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Measuring Our Mission: How Do We Know We Are
Making A Difference?
Deneen Richmond, RN, MHAExecutive Director, DFDC;
Senior Vice President, Interventions TeamPhone 202-496-6541; email –
Sandy Lesikar, PhDSenior Scientist, Interventions Team
Phone 410-712-7421; email – [email protected]
February 23, 2006
What We Are About
What We Do• DC and MD QIO
• AHRQ-Knowledge Transfer
• Maryland Patient Safety Center
• Public Reporting
• WIC “Western Integrity Center”
• Medi-Medi
• PERM
• EQRO “External Quality Review”
• MAQRO – QIP Evaluation
• UR-Utilization Review
• Long Term Care Eligibility
• Florida DD
• Administration
• Business Development
• Communications
• Finance
• Human Resources
• Information Technology
Measuring Our Mission
Dashboards Improving Health
Organizational Health
Financial Health
“Measuring Our Mission” – Why?
• Understand the impact we have on the communities we serve
• Demonstrate the effectiveness of the work we do in fulfilling our mission
• Baldrige JourneyLeadership criteria
• Communication and Organizational Performance• Support of Key Communities
Measurement, Analysis and Knowledge Management
• Performance Measurement
Process
• Convened Delmarva’s Community Impact WorkgroupPhase 1
• Defined what to measure and how to measure it
Phase 2• Validated work of Phase 1• Decided how the data should be organized
and the best way to communicate it
• 1st report issued 12/04• 2nd report issued 12/05
Direct vs Indirect Impact
• Direct impactOur intervention
efforts that directly improve the consumer’s overall quality of life
• Indirect impactWork we do with
health providers that improve the quality of care in health systems
Impact
FY2004
FY2005
Direct 350,131
508,833
Indirect
9,682,252
8,887,864
Example – QIO - HospitalsConditio
nMedicare
Beneficiaries
Hospitalized
Baseline Rate
Remeasure-ment
Rate
Difference
# Beneficiaries Directly Affected
HF -MD 13,208 76.2% 90.0% +13.8% 1,823
HF - DC 2,127 75.8% 85.8% +10.0% 213
PNE - MD
11,496 58.7% 66.7% +8.0% 920
PNE - DC 1,851 57.5% 56.3% -1.2% 0
AMI - MD
5,381 83.0% 87.7% +4.7% 253
AMI - DC 866 80.7% 82.93% +2.2% 19
Total 3,204
Example – Maryland Health Care Commission (MHCC) Hospital
Performance Evaluation GuideDirect Impact Hospitalizatio
nsIndirect Impact
320* 902,223 902,223**
•*Based upon the number of hits the Web site receives, the estimated percentage of hits that are from consumers, and an estimate based on research of the number of consumers who ultimately use the data they find on the Web
•**Because the Guide contains a broad range of administrative, utilization and performance data for all Maryland acute care hospitals, as well as comprehensive health education information targeting consumers, the project’s Indirect impact extends to the total number of consumers hospitalized in the state in acute care hospitals
Maryland Patient Safety Center (MPSC)
• Joint venture of Delmarva Foundation and the Maryland Hospital Association
• Focus includes:Safety Culture Collaborative SeriesEducation and Adverse Event Reporting
MPSC Collaborative Series
• In November 2004, Delmarva Foundation (DF) launched the MPSC Safety Culture Collaborative Series
• To rapidly translate the energy, knowledge, and will of the healthcare community into measurable, sustainable, and transferable action.
MPSC Collaborative Series
Intensive care units (ICUs) were selected as the first focus area for the following reasons:
• Existing interest • National initiatives• Immediate impact on patient
outcomes expected and measured• Proven strategies for rapidly
improving ICU care using collaborative models (IHI, AHRQ, Michigan, JHU, VHA-inc)
MPSC ICU Collaborative• 52 ICUs from 37 hospitals • Each unit had a interdisciplinary team
with a dedicated local coordinator, physician, and executive lead nominated by the Chief Executive Officer (CEO)
Over the course of the Collaborative teams worked on two or more of the following modules: Improving the Culture of Safety, Preventing Catheter-Related Blood
Stream Infections (Cr-BSI), Preventing Ventilator-Associated
Pneumonia (VAP), and Preventing Adverse Drug Events
(ADEs): Medication Reconciliation.
MPSC ICU Collaborative
Building a Safety and Improvement Infrastructure
Prework
WS 1 WS 3WS 2
Participants
Pre-Safety
Culture Survey
Post-Safety
Culture Survey
S
A
P
D
S
A
P
D
S
A
P
D
Expand into high risk settings
Eliminate MRSA transmission
Community ownership of safety agenda
- Monthly Lead & Team Calls; Quarterly Executive Sponsor Calls - Website & Listserv; Monthly E-data reports - Improvement Lead Development Workshops during each Action Period - Quarterly CEO update & Interim Team Improvement Report
Action Periods
Oct 04 Nov 04 Mar 05 Oct 05 Nov 05
MPSC ICU Collaborative: Results
• 47% percent of hospitals participating in the Collaborative implemented interventions from all four ICU Modules
• 41% of hospitals implemented interventions from three of the Modules.
• ICUs from five hospitals reached the challenge of zero Ventilator-Associated Pneumonia
• 10 hospitals achieved zero Catheter-Related Blood Stream Infections.
Measuring Our Mission
Goal: Measure the impact of the ICU Collaborative in terms of lives saved and dollars saved
Challenge #1: Data reporting to the MSPC ICU team was voluntary
–not all teams reported data –not all teams reported data
each month
Measuring Our Mission
Approach #1: Using available claims data from the Maryland Health Care and Cost Review Commission
• determine baseline infection rate, LOS, and cost per patient for VAP and BSI cases in the ICU
• trend overtime to estimate lives saved, LOS reductions, and cost savings
Measuring Our Mission
Challenges #2: • Not able to determine BSI from
claims data• Not all hospitals report ICU days
Measuring Our Mission
Approach #2: Using existing MPSC data to determine baseline BSI and VAP rates among those reporting data.
• Estimate monthly the number of infections prevented (number of observed– number expected)
• Obtain estimates from published literature of:Mortality for BSI and VAPHealthcare cost per BSI and VAP
Measuring Our Mission
Number of Prevented BSIs: Total Prevented in Jan-Nov 2005=36
-10
0
10
20
30
Jan(26)
Feb(26)
Mar(26)
Apr(24)
May(25)
Jun(24)
Jul(19)
Aug(16)
Sep(13)
Oct(9)
Nov(8)
Expected and O bserved BSIs by Month (Number Reporting)
Numbers are lower for final months, several hospitals report data quarterly.
Observed Cases
Expected Cases
P revented Cases
Catheter-related BSI are associated with an 18% mortality rate
36 prevented CR-BSI x 18% mortality rate
=6 Lives Saved through
Preventing CR-BSI
Measuring Our Mission
VAP raises mortality rate from 32% to
46%.
31 prevented VAP x 46% - 20 x 32%
=4 Lives Saved through
Preventing VAP
Number of Prevented VAP Cases: Total Prevented in Jan-Nov, 2005=31
-10
0
10
20
30
Jan(24)
Feb(25)
Mar(25)
Apr(22)
May(24)
Jun(23)
Jul(16)
Aug(13)
Sep(10)
Oct(7)
Nov(6)
Expected and O bserved VAPs by Month (Number Reporting)
Numbers are lower for final months, several hospitals report data quarterly.
Observed Cases
Expected Cases
P revented Cases
Measuring Our Mission
Cases Prevented
Low Cost Estimate
High Cost Estimate
Low Savings Estimate
High Savings Estimate
BSI 36 $3,700 $29,000
$133,200
$1,044,000
VAP 31 $34,508 $56,000
$1,069,748
$1,736,000
Total Cost SavingsLow Estimate $1,202,948Mid-Range Estimate $1,991,474High Estimate $2,780,000
Measuring Our Mission: The Bottom Line
10 Lives
$2 million dollars
Summary - Measuring Our Mission
• It’s impossible to be right and very easy to be wrong
• Very conservative estimates, especially for direct impact
• What’s the appropriate perspective?PeopleDollarsLives savedOthers
Next Steps• Reconvene Workgroup• Focus
Expand workgroup – size & expertiseReview Current Methodology – Is direct
vs. indirect the only/best approach?Review and incorporate other potential
methodologies, where applicableIncorporate new contractsReview data gathering & validation
processesSolicit feedback from DF staff and others
re: methodologies, publicizing report, etc.
