Kentucky
AHA/HRET Hospital Engagement Network
Charisse Coulombe, MS, MBA, CPHQ; Senior Director, HEN
Hospital Engagement Network
Health Research & Educational Trust
American Hospital Association
Hospital Engagement Network
• ACA considerable focus on quality
• Created the CMS Innovation Center
Hospital Leadership
• Public-private partnership
• Set 40/20 goal
• Tool: Hospital
Engagement Networks
• 26 contracts awarded
• Contracted with 31 state and
regional hospital associations
• 1,600 + hospitals
Clinicians & Front Line Staff (Teams)
THE PATIENT
Partnership for Patients
The 40/20 Goal
• Keep patients from getting injured or sicker
Reduce preventable hospital-acquired conditions by 40 percent
1.8 million fewer injuries to patients, with more than
60,000 lives saved over the next three years
• Help patients heal without complication
Reduce all hospital readmissions by 20 percent
1.6 million patients will recover from illness without
suffering a preventable complication requiring
re-hospitalization within 30 days of discharge
3
Where We’ve Been: November, 2012
4
Data Submission as of February 11, 2013
% of Hospitals Submitting Outcomes Data by Topic
Total
Number of
Number of
Hospitals
Hospitals
Data
Submitting on
OB
Submitting Submitted on all of their
ADE
CAUTI
CLABSI
Fall
HAPU
EED
Outcome
SSI
VTE
VAP
Readmit
Data on 6 or
6 or More
Applicable
State
Outcome Outcome Outcome Outcome Outcome Process*
**
Outcome Outcome Outcome Outcome # Hospitals*** More Topics
Topics (%)
Topics
AK
64%
100%
100%
82%
64%
17%
33%
83%
73%
83%
91%
11
10
91%
4
AL
31%
86%
82%
45%
7%
70%
80%
79%
0%
74%
100%
29
15
52%
0
AR
24%
83%
72%
78%
39%
58%
46%
88%
27%
68%
80%
41
28
68%
0
AZ
35%
95%
90%
90%
35%
73%
67%
79%
25%
79%
95%
20
18
90%
1
CA
7%
78%
92%
42%
32%
38%
8%
93%
7%
70%
39%
158
69
44%
4
CO
78%
73%
100%
73%
100%
0%
100%
91%
84%
56%
69%
51
47
92%
13
CT
100%
100%
100%
100%
100%
0%
16%
100%
0%
4%
100%
27
27
100%
0
DC
0%
100%
100%
33%
0%
67%
33%
67%
33%
67%
100%
3
2
67%
0
FL
93%
90%
92%
95%
95%
47%
49%
82%
92%
96%
88%
73
68
93%
36
ID
50%
100%
100%
75%
38%
14%
43%
100%
38%
100%
100%
8
5
63%
1
IL
100%
100%
100%
100%
100%
25%
100%
100%
100%
100%
100%
55
55
100%
55
IN
27%
98%
98%
94%
72%
79%
69%
98%
66%
95%
88%
97
97
100%
18
KS
1%
46%
63%
68%
26%
80%
49%
30%
14%
3%
55%
92
15
16%
3
KY
19%
99%
97%
95%
91%
47%
50%
75%
35%
86%
64%
77
68
88%
1
LA
78%
97%
96%
95%
89%
77%
60%
86%
68%
98%
89%
73
68
93%
37
MA
10%
81%
57%
57%
33%
33%
28%
67%
19%
57%
76%
21
12
57%
0
MO
99%
99%
100%
100%
99%
78%
100%
73%
99%
100%
98%
81
80
99%
59
MS
42%
81%
86%
65%
42%
23%
31%
67%
38%
57%
92%
26
15
58%
3
MT
50%
73%
86%
58%
81%
15%
62%
69%
65%
36%
96%
26
18
69%
10
ND
67%
60%
67%
90%
60%
33%
0%
33%
57%
33%
70%
30
14
47%
13
NE
100%
100%
100%
100%
100%
56%
26%
94%
97%
100%
100%
34
34
100%
11
NH
5%
100%
100%
43%
38%
94%
19%
100%
100%
81%
100%
21
21
100%
0
NM
15%
100%
100%
95%
10%
53%
40%
94%
10%
100%
100%
20
16
80%
1
OK
14%
71%
90%
93%
40%
97%
10%
91%
24%
92%
81%
58
36
62%
6
OR
90%
94%
100%
71%
61%
93%
86%
96%
13%
76%
100%
31
31
100%
2
PR
12%
88%
92%
90%
44%
36%
64%
69%
8%
80%
60%
50
44
88%
0
RI
100%
91%
100%
18%
0%
100%
9%
82%
0%
55%
64%
11
5
45%
0
SD
85%
100%
100%
100%
100%
80%
100%
95%
88%
100%
100%
33
32
97%
23
WI
10%
56%
40%
46%
28%
21%
41%
44%
29%
38%
70%
105
22
21%
2
WV
34%
90%
89%
76%
55%
100%
100%
91%
14%
76%
97%
29
25
86%
1
WY
0%
0%
100%
100%
100%
0%
100%
0%
81%
0%
0%
16
0
0%
0
AHA/HRET HEN
43%
83%
87%
77%
61%
51%
52%
79%
45%
73%
77%
1407
997
71%
304
HEN Progress to Date
EEDs/OB ADVERSE EVENTS
• 449 - Number of hospitals with hard stop policies
• 42% - Average percent reduction (from baseline to months 9 through 12)
in elective births < 39 weeks admitted to NICU for 286 hospitals
• 38% - Average percent reduction (from baseline through month 12) in EED
> =37 weeks and <39 weeks for 271 hospitals
• $40.8 m - Estimated projected cost savings for avoided NICU admissions
for 2012
CAUTIs
• 15 percent reduction in CAUTIs since 2011 for 290 hospitals
• 27 CAUTIs prevented each month
• $325,000 estimated projected costs avoided by end of 2012
CLABSIs
• 28% percent reduction of CLABSIs for 302 hospitals
• 5
CLABSIs prevented each month
• $4 m estimated projected costs for avoided CLABSIs by end of 2012
HEN Progress to Date
ADEs
•
•
32% - Average percent reduction (from baseline through month 12) in excessive
anticoagulation in inpatients with warfarin treatment for 80 hospitals
$1.32 m Estimated projected cost savings for avoided ADEs in 2012
FALLS WITH OR WITHOUT INJURY
•
•
4% - Average percent reduction (from baseline through month 12) in falls with or
without injury for 550 hospitals
$19.0 m Estimated projected cost savings for avoided falls in 2012
PRESSURE ULCERS
•
•
2% - Percent reduction (from baseline through month 12) in percent of patients with at
least one Stage II or greater pressure ulcer for 152 hospitals
$1.7 m Estimated cost savings for avoided pressure ulcers in 2012 (annualized)
SSIs
•
<1.2% Average surgical site infection rate (within 30 days following procedure) for over
500 hospitals in months 1 through 12
HEN Progress to Date
VTEs
• 11% Average percent reduction (from month 1 to month 12) in potentially
preventable VTE rate for 88 hospitals
• $11.7 m - Estimated projected cost savings for avoided VTEs in 2012
(annualized)
VAPs
• <1.23 Average ventilator-associated pneumonia rate in the ICU (per 1,000
device days) for 390 hospitals in months 1 through 12
READMISSIONS
• 16% Average percent reduction (from baseline to month 12) in 30 Day AllCause Readmission rate for 420 hospitals
• 24 - Average number of fewer readmissions per month, per hospital for
351 hospitals (from baseline to November 2012)
• $80.9 m Estimated projected cost savings for avoided readmissions in
November 2012
CMS Goals
• 40% reduction in all harm topics
• 20% reduction in readmission
• Have 60% or more hospitals (in HEN/state)
submitting data in all applicable topics and
attaining reduction goals for potential renewal
in 2014
CMS Commitments
• At least 70 percent of AHA HEN birthing hospitals will implement hardstop policies or have an EED rate less than 3 percent by April 1st of 2013;
80% as of 5/31/13: AHA/HRET HEN currently at 63% as of 2/18/13; KY
currently at 47% as of 2/18/13
• 100 percent of AHA HEN hospitals will be submitting data on at least six
HACs by January 31st of 2013: AHA/HRET HEN currently at 71% as of
2/25/13; KY currently at 88% as of 2/25/13 (68/77)
• Make transparent the hospitals part of the HRET HEN on the HRET
website: AHA/HRET HEN has posted the names of all of the HEN
hospitals by state.
• Make transparent all hospitals working on 10 HACs on the HRET HEN
website: AHA/HRET HEN has posted the names of all of the CMS HEN
hospitals by HEN that are working on the 10 HACs (or all that are
applicable). There are currently 292 hospitals that fit this criterion.
Kentucky has 1 hospital: Fleming County Hospital
• Doubling the number of hospitals showing a 20 percent improvement in
readmission; AHA/HRET currently at 124 hospitals as of 2/8/13;
Kentucky Summary Table
Topic
Most Popular
Outcome
Measure
Avg #
Hospitals
Reporting
Total
Eligible
Hospitals
Percent
Baseline
Reporting
Q4 2012 or
last 3
monitoring
months
Percent
Reduction
ADE
Excessive
Anticoagulation
9
77
12%
5%
8%
N/A
CAUTI
CAUTI Rate ICU
40
77
52%
1.58
1.33
28%
CLABSI
CLABSI Rate ICU
40
68
59%
1.13
1.26
N/A
EED
TJC EED
13
34
38%
OB
*
Falls
Falls with or
without injury
29
77
38%
3.47
3.46
0.28%
Pressure
Ulcer
Stage III or IV
46
77
60%
0.06
0.00
100%
* KY hospitals submitting 13 different OB measures
Kentucky Summary Table
Topic
Measure
Avg #
Hospitals
Reporting
Total
Eligible
Hospitals
Percent
Baseline
Reporting
Q4 2012 or
last 3
monitoring
months
Percent
Reduction
Readmission
30 Day All
Cause
22
77
28%
12.34%
10.07%
18.38%
SSI
SSI Rate
within 30
Days of
Procedure
37
67
55%
1.83
2.69
N/A
VAP
VAP Rate ICU
21
66
32%
3.89
0.19
95%
VTE
Post Op
PE/DVT
18
77
23%
1.85
2.80
N/A
Kentucky’s Progress to Date
ADE
Kentucky’s Progress to Date
CAUTI
Catheter-Associated Urinary Tract Infections Rate in ICU (CDC NHSN)
rate per 1,000 catheter days
Catheter-Associated Urinary Tract Infections Rate
(per 1000 Catheter Days)- ICU (CDC NHSN)- Kentucky
2.50
2.00
1.50
1.00
0.50
0.00
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
N
Rate
Baseline
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
8
44
43
44
44
44
44
43
45
45
41
39
32
1.58
0.79
2.04
1.15
1.42
1.50
1.62
1.21
1.58
0.92
1.22
1.06
1.12
AHA/HRET HEN Progress to Date
CLABSI
Central Line Associated Bloodstream Infection Rate- ICU
(per 1000 Central Line Days)- AHA HRET HEN
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
617
644
641
648
646
646
650
665
665
671
563
547
494
1.10
1.18
1.13
1.11
1.11
1.03
0.96 1.20 1.12
1.21
0.85
1.19
1.04
Kentucky’s Progress to Date
CLABSI
CLABSI Rate per 1000 Central Line Days
Central Line Associated Bloodstream Infection Rate- ICU
(per 1000 Central Line Days)- Kentucky
2.50
2.00
1.50
1.00
0.50
0.00
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
12
44
42
44
44
44
44
43
45
45
41
39
32
1.13 2.04 1.12 2.00 1.46 1.43 0.95 1.42 1.51 1.76 1.13 1.85 0.66
AHA/HRET HEN Progress to Date
Falls
N
Rate
Baseline
547
3.19
Jan-12
530
3.15
Feb-12
530
2.96
Mar-12
539
3.03
Apr-12
533
2.97
May-12
540
2.97
Jun-12
586
3.03
Jul-12
610
3.00
Aug-12
627
3.05
Sep-12
644
3.17
Oct-12
586
2.93
Nov-12
544
3.08
Dec-12
479
2.97
Kentucky’s Progress to Date
Falls
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
27
27
27
27
27
27
28
28
28
28
28
28
26
3.47
3.26
3.45
2.69
3.12
3.18
3.63 3.31 4.07
4.26 3.54
3.44
3.4
AHA/HRET HEN Progress to Date
Early Elective Delivery
Percent of Early Elective Deliveries at Gestational Age Greater
than/Equal to 37 and Less than 39 Weeks
Percent of EED at => 37 and <39 Weeks
20.00%
16.00%
12.00%
8.00%
4.00%
0.00%
Baseline
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
n=268
n=261
n=256
n=267
n=265
n=265
n=299
n=329
n=327
Percent of EED at => 37 and <39 Weeks
Month 9 Month 10 Month 11 Month 12
n=333
Rate Trend Line
n=309
n=296
n=255
Kentucky’s Progress to Date
Early Elective Deliveries
Percent of Early Elective Deliveries at Gestational Age Greater
than/Equal to 37 and Less than 39 Weeks- Kentucky
Percent of EED at => 37 and <39 Weeks
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Baseline
N
Rate
Baseline
12
21.79%
Jan-12
12
13.57%
Jan-12
Feb-12
12
17.97%
Feb-12
Mar-12
Mar-12
13
15.63%
Apr-12
Apr-12
12
16.33%
May-12
May-12
12
15.57%
Jun-12
Jun-12
14
14.20%
Jul-12
Jul-12
13
14.41%
Aug-12
Aug-12
13
11.08%
Sep-12
Sep-12
15
8.30%
Oct-12
Nov-12
Oct-12
15
13.15%
Dec-12
Nov-12
14
11.78%
Dec-12
11
18.95%
AHA/HRET HEN Progress to Date
Pressure Ulcers
Kentucky’s Progress to Date
Pressure Ulcers
N
Rate
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12
46
46
47
46
46
47
46
46
47
0.06
0.13
0.00
0.21
0.12
0.00 0.00 0.14
0.00
AHA/HRET HEN Progress to Date
Readmissions
Kentucky’s Progress to Date
Readmissions
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
N
18
19
19
22
20
21
24
23
23
27
23
23
19
Rate 12.34% 10.17% 10.06% 12.09% 11.51% 11.09% 13.04% 10.66% 10.51% 12.07% 11.04% 10.66% 7.37%
AHA/HRET HEN Progress to Date
SSI
Percent of Surgical Patients with an Surgical Site
Infection Within 30 Days After Procedure
Surgical Site Infection Rate (Within 30 Days After
Procedure) (CDC NHSN)- AHA/HRET HEN
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
Baseline Jan-12
Feb-12 Mar-12 Apr-12 May-12 Jun-12
Jul-12
Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
Kentucky’s Progress to Date
SSI
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
4
38
37
38
37
37
35
37
37
39
33
31
25
1.83% 2.40% 3.08% 3.24% 2.57% 1.96% 2.19% 5.71% 2.79% 3.47% 3.18% 3.33% 1.49%
AHA/HRET HEN Progress to Date
VAP
Kentucky’s Progress to Date
VAP
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
5
17
18
18
20
19
19
20
21
20
22
19
13
3.89
3.22
3.68
4.62
1.79
3.63
2.87 0.91 1.54
3.41 2.59
1.78
1.12
AHA/HRET HEN Progress to Date
VTE
N
Rate
Baseline
75
4.74
Jan-12
53
11.9
Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12
53
55
53
53
91
89
90
97
10.72 12.21 11.52 11.12 9.65 10.29 10.49 11.38
Kentucky’s Progress to Date
VTE
N
Rate
Baseline Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12
3
16
16
16
16
16
16
17
17
17
1.85
1.46
2.52
3.18
1.61
3.62
1.44 1.95 4.26
2.09
Results to Date
• CMS understands that all of the hospitals are making
rapid improvement in multiple areas
• The results at both the HEN and Kentucky levels are
showing improvement and areas that need focus
• For areas of focus - Talk to your teams, see what other
improvements can be tested and what will work for your
hospital/culture to improve patient safety and quality of
care
– Participate on webinars, LISTSERVs, networking events
• For areas showing improvement – ensure that your
processes are hard wired and the culture has shifted to
allow for this improvement to be sustained long after
the HEN project is completed
31
Next Milestones
for the HEN Project
• Continue to focus on improvement strategies to help
hospitals reduce harm and prevent readmissions
• Work with hospitals to expand their improvement
work across all (applicable) topics (2->5->All)
• Work with hospitals to continue to input data into
the CDS and evaluate improvement to date
– Confer rights via CDC NHSN
32
Thank You!
• AHA/HRET HEN is proud of the accomplishments
that have occurred to date and continue to look
forward to accelerating the improvement across all
topics!
• We are here to support KHA and you in any way
possible
– General Email: hen@aha.org
– Data Specific Questions: hendatasupport@aha.org
33