Premier Healthcare Alliance Leaders Announce Broad Care Delivery Improvements After Five Years of QUEST

Macaluso, whose six-hospital system has been participating in QUEST since 2010, said, “I see the strength of the QUEST program really in three ways. First, I see it in the encouragement of executive sponsorship in these efforts to improve care and reduce cost. The second is the ability to share what I consider sophisticated comparative data, again to help drive change. We say [at our organization], if there’s no data, there’s no improvement. And QUEST is providing comparative data that’s helping us to drive change. And the third,” Macaluso said, “is the ability for us to collaborate with colleagues in other organizations to drive change and improve care. Our changes mirror those of others. Our hospitals have had achievement in evidence-based care, mortality, and harm events.”

Both Parsons and Macaluso spoke extensively about the challenges and opportunities involved in driving clinical and operational performance forward in their organizations, as well as the broad opportunities involved in collaborating with the other 331 QUEST hospital organizations.

One area of particularly intense focus at Memorial Health System, Macaluso noted, has been the organization’s CHF readmissions project, aimed and reducing inpatient readmissions for patients with congestive heart failure. “The project,” he said, “began with an opportunity identify different categories of strategies to help reduce avoidable CHF readmissions. These strategies came directly from QUEST phone calls. We focused on four areas of strategies: first, the immediate prevention of a clearly avoidable readmissions; second, patient education and communication; third, medication reconciliation; and lastly, transitional care.” Among the strategies he and his colleagues implemented to support the CHF readmissions avoidance effort have been expanding case management coverage in the ED to a target 24 hours weekdays and 16 hours on weekends; evaluating and admitting CHF patients to observation status when appropriate; and having ED case managers review potential Medicare admissions for appropriate status and potential readmission avoidance.

The goal at Memorial Healthcare System was a 20-percent reduction in avoidable CHF readmissions. “So far, Macaluso reported, “we’ve achieved that goal at our flagship regional hospital, which has lowered that rate from 36 percent to 23 percent.” Other facilities in the system are achieving variable results so far on that measure, he added.

Parsons described in detail a variety of initiatives under the QUEST umbrella taking place at her 13-hospital system, and went into particular depth describing her team’s realization that, when it came to overall mortality statistics, she and her colleagues had uncovered a real “opportunity” area in improving sepsis-related mortality. “Where we were falling short was identifying patients with sepsis early enough with evidence-based tools to prevent their deaths,” she noted. “We were finding that it was upwards of a day or more to identify our opportunity. So we went into the best practices sharing work.” And, making full use of all the tools and data available in the QUEST program, including process maps and lists of interventions, she and her colleagues have dramatically reduced sepsis-related mortality in several of their facilities.

IT foundation seen as critical

Asked by Healthcare Informatics about the importance of a strong IT foundation to facilitate all this work, Memorial’s Macaluso readily agreed. “Unfortunately,” he said, “we’ve not been able to find a risk assessment IT tool that helps us identify patients at risk any better than common clinical sense. But three of our hospitals are now live with the Epic EHR; and the rest will go live next month. We already have been reaping benefits from that,” he said, adding that the inpatient and outpatient EHR “is an enormous tool from a data-gathering perspective. For someone in my position, it’s really a wonderful tool in terms of extracting data, identifying patients; for example, we’re able to put a banner on the first page of a patient’s EHR saying, for example, this is a CHF patient or with a history of difficulty of intubation. And we utilize what QUEST has offered, but we have invested in other types of business intelligence tools. As I’ve said, if we can’t look at this and show comparative data to our physicians, we can’t make any progress.”

Responding to the same question with regard to progress more broadly among the QUEST hospitals on quality improvement, Premier’s DeVore said, “when you think about the six dimensions we’re measuring, there’s data coming from a lot of sources. And we had to develop the QUEST reporting capability, via Quality Advisor,” as well as a number of other solutions, including a physician performance program, an assessment of harm solution, real-time alerting for safety and harm work, and an operational waste report program.

“And so,” DeVore noted, “we’ve made significant investments on behalf of the QUEST and other Premier members, in those capabilities. We also have fundamentally rebuilt our data platform to obtain data from all sources, including integrating EHR data from everyone. We view this as being vendor-agnostic, in that we have to put the raw data together. So we’re evolving all of the technology capabilities together with the collaborative capabilities. And per the discussion of QUEST 3.0, when we get into bundled cost measures, and others, we intend to have the capabilities for that.”