resources: http://www.qualitynet.org • When: Enrollment starting October 1, 2010 • To Enroll: Enrollment is online at http://www.qualitynet.org • For Questions: • Contact Jeff Spade, NCHA (jspade@ncha.org) for questions about the collaborative.

  5. NC Top 10% 203% Improvement 26.4% in 2004

  6. 95% Reliability NC Top 10%

  7. Transparency and Reliability A process achieves exactly the results it is designed to achieve.

  8. Starting Labels of Reliability • Chaotic process: Failure in greater than 20% of opportunities • 10-1: 80 or 90 percent success. 1 or 2 failures out of 10 opportunities • 10-2: 5 failures or less out of 100 opportunities • These are IHI definitions and are not meant to be the true mathematical equivalent.

  9. NC Top 10% 203% Improvement 26.4% in 2004

  10. NC Top 10% 95% Reliability

  11. NC Top 10% 122% Improvement 34.2% in 2004

  12. First Health Montgomery 97% performance www.nchospitalquality.org

  13. www.nchospitalquality.org Duplin General 98% performance

  14. Sample Quality Dashboard

  15. Combined Indicators

  16. Outpatient Quality Measures OP-1 Median Time to Fibrinolysis OP-2 Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival OP-3 Median Time to Transfer to Another Facility for Acute Coronary Intervention OP-4 Aspirin at Arrival OP-5 Median Time to ECG OP-6 Prophylactic Antibiotic Initiated Within One Hour Prior to Surgical Incision OP-7 Prophylactic Antibiotic Selection for Surgical Patients OP-8 MRI Lumbar Spine for Low Back Pain OP-9 Mammography Follow-up Rates OP-10 Abdomen CT Use of Contrast Material OP-11 Thorax CT Use of Contrast Material

  17. Board Governance of Quality • Board governance curriculum on the critical topic of Improving Board Governance of Quality and Patient Safety. • Organized as a four to six-hour board retreat. • designed to help hospital trustees understand, evaluate and improve their governance of quality by creating a board action plan. • Quality Curriculum may be offered as a one-day board retreat or a two-day session. • Purpose: To improve Board Governance of Quality for 30 small, rural NC hospitals. • Eligibility: Small, rural hospitals and CAHs (rural hospitals less than 50 ADC)

  18. Board Governance of Quality • Outcomes: Conducted four pilot Board Retreat sessions, culminating in Governance of Quality improvement plans. • Expectations: Hospital cost: $1,000 plus meeting expenses. Total value of Board Retreat: over $10,000 for facilitator, materials, and license fees. Hospitals are responsible for organizing the board retreat, scheduling meeting space, developing agenda and ensuring the participation of board members and senior leadership. • Funding Source: Assistance made possible through the NC Flex Grant. • When: Reservations accepted for Board Retreats starting November 2010. • For Questions & To Enroll: Jeff Spade, NCHA

  19. 340B Drug Program • The 340B Drug Pricing Program is an outpatient drug purchasing program that achieves significant discounts for eligible hospitals. The 340B program was recently expanded to include critical access hospitals and lower disproportionate share hospital (DSH) requirements for sole community hospitals. • Purpose: To enroll all NC rural hospitals that are eligible to participate in the 340B drug pricing program. • Eligibility: Non-profit or public hospitals with a DSH percentage > 11.75%. All non-profit and public CAHs. Non-profit and public sole community hospitals with a DSH percentage > 8%.

  20. 340B Drug Program • Outcomes: 56 NC hospitals enrolled, including 3 CAHs. • Support: Technical assistance made possible through the NCORH and The Duke Endowment. • Internet Resources:http://www.hrsa.gov/opa/ • http://pssc.aphanet.org/default.htm • When: Enrollments are accepted quarterly. Application materials must be submitted 30 days in advance of the new quarter. • To Enroll: Register through Office of Pharmacy Affairs, HRSA: www.opa.net.hrsa.gov/OPA • For Questions and Technical Assistance:Jeff Spade(jspade@ncha.org)

  21. AHRQ Culture of Patient Safety Survey • The NC Center for Hospital Quality and Patient Safety has partnered with The Patient Safety Group to provide an electronic tool to administer this important measurement of culture. • The AHRQ survey is easy to setup, simple to administer and the results are instant. • Hospitals can benchmark results to the national AHRQ data. • Purpose: All CAHs and small, rural hospitals (< 30 ADC) to perform AHRQ survey to guide quality and patient safety improvements. • Eligibility: CAHs and small, rural hospitals (< 30 ADC).

  22. AHRQ Culture of Patient Safety Survey • Expectations: Conduct AHRQ survey, review comparative results and participate in collaborative learning opportunities. • Cost: Enrollment with Patient Safety Group is subsidized. • Funding Source: Assistance to pay for survey and access to tools provided by the NC Center for Hospital Quality and the NC Flex Grant. • Internet Resources:www.ncqualitycenter.org • www.patientsafetygroup.org • When: Reservations accepted from CAH and small, rural hospitals starting October 2010. • To Enroll: Dean Higgins, NC Center for Hospital Quality (dhiggins@ncha.org) (919) 677-4212

  23. HCAHPS • A national, standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience and their perspectives of care. • Purpose: To ensure that all small, rural hospitals and CAHs collect, report and improve HCAHPS measures. • Eligibility: All hospitals are eligible for technical assistance. • Outcomes: 11 CAHs currently reporting HCAHPS measures. • Funding Source: Assistance made possible through the NC Flex Grant. • Internet Resources:www.hcahpsonline.org • To Enroll: Complete an application for Flex Funding. • For Questions:Matt Womble, NCORHCC (matt.womble@dhhs.nc.gov)

  24. Medication Safety Project • 29 SHIP-eligible hospitals joined together to form the NC Collaborative for Medication Safety (NCCMedS). • The pilot began September 1, 2010, through August 31, 2011. • Purpose: To collectively improve the safety of inpatient medication delivery. • Eligibility: Only SHIP-eligible hospitals can participate at this time. • Expectations: Hospitals voluntarily submit SHIP funding for the project and are expected to participate in the on-site consultation and engage the hospital and medical staff in the medication safety improvement effort.

  25. Medication Safety Project • Funding Source: 100% funded by participating SHIP-grant dollars • Internet Resources: SHIP grant website: http://www.raconline.org/funding/funding_details.php?funding_id=64 • NCCMedS website in development • When: SHIP grant cycle deadline is April 2011. • To Enroll: SHIP-eligible hospitals that wish to join should submit their SHIP application during the next SHIP grant cycle (April 2011) to be part of the NCCMedS. • For Questions:Matt Womble, NCORHCC (matt.womble@dhhs.nc.gov)

  26. Trauma Cardiac and Stroke System Development • Purpose: A state-wide effort to improve the system of care for patients who suffer from traumatic injury, myocardial infarctions and stroke. • Funding Source: Rural Trauma System Coordinator is funded 100% by the NC Flex Grant. • To Enroll: Express interest in participating in a community assessment to Matt Womble, NCORHCC. • For Questions: Beth Diaz, Rural Trauma System Coordinator with the NC Office of EMS: (Beth.Diaz@dhhs.nc.gov) or 919-855-3965. • General questions: Matt Womble, NCORHCC (matt.womble@dhhs.nc.gov)

  27. Trauma Cardiac and Stroke System Development • Expectations: Hospitals and physicians drive this facilitated process locally and regionally. Staff and support will be provided for this effort but hospitals and their medical staff must take a very active and participative role in this effort to ensure its success. • Funding Source: Rural Trauma System Coordinator is funded 100% by the NC Flex Grant. • To Enroll: Express interest in participating in a community assessment to Matt Womble, NCORHCC. • For Questions: Beth Diaz, Rural Trauma System Coordinator with the NC Office of EMS: (Beth.Diaz@dhhs.nc.gov) or 919-855-3965. For general questions: Matt Womble, NCORHCC (matt.womble@dhhs.nc.gov)

  28. Rural HospitalPilot Projects • Rural Hospital Lean Culture Transformation • HIT Strategic Planning • Community Paramedicine Program • Critical Access for Pediatric Emergencies

  29. Improvement and Project Options • Self-Help and GoldenLEAF Loan Program • Triple AIM for Rural Hospitals and Networks • NC Center for Hospital Quality Collaboratives • NC AHEC Programs and RECs • Lean Management Learning Opportunities

  30. Scholarships for CAHs Quality Improvement (up to $500 per hospital) • NC Center for Hospital Quality Center • NC AHEC Programs (QI 101 & 201) • NC State University (Lean Healthcare) • IHI Open School ($250 per person) • IHI Forum (apply to IHI, then NCHA) • Apply to Jeff Spade, NCHA IHI Passport ($2,500 – hospitals under 50 beds) • Apply to Matt Womble, NC ORH

  31. Portfolio Reservation • Place Hospital Name at top • Check the Portfolio Service and the quarter

  32. NC/SC Small Rural Hospital Conference CAH and Small, Rural Hospital Performance Improvement November 9, 2010 NC Office of Rural Health and Community Care Matt Womble matt.womble@dhhs.nc.gov NC Center for Rural Health Innovation and Performance Jeff Spade jspade@ncha.org

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