3. Implement Proven Quality and Safety Improvements
Case in Point: University of Colorado Health Sciences Center
Substantial gains in health system performance could be achieved if all providers were to adopt the "proven." These include use of evidence-based medicine, promoting effective chronic care management techniques, "reengineering" delivery within and among provider organizations to improve safety and reliability, and ensuring care coordination across sites of care, especially when transitioning from the hospital to other settings.
The Institute for Healthcare Improvement has been a leader in mobilizing hospitals and other providers to implement proven quality and safety improvements, saving lives and dollars.(9)
Hospitals and health systems throughout the nation have achieved stunning improvements in clinical outcomes and cost reduction by standardizing care processes based on proven best practices.
Some efforts are institutional, and some are broader. The Pittsburgh Regional Health Initiative is an unusual collaborative of 44 hospitals in southwestern Pennsylvania that works together to improve together. The group shares data, information, ideas, successes, and failures openly, focusing on a wide range of clinical and safety issues. As a result, more than 30 of the region's hospitals have reduced the incidence of a lethal, hospital-acquired bloodstream infection by 68 percent.(10)
A Fund-supported effort by Eric Coleman, M.D., at the University of Colorado Health Sciences Center, is creating more effective forms of "transitional care" for patients returning home from the hospital. The goal is to ensure their care needs are met while avoiding preventable complications and costly rehospitalizations.
Dr. Coleman has worked to develop quality-of-care measures to help pinpoint problems that occur during the transition from one site of care to another. This led to the development of the Care Transitions Measure,
which includes a discharge preparation checklist that asks patients to sign off on statements such as: "The hospital staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left the hospital"; and "When I left the hospital, I had a good understanding of the things I was responsible for in managing my health"; and "When I left the hospital, I clearly understood the purpose for taking each of my medications." The Care Transitions Measure has been adopted by the National Quality Forum as the best measure of care coordination.
In an intervention to improve care coordination at Group Health Cooperative in Seattle, patients receive tools and are taught skills reinforced by a "transition coach" who follows patients across care settings for the first 30 days following their discharge from the hospital. Dr. Coleman has found that patients who participate are less likely to be readmitted during this time-and even in the six months following discharge.