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Health Care Costs, Deaths Reduced in National Initiative’s First Three Years

Hospitals establish proven standards of care that outpace industry trends and national averages

Published: Friday, January 20, 2012 - 14:13

In three years, 157 hospitals participating in the Premier health care alliance’s QUEST have saved an estimated 24,820 lives and reduced health care spending by nearly $4.5 billion.

QUEST can be adopted by any hospital in the nation seeking to track performance against a higher standard of care. If all hospitals in the country had been able to achieve similar results, estimates project an additional 87,250 lives and $34 billion more could be saved across all payers each year. These are savings that hospitals can use to reinvest in care improvements for their local communities.

Spanning 31 states, QUEST includes a nationwide sample of urban/rural, large/small, teaching/nonteaching, and safety net hospitals. Together the hospitals volunteered to transparently share data and define a common framework with consistent measures of top performance—something that has never existed in health care. During QUEST’s first three years, hospitals tracked and compared their performance levels to match or exceed the top 25 percent of hospitals in all categories except cost, which was set at the top 50 percent. To reach these standards, hospitals needed to:
• Reduce mortality at least 18 percent
• Reduce the average cost of care to less than $5,720 per discharge
• Reliably deliver all evidence-based care measures to patients in the areas of heart attack, heart failure, pneumonia, and surgical care at least 84 percent of the time
• Improve the hospital experience so that patients favorably rate their stay and would recommend the facility to others
• Eliminate preventable harm events

“QUEST creates new, higher targets that any hospital can strive for,” says Terry Andrus, CEO of East Alabama Medical Center. “Once we saw what could be achieved, we had a very systematic way to focus and work on performance improvement. All the QUEST measures are very clear, making it easier for us to articulate the vision of where we want to be, and get buy-in from doctors, nurses, administrators, and our board. It’s crystallized our quality work and given us a clear path forward.”

East Alabama Medical Center and 120 other hospitals participating in QUEST achieved top performance standards that directly led to patient care improvements and other quality gains. These advances have historically eluded most health care improvement programs. In fact, QUEST hospitals are far outpacing current industry trends and national averages. For example:
• When compared to a national group with similar characteristics, the mortality rate among QUEST hospitals was 29-percent lower than national averages, according to Medicare data from federal fiscal year 2009, the most recent year of this information.
• Data from the U.S. Bureau of Labor and Statistics suggests that QUEST hospital inpatient costs only increased by about 2-percent above the rate of inflation over three years (2008–2010). In contrast, nonparticipant costs increased by an average of 17-percent above inflation.

“QUEST gave us the ability to look at ourselves differently,” says Donna Isgett, senior vice president of corporate quality and safety at McLeod Health in South Carolina. “When we just looked at our data we thought we were doing well, but when we compared [it] to others, we realized we weren’t among the best. For mortality, we talked to other top performers to learn how they tested, analyzed, and measured their data to come up with better processes. We did something similar and have been able to replicate those high performance scores to save lives at McLeod. Now, we are sharing our own learnings and best practices with others.”

QUEST hospitals have been measuring 24 specific harm events that align closely with national priorities, including the Medicare value-based purchasing program, the Centers for Medicare & Medicaid Services (CMS) nonpayment policy, and the Partnership for Patients hospital quality improvement and safety initiative. However, while many organizations have targeted hospital-acquired conditions (HACs) based on these and other federal policies, QUEST data show that a broader focus on harm may be required. As a result, QUEST is now examining more than 140 HACs that have been shown to cause deaths, and added length of stay and unnecessary costs. These new measures will be rolled into the program over time.

“QUEST hospitals show what’s truly possible in health care,” says Susan DeVore, Premier president and CEO. “Together they have proven that top performance can be achieved by any hospital, no matter where they are, what their patient mix, or their reimbursement levels. QUEST is discovering the keys to providing the best quality care and teaching others how to replicate their accomplishments so that we don’t have pockets of excellence—we have systemwide excellence.”

Most recently, QUEST hospitals have been driving improvement in patient experience and are already ahead of national averages. In fact, according to data from Medicare’s Hospital Compare database, QUEST hospitals have improved patient experience levels by 4.9 percent, as opposed to nonparticipants, whose scores improved by just 2.6 percent.

Participants also expanded their focus on reducing readmissions to better understand and make evidence-based recommendations to CMS on how to appropriately implement new readmission policies. Additionally, the collaborative is adding new evidence-based care measures across the inpatient and outpatient settings.

“Hospitals participating in QUEST have demonstrated that putting patients first makes good business sense,” says Tanya Alteras, associate director of the Consumer-Purchaser Disclosure Project at the National Partnership for Women & Families. “By scaling this comprehensive improvement model with data-driven approaches, they set the standard for new care delivery models. QUEST addresses the larger picture of patient safety, costs, and efficiency in health care organizations. The fact that QUEST has been designed to align with federal and other private-sector delivery system models, such as bundled payments and accountable care, is a crucial building block to creating patient-centered, coordinated care systems that drive us toward better care at lower cost.”

Premier reviewed year three QUEST results with academic researchers from the Center for Quality of Care Research at Baystate Health in Springfield, Massachusetts, to ensure they were accurate, and not anomalies due to measurement or analytic approaches. Reviewers also provided feedback on how to better collect and use data moving forward to help draw causal pathways from improvement strategies to the outcomes seen in Premier measures.

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Premier

Premier is a performance improvement alliance of more than 2,500 U.S. hospitals and 80,000-plus other health care sites working together to achieve high-quality, cost-effective care. Owned by hospitals, health systems, and other providers, Premier maintains the nation’s most comprehensive repository of clinical, financial, and outcomes information and operates a leading health care purchasing network. A world leader in helping deliver measurable improvements in care, Premier has worked with the Centers for Medicare & Medicaid Services and the UK National Health Service North West to improve hospital performance. Headquartered in Charlotte, North Carolina, Premier also has an office in Washington.