Everyone in healthcare is looking to "bend the cost curve." Hospital executives taking part in the Premier healthcare alliance's QUEST program say they're doing so by making small changes – to the tune of $577 million last year in savings.
Jan Mathews, director of clinical performance at Gaston Memorial Hospital in Gastonia, N.C., says measuring has been critical to the hospital's efforts to decrease its overall morality rate from 2.75 percent in 2005 to 1.47 percent in 2009.
"In order to make changes in quality, you have to track concurrent data," she said. "We know you cannot manage what you do not measure."
Mathews calls it "moving the dot," referring to pushing the dots on a graph toward a goal.
The goal on this graph is to decrease the incidence of sepsis – a life-threatening condition caused by an infection of the bloodstream that's responsibile for 90,000 deaths a year nationwide. At Gaston Memorial Hospital, sepsis is the main cause of preventable mortality, Mathews said.
Mathews spoke at a Jan. 6 online presentation highlighting the hospitals that are part of the Premier healthcare health alliance's QUEST: High Performing Hospitals program.
The three-year program includes nearly 200 not-for profit hospitals in 34 states. The program, which includes rigorous measures, is designed to spur hospitals to new levels of performance. The goal is to save lives, improve care and safely reduce the cost for each patient's hospitalization.
QUEST hospitals track five measures to help drive performance, said Richard Bankowitz, MD, Premier's chief medical officer. They are:
- Evidence-based care;
- Mortality ratio;
- Cost of care;
- Harm avoidance; and
- Patient experience.
The intent, said Bankowitz, is to boost performance – and save money – by "sharing knowledge and sharing data."
Premier released the results from the first year of the QUEST project last October. They showed that the original 157 hospitals participating in the program saved an estimated 8,043 lives and $577 million in one year. Also, 24,818 patients received treatment that met the highest quality of patient care standards when compared to the baseline performance at the beginning of the program.
Tackling sepsis
To reduce mortality from sepsis, Gaston Memorial employed automated alerts developed by Addison, Texas-based MEDHOST, a developer of emergency department technology.
In the emergency department, it's critical to get antibiotics ordered and administered quickly, Mathews said. The alerts remind the clinicians to do just that.
"The longer you wait, the mortality for severe sepsis rises," she said.
At North Side Hospital and Johnson City Specialty Hospital in Johnson City, Tenn., part of the Mountain States Health Alliance, Gail Hicks, vice president and director of nursing, is tracking the five measures put forward by Premier and the Institute for Healthcare Improvement. Mountain States Health Alliance encompasses 14 hospitals and spans 29 counties in a four-state region.
Among the strategies to reduce mortality at Mountain State the use of drill-down reports to find small windows of opportunity. According to Hicks, the mortality indices dropped from 1.54 for 2007 to 0.62 for the second quarter of 2009.
Small changes can make a big difference in better patient care and in bending the cost curve, Hicks said.
Mathews agreed. "If you're looking at value based health, you really have to look at the 360-degree view," she said.