The 10 th SOW and How is Aligns with the State Hospital Associations

1. CLABSI Supplemental Call The 10th SOW and How is Aligns with the State Hospital Associations February 21, 2012 1pm CST/2pm EST

2. Reducing Healthcare-Associated Infections Through Partnerships Marge Cannon, MD Medical Officer CMS, Quality Improvement Group

3. OBJECTIVES • What are the projects in the 10th SOW that focus on reducing healthcare-associated infections? • How are the principles of CUSP incorporated into QIO work in the 10th SOW? • What are QIOs contractual requirements in the 10th SOW as they relate to CUSP in both the CLABSI and CAUTI projects?

4. AIMS IN THE 10th SOW • BENEFICIARY AND FAMILY-CENTERED CARE • IMPROVING INDIVIDUAL PATIENT CARE • IMPROVE HEALTH FOR POPULATIONS AND COMMUNITIES • INTEGRATE CARE FOR POPULATIONS AND COMMUNITIES (CARE TRANSITIONS)

5. Improving Individual Patient Care (IIPC) • Reducing Healthcare-Associated Infections • Reducing Healthcare-Acquired Conditions in Nursing Homes Collaborative • Reducing Adverse Drug Events • Quality Reporting and Improvement

6. Reducing Healthcare-Associated Infections • Central line-associated bloodstream infections (CLABSI) • Catheter-Associated Urinary Tract Infections (CAUTI) • Clostridium difficile infections (CDI) • Surgical Site infections (SSI)

7. Reducing Healthcare-Associated Infections • 18 QIOs are working to reduce CLABSI in ICU and non-ICUs • Those states that exempted from CLABSI work because of low rates are encouraged to have their high-performing facilities serve as mentors and participate in LANs • Continued declining CLABSI rates need to be tracked and monitored for sustainability

8. Reducing Healthcare-Associated Infections • All 53 QIOs are participating in CAUTI reduction activities • Use of trigger tools to prompt unnecessary catheter removal, tracking and monitoring system for compliance with hand hygiene and data reporting including use of central line insertion practices (CLIP) protocol to NHSN are some of components of HAI reduction initiative

9. Reducing Healthcare-Associated Infections: More on the “How?” • The “HOW” is not generally prescribed to the QIOs but large focus is on applying the following principles to pt-centered care: • Use of Evidence-Based Practices • Promoting a culture of safety • Engaging leadership • Educating and empowering staff at all levels • Teamwork, collaboration • Using data and measurement to guide progress and feedback

10. Reducing Healthcare-Associated Infections “LOOK FAMILIAR?”

11. Reducing Healthcare-Associated Infections Emphasis on these guiding principles is why training in the Comprehensive Unit-based Safety Program is included as one of the contractual tasks in the 10th SOW

12. Partnering with AHRQ • Reducing Healthcare-Associated Infections sub-AIM of 10th SOW was written in collaboration with federal partners: AHRQ, CDC and OASH • We continue to collaborate in order to coordinate AHRQ-sponsored CUSP initiatives with QIO work

13. Partnering with AHRQ • Recent 10th SOW contract modification written to change deliverable date so that QIOs could take advantage of HRET-sponsored CUSP training • Feb 7th, 2012: HRET-sponsored CUSP training webinar for QIOs • March 7th, 2012: HRET-sponsored CUSP training for QIO-recruited hospitals

14. Reducing Healthcare-Associated Infections • We recognize that no one entity can drive infections to zero alone • Spreading best practices through LANs, collaboration and effective partnerships are key strategies and performance indicators for QIOs in the 10th SOW and beyond

15. Partnership to Reduce HAIs Nancy Vecchioni, RN, MSN, CPHQ MPRO Jenny Finks Michigan Department of Community Health Chris George,RN MS, Michigan Health & Hospital Association Jodie Elsberg Michigan Health & Hospital Association

16. Partnership to Reduce HAIs Michigan Experience

17. Partnership to Reduce HAIs • MPRO • CMS’s designated Quality Improvement Organization (QIO) for MI • Contracting with CMS since 1985 • Statements of Work are for three years • Each state has a designated QIO

18. Partnership to Reduce HAIs • MPRO results • MRSA reduced by 49 percent in Michigan • 32 percent increase in antibiotics administered within one hour of cut time • 49 percent increase in antibiotics discontinued within 24 hrs • 18 percent increase in the ordering of post op anticoagulant therapy • 19 percent increase in anticoagulant therapy provided in a timely basis • Greater than 100 percent increase in breast and colon cancer screenings and influenza and pneumococcal immunizations •  Reduced readmissions from 31 per 1000 admissions to 27 per 1000 admissions • Total estimated Medicaid savings of 26 million dollars for pre-authorization reviews over last ten years

19. Partnership to Reduce HAIs • MPRO • Currently in 10th SOW • Beneficiary & Family Centered Care • Improve Individual Patient Care • Integrate Care for Populations & Communities • Improve Health for Populations & Communities

20. Partnership to Reduce HAIs • The MHA Keystone Center uses evidence-based best practice in combination with cultural improvement to effect change in patient safety and quality. • Cohesive commitment to top performance • We can achieve broad scale improvement by working together; Patient Safety and Quality are Not Competitive – the tide raises all ships. • United voice to practitioners • Support for evidence-based care • Rigorous measurement • Create and sustain a culture of No preventable harm Vision: Health care that is free of harm

21. Partnership to Reduce HAIs MHA Keystone Center Results • Decreased central line-associated bloodstream infections by 67 percent. • Decreased ventilator-associated pneumonia by over 70 percent. • Reduced the use of urinary catheters by 25 percent. • Improved the number of new born with Apgar Scores greater than 7 by 50 percent. • Saved an estimated 1,800 lives, reduced hospital days by more than 180,000 and avoided over $300 million in costs since 2004.

22. Partnership to Reduce HAIs MHA Keystone Center HEN

23. Partnership to Reduce HAIs MHA Keystone Center HEN

24. Partnership to Reduce HAIs • Michigan Department of Community Health – MDCH will protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations. • Surveillance of Healthcare-Associated and Resistant Pathogen Unit (SHARP): • Coordinate activities related to HAI surveillance and prevention in Michigan • Improve surveillance and detection of antimicrobial-resistant and healthcare-associated infections • Identify and respond to disease outbreaks • Use collected data to monitor trends • Educate healthcare providers and the general public

25. Partnership to Reduce HAIs • In 2009 the SHARP unit convened the Michigan HAI Advisory Group, chaired by the SHARP HAI Coordinator • The HAI Advisory Group consists of representatives from: • MPRO, Michigan’s Quality Improvement Organization • Michigan Health & Hospital Association • Michigan Infectious Disease Society • Professional Infection Control Organizations • Michigan Association of Local Public Health • Clinical Microbiology Organization • Long Term Care Representatives • Consumer Advocate • In 2009 the HAI Advisory Group submitted the Michigan HAI Surveillance and Prevention Plan to HHS

26. Partnership to Reduce HAIs • MDCH SHARP HAI Surveillance Activities • Since 2009, hospitals voluntarily shared their National Healthcare Safety Network (NHSN) HAI data with MDCH SHARP • 54 hospitals currently share data • MDCH SHARP releases hospital de-identified aggregate reports depicting Michigan HAI trends • Data are analyzed quarterly and semi-annually • Participating facilities receive individual hospital reports semi-annually • Hospitals may sign a Data Use Agreement Addendum which allows MDCH SHARP to share NHSN HAI data with specified entities • MHA Keystone Center for Patient Safety and Quality • Michigan’s Vermont Oxford Network (VON) NICU Collaborative • Monthly education and training webinars • Aid healthcare facilities with NHSN data entry and analysis

27. Partnership to Reduce HAIs • MDCH SHARP HAI Prevention Initiatives • In addition to supporting HAI initiatives throughout the state, MDCH SHARP implemented the following HAI prevention initiatives • Methicillin-Resistant Staphylococcus aureus and Clostridium difficile Prevention Initiative (started in 2011) • Collaborative group of infection control experts, quality improvement organization, healthcare providers, and consumer advocates • Goal is to reduce MRSA and CDI in acute care hospitals and long-term care facilities recruited into the initiative through evidence-based best practices • The initiative will provide education resources, trainings, technical assistance, tool kits, and consultation to help facilities reduce their MRSA and CDI rates • Carbapenem-Resistant Enterobacteriaceae Prevention Initiative (2012) • Collaborative effort of clinical microbiologists, infection control experts, acute and long-term acute care facilities, and academia • Goal is to reduce CRE in participating facilities • Identify and implement best practice recommendations across the healthcare continuum to reduce the burden of CRE • Collaborative group to be convened in the upcoming months

28. Partnership to Reduce HAIs Prior to the Affordable Care Act • Misalignment of programs caused • Confusion by participating facilities • Participants pulled in multiple directions • Duplication • Excess data burden • Voices of our participants were not heard

29. Partnership to Reduce HAIs PARTNERSHIP Joining together to increase the likelihood of each organization achieving their goal and to amplify their reach

30. Partnership to Reduce HAIs Synergistic not Competitive • 10th SOW – QIOs, Hospital Engagement Networks and State Health Departments • HAI • 10th SOW – QIOs, Hospital Engagement Networks • ADE • Reducing readmissions • Surgical Site Infections

31. Partnership to Reduce HAIs Aligning Activities • 10th SOW – HAI • Developed recruitment materials that demonstrated partnership • No duplication • Utilizing existing Learning and Action Networks • CAUTI, CLD, SSI, MI STA*AR • Boots on the ground • Quarterly partnership planning meetings • Data use agreements • Combined feedback reports to participants • Developed a Cross Walk for the various initiatives

32. Partnership to Reduce HAIs QIOs Hospital Associations Health Departments

33. Partnership to Reduce HAIs Individually, we are one drop. Together, we are an ocean."– “A TSUNAMI” Ryunosuke Satoro & Nancy Vecchioni

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