In a report to Congress, HHS highlighted increased interest and activity in quality improvement activities in healthcare since passage of the Patient Protection and Affordable Care Act.
The 2013 Annual Progress Report to Congress on the National Strategy for Quality Improvement in Health Care discusses healthcare stakeholders' efforts to meet the strategy's three aims and six priorities for quality improvement, which were developed in March 2011. The three aims are better care, healthy people/healthy communities and affordable care.
HHS gave some examples of improvements in each of the six priority areas:
Priority 1: Making care safer by reducing harm caused in the delivery of care. This priority focuses on hospital-acquired conditions and hospital readmissions.
• Irving, Texas-based VHA reduced all-payer, all-cause readmissions by 17.6 percent in 12 months across 192 hospitals.
• Since 2011, San Francisco-based Dignity Health has decreased central line-associated bloodstream infections by 70 percent, ventilator-associated pneumonia by 53 percent, surgical site infections by 52 percent and catheter-associated urinary tract infections by 24 percent.
Priority 2: Ensuring each person and family is engaged in their care. This priority focuses on timely care and shared decision-making.
• Mount Sinai Hospital in New York City opened a geriatric emergency department that is quieter, has more space and offers reading glasses, hearing aids, crossword puzzles and magazines to make patients more comfortable and improve communication.
• Oakland, Calif.-based Kaiser Permanente launched a shared decision-making pilot in January 2011 that provided video-based decision aids to patients, which more than 80 percent of the patients said were helpful. The pilot yielded a 50 percent decrease in the number of elective hip replacement surgeries compared with a control group from a past year.
Priority 3: Promoting effective communication and coordination of care. This priority focuses on the patient-centered medical home and a three-item care transition measure.
• Southcentral Foundation in Anchorage, Alaska, provides primary outpatient care through a National Committee for Quality Assurance-recognized level 3 PCMH. The PCMH has decreased specialty care visits by 65 percent, hospital admissions by 53 percent, primary care physician visits by 20 percent and ED visits by 5 percent.
Priority 4: Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. This priority focuses on aspirin use, blood pressure control, cholesterol management and smoking cessation.
• Through the use of care coordinators and an electronic health system's analytics and decision support, Ellsworth (Wis.) Medical Clinic improved the blood pressure control rate among patients with cardiovascular disease from 68 percent to 97 percent from 2007 to 2011.
Priority 5: Working with communities to promote best practices for healthy living. This priority focuses on depression and obesity.
• From 2005 to 2011, childhood obesity rates decreased by 13.3 percent in Mississippi and by 5.5 percent in New York City through interventions such as healthier foods and increased physical activity requirements in schools.
Priority 6: Making quality care more affordable by developing and spreading new healthcare delivery models. This priority focuses on out-of-pocket expenses and health spending per capita.
• CareFirst BlueCross BlueShield's patient-centered medical home program tied physician and nurse practitioners' reimbursement to cost savings and quality measures. The program saved $38 million in its first year and $98 million in its second year.
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