Premier hospitals save lives

Sharing data, expertise drives better care, lower costs
By Bernie Monegain
12:00 AM

CHARLOTTE, NC  -  Premier healthcare alliance members and executives traveled to Capitol Hill last month to let lawmakers know what the alliance's member hospitals have been doing to help transform care across the country.

 It is pretty heady stuff  -  92,000 lives saved and $9.1 billion in costs cut over 4.5 years, by Premier's count. Hospitals nationwide could save 950,000 lives and approximately $93 billion over five years by replicating performance-boosting practices employed by QUEST, the alliance asserts.

Data sharing, particularly on outcomes, and sharing what they learned about best practices drove high results for all 333 hospitals participating in Premier's QUEST initiative.

There was technology employed at each hospital, of course, EHRs, data warehouses and the like. Also, there was technology Premier developed and put to work specifically for the QUEST initiative. 

As Premier CEO Susan DeVore put it during a conference call with reporters before she and her team caught a flight to the nation's capitol, the technology is "absolutely critical."

"The challenge is how do you scale this to get industry results," DeVore said.

To that end, Premier built a platform to connect 2,700 member hospitals.

"We put social media on the front end," DeVore said. "We put enterprise data warehouse on the back end, and we put all these applications in the middle. We are connecting in a vendor agnostic and a payer agnostic way to be able to pull all the data that we need, put it together and direct these collaboratives around what we think, from the data, are the focus areas that our health systems need to work on." 

"There is a problem with boiling the ocean here," Devore told Healthcare IT News. "So what we attempt to do is use the data and data integration capabilities we have to focus the effort.

The results that Premier achieved and spotlighted are what Donald Berwick, MD, likes to see. Berwick, senior fellow at the Center for American Progress and former administrator for Centers for Medicare & Medicaid Services, worked with Premier on the QUEST project before his stint at CMS

"I see QUEST as undoubtedly a breakthrough," Berwick said. "It's a breakthrough first for American hospital care. It could be a breakthrough for all of our healthcare."

Berwick described QUEST as a project about systems and processes, working with innovation and applying science in terms of delivery of healthcare within hospitals across the continuum. 

QUEST applies "very important principles of design and qualities, such as reliability, focus on safety, patient engagement and innovation," he said. "It's a clear example of how proper work on the design and redesign of healthcare delivery is the way to get the results we're after. The alternative to the design and redesign approach is not a good one  -  that is, saving money by just cutting, and cutting, and cutting, and taking things away from people. What we need to do is to redesign healthcare so that it performs better across the board."

"The very best way to control costs is to make care better," Berwick said.

By pulling together both the scientists and experts on improvement, and hospitals and leaders with each other, QUEST has recreated the atmosphere for promoting quality through the "all teach, all learn" approach, where it is assumed that everyone knows something that can help everyone else, Berwick noted. He also applauded QUEST for its transparency, sharing results and turning the light on its own performance. "That takes courage," he said.

Members of the QUEST initiative shared outcomes data and expertise, such as best practices in order to improve their performance across the board.

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

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. "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.

One 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.

Premier officials announced that 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 drive 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.