Guest written by Stephen C. Schoenbaum, M.D., M.P.H., Executive Vice President for Programs
To watch an Oct. 20, 2006 video editorial by Dr. Schoenbaum on this topic, visit Medscape General Medicine.
June was an excellent month for quality improvement in health care, as two initiatives revealed that their activities are taking hold in hospitals across the country—and yielding life-saving results.
On June 14, Donald Berwick, M.D., CEO of the Institute for Healthcare Improvement (IHI), announced that the 100,000 Lives Campaign, launched in December 2004, had exceeded its 18-month goal of preventing 100,000 deaths. More than 3,000 hospitals, representing more than 75 percent of U.S. hospital beds, participated, saving an estimated 122,000 lives. And on June 20, Premier, Inc., an alliance of nonprofit hospitals and health care systems, announced that its three-year demonstration project with the Centers for Medicare and Medicaid Services (CMS), launched in October 2003, is resulting in better care at lower costs. Approximately 260 not-for-profit hospitals are participating in this pay-for-performance project.
The 100,000 Lives Campaign focuses on six interventions in participating hospitals: Deployment of rapid response teams to provide early intervention for patients whose conditions are deteriorating; medication reconciliation to prevent adverse drug events as patients are transferred from location to location within hospitals or between care settings; delivery of evidence-based practices for the care of patients with heart attacks such as beta blockers and ACE-inhibitors; implementation of the "central line bundle," five practices that have been shown to prevent certain blood stream infections; prevention of surgical site infections; and implementation of a group of four practices to prevent ventilator-associated pneumonia.
The campaign is organized like a national political campaign, with 55 local field offices or "nodes," consisting of 155 organizations, across the country. According to Joe McCannon, IHI's young and dynamic campaign manager, the responsibilities of the nodes are to "raise awareness, drive enrollment, convene appropriate parties, and act as a communications relay point for the network." The nodes also support and monitor the campaign, McCannon says, by coordinating the provision of technical assistance to participating sites, tracking progress, and identifying and responding to emerging challenges within the network. He notes that the campaign nodes include 33 quality improvement organizations (QIOs), 24 state hospital associations, many nurses associations and medical societies, and several large health care delivery systems.
IHI has engaged a variety of local and national organizations as supporters, including private groups, such as the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations, and governmental agencies, such as the Centers for Disease Control and Prevention and CMS. Some foundations, such as the Colorado Trust, have given grants to area hospitals to support participation. The Gordon and Betty Moore Foundation in the Bay Area provided core support to IHI as well as campaign support to local hospitals. Similarly, some insurers have supported the campaign. Massachusetts Blue Cross Blue Shield recently announced that it had supported IHI with a $1,000,000 award and "by giving patient safety-improvement grants to every acute care hospital in Massachusetts." Each hospital received $35,000 and "committed to at least one safety improvement aligned with the 100,000 Lives Campaign."
Much is not yet known about the 100,000 Lives Campaign. There has been some controversy about exactly how many lives have been saved; and the number of interventions each participating hospital actually implemented and the degree of success achieved for each attempted improvement are unknown at this time. Nonetheless, it seems clear that participation was broad, and that lives have been saved. And that is impressive.
The Premier demonstration project, though smaller in terms of the number of hospitals participating, will provide detailed information about improvement and its associated benefits to patients and hospitals. The recently released results show that, spurred by a small financial incentive, hospitals improved their performance quarter after quarter for patients with heart attacks, bypass surgery, pneumonia, heart failure, and hip and knee replacements. More detailed results for two of these, pneumonia and heart bypass surgery, demonstrate that better care resulted in lower costs, saved lives, fewer complications, fewer readmissions, and shorter lengths of stay. This is a "win-win" result by anyone's standards.
Toward National Quality Goal-Setting
After decades of resistance within the health care industry to recognizing that quality of care can be improved and to adopting robust methods of improving it, the 100,000 Lives Campaign and the Premier demonstration project show that it is possible to engage a broad constituency in improving care—and that when that is done with an evidence-based set of interventions, the results are meaningful not just to the health care industry but to the American people.
Second, it is important to consider quality, efficiency, coverage, and access together and recognize that improving one dimension often improves others. For years, we have heard about the "business case" for quality. Now, the Premier results demonstrate that it is possible to achieve significant cost savings as one improves quality of care—at least for certain conditions.
Third, it takes cross-institutional, preferably national, goals and shared strategies to generate this type of improvement. Both these efforts were voluntary, and although many hospitals participated, we need to ensure that all Americans get excellent care. While IHI and CMS and probably Premier, Inc., will most likely continue to set goals, the U.S. needs a broad, centrally coordinated national process for stimulating improvement across the entire population in all care settings. That process needs to integrate and draw on the combined expertise and resources of the public and private sectors.
In the meantime, we join those who are celebrating these important achievements and congratulate all who contributed to them. As always, we'd like to hear from you. Send your feedback to email@example.com
July 2006Written with the assistance of Christine Haran, web editor.