HQID lets San Diego hospitals focus on evidence-based care
Palomar Pomerado Health (PPH) in north San Diego is North County’s most comprehensive healthcare delivery system, and the only Magnet® recognized system in the state. Nationally recognized for clinical excellence in cardiac care, women’s services, cancer, orthopedics, trauma, rehabilitation and behavioral health services, PPH has more than 3,600 employees and 700 physicians. It was named by Modern Healthcare as one of the Top 100 places to work in the U.S. Facilities include Palomar Medical Center, Pomerado Hospital, Villa Pomerado, Palomar Continuing Care Center, the Jean McLaughlin Women’s Center, and PPH Expresscare health centers. www.pph.org
Situation:
Are economic incentives to hospitals – also known as pay-for-performance or value-based purchasing – an effective way to improve the quality of inpatient care?
Solution:
In 2003, The Centers for Medicare & Medicaid Services (CMS) and the Premier healthcare alliance teamed up to launch the Hospital Quality Incentive Demonstration™ (HQID) – the first national project of its kind designed to answer that question. More than 250 hospitals from across the nation joined the project initially. A long-time Premier Healthcare Informatics products user, Palomar Pomerado Health chose to participate in HQID.
Results1
As politicians and policymakers search for models of healthcare payment and reform, fourth-year results reveal the HQID project is helping patients live longer and receive recommended treatments more frequently.
- Participating hospitals have raised overall quality an average of 17.2 percent over four years based on delivery of 30-plus nationally standardized and widely accepted care measures to patients in five clinical areas.
- The improvements have saved the lives of an estimated 4,700 heart attack patients, according to a Premier analysis of mortality rates at participants.
- During the same time, the more than 1.5 million patients treated in five clinical areas at the 230 hospitals also received about 500,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination.
- In addition to significant incentive payments, Palomar Pomerado Health’s two participating hospitals won 10 out of 18 possible awards in the fourth year of the HQID project.
1From an article by Susan D. DeVore, President and CEO, Premier healthcare alliance, “Results from the First 4 Years of Pay for Performance” in the January 2010 edition of HFM Magazine.
“Participating in the HQID
project has allowed us to enhance our focus on, among other things,
evidence-based care. We have worked diligently to ‘hard-wire’ our key
processes to ensure that our patients are receiving evidenced-based measures
whenever possible, across all of our areas of care.
“Three years ago, Palomar Pomerado created ‘Best Practice Teams’ to focus on
each of the project’s five clinical areas. These multidimensional teams are
chaired by nursing leaders, facilitated by quality staff and include a
designated physician champion, and they work with staff-level caregivers to
identify the action steps needed to ensure that they are adhering to the
evidenced-based measures that are a part of the project. Through their
experiences, the teams have been able to create order sets, education tools,
and checklists.
“Because communication is key, we ask our staff to partake in huddles to
ensure consistent communication. The need for ongoing feedback from the
front-line caregivers is essential, and our teams continue to create
mechanisms that allow for communication among nurses, physicians and others.
“Palomar Pomerado has also made a point to publicly recognize care givers
while consistently communicating our results to all levels of the
organization. In fact, we’ve tied our success in administering the measures
and in the overall project to our system-wide initiatives for strategic
planning, and they are a part of employee incentive packages at all levels –
from executives on down.
“Evidence-based care has truly become an integral aspect of the care Palomar
Pomerado offers our patients. We’ll continue to monitor key indicators and
measures to ensure success with these processes, and we are in the process
of linking them to specific outcomes, such as mortality rates,
length-of-stay, and more.1”
Opal Reinbold
Chief Quality Officer
Palomar Pomerado Health, San Diego
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