PneumoniaAdvisoryGroupNorthCarolinaHospitalAssociation
Thursday,June8th,201710:30AM– 12PM
WelcomeMeetingObjectives:• LevelsetontheimportanceofcollaborationandpartnershiparoundcommunityacquiredpneumoniainNCtocollectivelyimpactreductioninpneumoniamortalityandreadmissionrates.
• ShareNCHABoardofTrusteesrecentlyapproved2-yearpneumoniaqualitygoalandthePneumoniaPnockoutCampaign.
• Seekalignmentofwork,assessmentofcurrentandpastimprovementworkaroundpneumonia.
• Gaincommitmentandlevelofengagementaroundpneumoniaimprovementwork.
Agenda:• Welcome,ReviewObjectives&MeetingAgenda• LevelSet&CurrentState:CommunityAcquiredPneumonia• PneumoniaProgramming&PneumoniaPnockoutCampaign• ModeratedDiscussion:
• Alignmentwithwork(assessmentofcurrent&pastimprovementefforts)• EngagementOpportunities
• WrapUpandNextSteps• Lunch12PM– 12:30PM
2017QualityGoalImproving30-dayPneumoniaMortalityandReadmissionRates
StatewideCrossContinuumInitiative
PrioritizingPneumonia
Sources:CMSdata,RAI,PDS+
Variationincomparablecosts
Greatest Opportunity
IdentifyingOpportunitiesforImprovement:Pneumonia
• Step1:ReviewCMSdataviaDatagenReports(NCHAprovidesDatagenreportstoeachhospital)
Step 2: Evaluate opportunity according to criteria for transformation: ü Aligned with CMS priorities? Publically reported?ü Among top 10 causes of death in NC? ü Identified variation in RAI performance statewide?ü NC performing worse than hospitals nationwide?ü Hospitals interested in improving in this area?
PneumoniaMortalitybyCounty
Number label indicates total cases by county in 2016. Color indicates performance compared to national benchmark on mortality – red is worse, green is better.
PoorperformanceonCMSPneumoniaMortalityandReadmissions
NumberofHospitalsPerformingWorsethantheNationalAverageonCMSPneumoniaMeasures
Benchmark HPHSReadmissions
NCReadmissions(NationalRank
28of50)
HPHSMortality
NCMortality(NationalRank
49of50)
ComparedtoNationalAverage 7 47 13 71ComparedtoNationalTopQuartile 13 70 16 92ComparedtoNationalTop10% 18 89 17 98ComparedtoNCaverage 7 42 8 44TotalHospitalsReporting 19 100 19 100
0
0.2
0.4
0.6
0.8
1
ComparedtoNationalAverage
ComparedtoNationalTopQuartile
ComparedtoNationalTop10%
ComparedtoNCaverage
PercentofHospitalsPerformingWorsethanBenchmarks
HPHSReadmissions NCReadmissions(NationalRank28of50)
HPHSMortality NCMortality(NationalRank49of50)
Admitted through Emergency Department
PneumoniaPatientCharacteristicsHad Surgery
PDS+ data source, drill-down possible to patient encounter-level
PneumoniaMortalitybyAge,2015
TrackingChangeoverTimeforRAIHospitals
Between 2014-2016, • Fewer hospitals in middle
quartiles; • More in lowest quartile.• NC is currently 49 out of 50
states on pneumonia mortality.
• Range in pneumonia mortality has increased since 2012. Among RAI hospitals, lowest in 1% of hospitals; highest in top 95% of hospitals nationally.
• Variation indicates opportunity for improvement
DefiningandTargetingOpportunities
PneumoniaReadmission
andMortalityRate
QualityData
PatientActivation
CostofCare
CrossContinuumOpportunities
IMPACT• Adoptthe2017QualityGoalofreducingPneumonia(PNE)MortalityRateover2yearstobringNCtothenationalaverage;andreducingPNEReadmissionratetobringNCtothetop25th percentileofhospitalsnationally.
•1000NCLivesImpacted- ReducingPneumoniaMortalityby7.5%
• 950ReadmissionsPrevented• $8,835,000- Saved
MeasuringSuccess- Outcomes• EachHealthSystem/IndependentHospitalwillreceivequarterly/semi- annually
• CMSClaimsData- (6-9monthLag)• CurrentMortalityRateandPNEReadmissionRatesE/ORatios• CommunityPrevalenceRate• SocialDeterminantImpact• CostVariationandROI
• RAIParticipants(24hospitals)• DRGlevelcostvariation
• ADTParticipants• PNELOS• PointofOrigin• Disposition• 30- daymigrationtables
“ItAlwaysSeemsImpossibleUntilItisDone”NelsonMandela
PerformanceImprovementStrategy• PneumoniaAdvisoryGroup&Workgroups
• StatewideCollaborationandPartnerships• GuideStatewideStrategyaroundreducingpneumoniamortalityandreadmissionrates• Developprogrammingandcontentforpneumoniawork
• PneumoniaPnockoutCampaign• PledgefromallNChospitalsandhealthcaresystems• Identifyonetotwoopportunitiestoimprovebasedontheirinternalperformanceontheidentifiedmeasures• Communitypartnersandpost-acutecareproviderswillbeinvitedtoparticipate• ConveneLocalandNationalExpertsforLearning• PeertoPeerSharing• CrossContinuumForum• Coalitionfocusedwithcommunitypartners
• FocusedCollaborative• CoachingandFacilitation• FocusedGoalsandmeasurement
n
ockout neumonaP Pneumonia Pnockout CampaignInMarch2017,theNCHABoardofTrusteesapprovedatwo-yearQualityGoaltoreducepneumonia(PNE)mortalityandreadmissionratestoputNorthCarolinaatandbelowthenationalaverage.Specifically,thegoalisto:
•Reduce thePNEmortalityrateby7.5%tothenationalaverageover2years•Reduce PNEreadmissionsby5.4%over2yearstotargettop25%quartile
TheBoard’sapprovalofthisgoalsignifiesanorganizationalcommitmenttoguidethisworkandacalltoNCHA’s130memberhospitalsandhealthsystemsstatewidetoactivelyparticipate.
n
ockout neumonaPPneumoniaPnockoutCampaign
CAMPAIGNPARTICIPATIONParticipatinghospitalsandhealthsystemswillbeaskedtoidentifyonetotwoopportunitiestoimprovebasedontheirinternalperformanceontheidentifiedmeasures.Communitypartnersandpost-acutecareproviderswillbeinvitedtoparticipatewithhospitalsandhealthsystems.
Eachorganizationwillcommittoleaditsimprovementefforts.
NCHAQualityCenterstaff,withguidancefromanAdvisoryCouncil,willprovideparticipatingteamswithtechnicalsupport,educationandbestpracticelearning/sharing.NCHAwillprovidedatatomemberorganizationstosupportthisworkandwillcoordinateapubliceducationcampaign,includingmediaandcollateralmaterials.
PNEUMONIAFACTS
• NorthCarolinaisranked49of50states foritspneumoniamortalityrate,with73%ofhospitalsbelowtheCMSnationalbenchmark.
• MorethanhalfofallN.C.hospitalsareabovethenationalbenchmarkfor30-daypneumoniareadmissionrates.
• Pneumoniaismostoftenacquiredinthecommunity,outsideofthehospitalsetting.
• CDCrecommendspneumococcalvaccinationforalladults65yearsorolder.Accordingto2015datafromtheBehavioralRiskFactorSurveillanceSystem,73.6%ofNorthCaroliniansover65yearsoldreportthattheyhavebeenvaccinated,slightlyabovetheU.S.average.
n
ockout neumonaPPneumoniaPnockoutCampaign
Opportunities• ParticipateasanNCHAmemberorganizationorpartnerintheQuality
Goal.• Provideeducation,informationaspartofthelearningcollaborative.• Supportpubliceducation/outreacheffortsoutsidethehospitalsetting.• Committofunding/underwritingtowardthecampaign.
TIMELINE
May/June: NCHAQualityCenterstaffintroducesgoaltomemberhospitalsandhealthsystemsandprospectivepartnerorganizations
July: KickoffatNCHASummerMembershipMeeting(July19-21)Aug-Sept: EnrollmentcontinuesOct: LearningandActionNetwork/PubliccampaignbeginsNov: WorldPneumoniaDayisNovember12
ModeratedGroupDiscussion:Alignmentwithwork,assessmentofcurrent&pastimprovementefforts
• Stateyournameandorganization;• Sharethoughtsonyourorganization'salignmentwiththiswork,whatareyourneeds/goalsaroundthiswork?
• Howcanwepartnerandcollaboratetogetherforcollectiveimpact?
EngagementOpportunities
PneumoniaPrograms
PublicCampaign
PostAcuteCare Hospital Endorseand
Sponsor
AdvisoryGroup
WrapUp&NextSteps
• ThankYou
• AdvisoryGroupPledge• WorkgroupSelection
• NextAdvisoryGroupMeeting• July11th,10:30AM– 12PM,12PM– 12:30PMLunch