NC Center for Rural
Health Innovation
and Performance
NC Office of Rural
Health and
Community Care
North Carolina Hospital Association
NC Center for Rural Health
Innovation and Performance
 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
NC Office of Rural Health
and Community Care
 Healthcare Leadership
Quality Assessment Tool
(HLQAT)
 Trauma, Cardiac and Stroke
System Development
 Pediatric Emergency Care
Pilot
 Community Paramedic
Program
 Telehealth
North Carolina Hospital Association
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.
North Carolina Hospital Association
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.
•
North Carolina Hospital Association
Pneumonia Composite Score
Time Period: April 2009 through April 2010
100%
NC Top 10%
90%
95% Reliability
Pneumonia Composite
80%
70%
60%
50%
40%
30%
20%
10%
0%
Mean of CAH / Rural Hospitals
North for
Carolina
Hospital Association
Benchmark
NC Hospitals
Reliable Care
Pneumonia Trend
Composite Aggregate
100%
90%
90%
92%
94%
93%
93%
93%
91%
91%
97%
98%
77%
77%
99%
99%
79%
80%
93%
84%
80%
Aggregate Pneumonia Composite
NC Top 10%
77%
80%
72%
70%
72%
68%
60%
60%
62%
63%
65%
66%
65%
57%
50%
53%
52%
54%
203% Improvement
47%
40%
30%
20%
10%
26.4% in 2004
0%
Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09
to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1
06
06
06
06
07
07
07
07
08
08
08
08
09
09
09
09
10
Rolling Year Time Periods
Mean of CAH/Rural Hospitals
Benchmark for NC Hospitals
NOTE: The data points represented here represent the group of hospitals and the makeup
of theCarolina
composite at Hospital
the time that time
frame was originally ran. Changes to
North
Association
the measure definition and group defintion have occured over time.
Heart Failure Composite Score
Time Period: April 2009 through April 2010
100%
NC Top 10%
90%
95% Reliability
Heart Failure Composite
80%
70%
60%
50%
40%
30%
20%
10%
0%
Mean of CAH / Rural Hospitals
North for
Carolina
Hospital Association
Beanchmark
NC Hospitals
Reliable Care
Heart Failure Trend
Composite Aggregate
100%
91%
92%
93%
93%
94%
96%
96%
96%
97%
97%
96%
97%
97%
97%
98%
99%
99%
76%
76%
76%
Aggregate Heart Failure Composite
90%
80%
NC Top 10%
70%
74%
68%
60%
59%
57%
50%
40%
52%
46%
46%
60%
63%
69%
65%
54%
122% Improvement
47%
42%
30%
20%
34.2% in 2004
10%
0%
Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09
to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1 to Q2 to Q3 to Q4 to Q1
06
06
06
06
07
07
07
07
08
08
08
08
09
09
09
09
10
Rolling Year Time Periods
Mean of CAH/Rural Hospitals
Benchmark for NC Hospitals
NOTE: The data points represented here represent the group of hospitals and the makeup of the composite at the time that time frame was originally ran. Changes to the measure
North Carolina Hospital Association
definition and group defintion have occured over time.
CAH Combined Indicator Scores
Time Period: April 2009 through April 2010
Combined Indicators
100%
92%
90%
91%
93%
91%
94%
94%
95%
92%
88%
87%
82%
80%
80%
Aggregare Indicator
70%
60%
50%
40%
30%
20%
10%
0%
CAHNorth
Indicators
Carolina Hospital Association
Outpatient Quality Measures
OP-1
OP-2
Median Time to Fibrinolysis
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
North Carolina Hospital Association
Questions for You
North Carolina Hospital Association
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)
North Carolina Hospital Association
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
North Carolina Hospital Association
Questions for You
North Carolina Hospital Association
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. Nonprofit and public sole community hospitals with a DSH
percentage > 8%.
North Carolina Hospital Association
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)
North Carolina Hospital Association
Questions for You
North Carolina Hospital Association
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).
North Carolina Hospital Association
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
North Carolina Hospital Association
Questions for You
North Carolina Hospital Association
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)
•
North Carolina Hospital Association
Questions for You
North Carolina Hospital Association
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.
North Carolina Hospital Association
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?fundi
ng_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)
•
North Carolina Hospital Association
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 919855-3965.
• General questions: Matt Womble, NCORHCC
(matt.womble@dhhs.nc.gov)
North Carolina Hospital Association
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 919855-3965. For general questions: Matt Womble, NCORHCC
(matt.womble@dhhs.nc.gov)
North Carolina Hospital Association
Rural Hospital
Pilot Projects
• Rural Hospital Lean Culture
Transformation
• HIT Strategic Planning
• Community Paramedicine
Program
• Critical Access for Pediatric
Emergencies
North Carolina Hospital Association
NC Center for Rural
Health Innovation
and Performance
NC Office of Rural
Health and
Community Care
North Carolina Hospital Association