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Oregon PfP: State of the HEN June 25, 2013
Oregon PfP: State of the HEN
June 25, 2013
TODAY’S OBJECTIVES
Progress to date as a state
Resources
Harm Across the Board
CMS/HRET updates
What’s next for Oregon
2
PARTNERSHIP FOR PATIENTS
• National CMS program for 2012-2013
• Goals:
• Reduce preventable harm by 40%
• Reduce readmissions by 20%
3
What is the data telling us?
• How are we doing as a state?
• How do we compare with other HRET HEN hospitals?
• What is the significance of our impact?
4
ADVERSE DRUG EVENTS
5
0
1
2
3
4
5
6
7
Nu
mb
er
infe
ctio
ns
pe
r 1
0,0
00
pat
ien
ts d
ays
Oregon PfP C. Difficile Rates (ADE)
OR PfP Rate(n=21)
20% reduction(OR)
40% reduction(OR)
OR Baseline
CATHETER ASSOCIATED URINARY TRACT INFECTIONS
6
0
0.5
1
1.5
2
2.5
3
3.5
Nu
mb
er
infe
ctio
ns
pe
r 1
,00
0 c
ath
ete
r d
ays
Oregon PfP CAUTI Rates OR PfP Rate(n=26)
All HRET PfPhosps rate(n=874)
20% reduction(OR)
40% reduction(OR)
CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS
7
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Nu
mb
er
CLA
BSI
s p
er
1,0
00
ce
ntr
al li
ne
day
s
Oregon PfP CLABSI rates OR PfP Rate (n=23)
All HRET PfP hospsrate (n=643)
20% reduction (OR)
40% reduction (OR)
OR Baseline
HRET Baseline
EARLY ELECTIVE DELIVERIES
8
0
2
4
6
8
10
12
14
16
18
20
% o
f Ea
rly
Ele
ctiv
e D
eliv
eri
es
Oregon PfP Early Elective Delivery Rates
OR PfP Rate (n=22)
All HRET PfP hospsrate (n=442)
20% reduction (OR)
40% reduction (OR)
OR Baseline
HRET Baseline
FALLS WITH INJURIES
9
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Nu
mb
er
infe
ctio
ns
pe
r 1
,00
0 p
atie
nt
day
s
Oregon PfP Falls with Injury Rates
OR PfP Rate(n=20)
All HRET PfPhosps rate(n=365)
20% reduction(OR)
40% reduction(OR)
OR Baseline
HRET Baseline
HAPU
10
0
0.2
0.4
0.6
0.8
1
1.2
1.4
nu
mb
er
of
pre
ssu
re u
lce
rs p
er
10
00
dis
char
ges
Oregon PfP HAPU Rates
OR PfP Rate (n=15)
20% reduction (OR)
40% reduction (OR)
OR Baseline
All HRET PfP hospsrate (n=192)
HRET Baseline
SURGICAL SITE INFECTIONS - KNEE
11
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
TKR
In
fect
ion
Rat
e p
er
10
0 p
roce
du
res
Oregon PfP SSI-Knee Rates
OR PfP Rate (n=21)
20% reduction (OR)
40% reduction (OR)
OR Baseline
SURGICAL SITE INFECTIONS - HIP
12
0.00
0.50
1.00
1.50
2.00
2.50
3.00
THR
Rat
e p
er
10
0 p
roce
du
res
Oregon PfP SSI-Hip Rates
OR PfP Rate (n=15)
20% reduction (OR)
40% reduction (OR)
OR Baseline
VENTILATOR ASSOCIATED PNEUMONIA
13
0
1
2
3
4
5
6
7
Nu
mb
er
VA
P p
er
1,0
00
ve
nti
lato
r d
ays
Oregon PfP VAP Rates
OR PfP Rate (n=16)
All HRET PfP hosps rate(n=282)20% reduction (OR)
40% reduction (OR)
OR Baseline
HRET Baseline
READMISSIONS
14
4.00
5.00
6.00
7.00
8.00
9.00
10.00
11.00
%
Oregon PfP 30-Day All Cause Readmissions
OR PfP Rate (n=9)
All HRET PfP hosps rate(n=529)10% reduction
20% reduction
OR PfP baseline
HRET Baseline
READMISSIONS
15
4.00%
4.50%
5.00%
5.50%
6.00%
6.50%
7.00%
Baseline (CY 2011) Apr 2011-Mar 2012 Jul 2011-Jun2012 Oct 2011-Sept 2012
Jan 2012-Dec 2012
Pe
rce
nt
of
Re
adm
issi
on
s D
ee
me
d P
ote
nti
ally
Pre
ven
tab
le
Oregon PfP Potentially Preventable Readmissions (PPR)
OR PfP Rate(n=29)
10% reduction
20% reduction
OR Baseline
Data Summary
Overall, downward trend in 8/10 focus areas
• VTE area needs increased engagement ; currently only 5 hospitals are reporting
• We have a critical mass that is making improvement
– At least 60% of our participating hospitals have made at least a 30% improvement in the following areas:
• CLABSI
• CAUTI
• EED
• SSI
– We are very close to hitting this target for:
• VAP
• HAPU
• Falls with injuries
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What can you do?
• You are probably already tracking VAP, Falls, and HAPU, so please get your data into your worksheets!
• Of course, all other data is appreciated as well!
• Let’s show that Oregon can have a significant impact with the PfP work!!
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Resources
• HRET HEN website: www.hret-hen.org
– Top Ten Process Interventions
– HRET PfP Change Packages
• AHRQ PSLN website: www.psl-network.org
– Archived webinars
– Links to tools
• OAHHS – PfP website: www.oahhs.org/quality/initiatives/partnership-for-patients
– PfP newsletter
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Harm Across the Board
• Improvement leader fellows were asked to complete a senior project
• The improvement/cost calculator is a key component to help you state the business case for quality
• Seven hospitals completed the HAB template
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KUDOS TO COQUILLE VALLEY!
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“Improving Lives Through Exceptional Healthcare”
CMS/HRET Updates
• Current discussions in progress about 2014 PfP – Continued focus on ten PfP areas
– Option for an advanced track
– We expect further details this Fall
• Commitment for five additional focus areas with clear transparency of data & processes – Sepsis
– C. Difficile
– Failure to rescue
– HA acute renal failure
– Airway safety
– Delirium
– Others
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What’s next for Oregon?
• This summer:
– Continued site visits
– Lean coaching calls
• September 11 @ the OMA: HCAHPS workshop, featuring Carrie Brady
• September webinar, date TBD: Sustaining CUSP, featuring Kristina Weeks from JHI
• November 1: PfP state meeting in Portland
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OREGON PFP LEADERSHIP TEAM:
• Diane Waldo, director of quality and clinical services
[email protected] 503.479.6016
• Jodie Elsberg, associate director of quality
[email protected] 503.479.6028
• Lyndsey Shaver, quality coordinator
[email protected] 503.479.6022
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