Data sharing collaborative saves lives and money

The 333 hospitals taking part in Premier healthcare alliance’s QUEST collaborative saved 92,000 lives and $9.1 billion over four-and-a-half years, Premier announced on March 19, and if the practices employed in the collaborative were replicated nationwide, Premier officials say, hospitals potentially could save 950,000 lives and approximately $93 billion.

During a press call Tuesday, members of the QUEST initiative shared outcomes data and expertise, such as best practices in order to improve their performance across the board.

[See also: Maine's NovaHealth, Aetna partnership lowers cost, improves care]

Among some of the results: Central-line associated blood stream infections (CLABSI) reduced by 59 percent, falls and pressure ulcers by 64 percent. Supply costs cut by 29 percent, labor costs by 26 percent.

The $9.1 billion saved is enough to pay the annual salaries of every active NFL, NBA and MLB player combined, according to Premier executives, who describe QUEST as the largest value-based initiative designed to help hospitals and health systems reliably deliver the most efficient, effective and caring experience for every patient, every single time.

Those are the kind of results Donald Berwick, MD, likes to see. Berwick is senior fellow at the Center for American Progress and former administrator for Centers for Medicare & Medicaid Services.

“Providers in Premier’s QUEST collaborative have committed to specifically matching the level of care with the needs of the patient to achieve positive outcomes,” he said. “Through this and other initiatives, the alliance is creating a quality framework that helps to answer important questions in healthcare that help improve quality and bend the cost curve.”

QUEST hospitals observed mortality is 10 percent lower than national averages. At the same time QUEST hospitals have been improving their overall quality standards, they have also reduced the mean cost per discharge by $1,110, primarily by reducing costs for both labor and supplies by focusing on resource utilization, improved workflows and eliminating waste. As a result, QUEST hospitals’ costs are 14 percent lower than national averages and have remained flat for the last three quarters.

“Together we’re showing that there is room for improvement in any hospital, no matter who they are – we all must focus on consistently providing better care,” said Thomas Macaluso, MD, chief quality officer, Memorial Health System of South Broward, Fla. in a press release about QUEST's results. “We’re both learning from and teaching others how to achieve system-wide change that impacts quality, costs and one’s personal care experience.”

QUEST hospitals of varying sizes across the country, including disproportionate share and safety-net facilities, transparently share patient outcomes data and define consistent measures of top performance. Over time, they compare their performance to match or exceed the top 25 percent of hospitals in all categories except cost, which is set at the top tercile. To reach these standards, they strive to:

• Reduce mortality by at least 31 percent;
• Reduce the average cost of care to less than $5,690 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 95 percent of the time;
• Improve the hospital experience so that patients favorably rate their stay and would recommend the facility to others at least 73 percent of the time;
• Reduce preventable harm events; and
• Reduce readmissions by at least 12 percent.

“Eliminating the burden of costs, means spending more time ensuring patients are satisfied and not unnecessarily readmitted, which is a growing concern due to national value-based purchasing and risk-based reimbursement programs,” said Tamera Parsons, vice president of quality and patient safety, Mountain States Health Alliance of Northeast Tennessee and Southwest Virginia. “We’ve stepped up efforts in patient-provider communication and in delivering evidence-based, data-driven care to make decisions that keep our patients happy and avoid preventable readmissions.”

A primary way QUEST hospitals improved their mortality rates was to focus on sepsis, which data showed was the leading cause of deaths in excess of expected when the collaborative was established in 2008. After sharing techniques for earlier detection and appropriate treatment in the emergency department, sepsis has moved to the bottom of the list, and QUEST members now avoid about 1,700 sepsis mortalities per quarter. Using a similar, data-driven approach, QUEST members have also been actively reducing harm rates, including CLABSI by 59 percent and hospital-acquired injuries including falls and pressure ulcers by 64 percent.

Complementing efforts to lower mortality, costs, harm and readmissions QUEST members provide all recommended evidence-based care measures at least 96 percent of the time, a 14 percent improvement since 2008. This equates to 80,128 additional people receiving evidence-based care – more than attended the 2013 Super Bowl, Premier noted.

Patient experience scores among QUEST hospitals have increased by 3 percent and they maintain a 1 percent edge over non-participants. Their readmission rates have declined modestly, dropping by 4 percent, a somewhat predictable result given that many facilities have just begun to work on this issue.

“Healthcare is an industry that has been in dire need of change, but traditionally has not done so. QUEST has shown that change is not only possible, it’s probable in the right conditions," said Premier President and CEO Susan DeVore. "By setting high standards, comparing performance to others, transparently sharing results and creating open forums for idea exchange, QUEST hospitals are transforming our health systems in a way that makes them an example to follow. Using the scale of the alliance, these hospitals are passionate about designing powerful, innovative advances in healthcare, building ahead of the future to continually safeguard a system that delivers on creating healthier communities."

Premier officials announced QUEST would continue to drive its efforts to improve care with the next generation of QUEST, which will launch in January 2014, to continue to push toward improvement on inpatient metrics that align with value-based purchasing and payment reductions and penalties, and to begin to enhance improvement on ambulatory and community health based metrics that will further help providers move to new models for delivering care.

The collaborative, which represents almost every state, including all hospitals in the state of Hawaii, aligns closely with federal policies such as value-based purchasing and the Partnership for Patients effort, but it started well before those policies became reality, Premier executives said. Working with Premier’s partner, the Institute for Healthcare Improvement, QUEST has provided education and best practice sharing on various strategies for improving healthcare since 2008.