Hospital Associations

State hospital associations have a long history of leading quality improvement efforts and have been at the forefront of campaigns to reduce readmissions, to prevent harms from reaching patients, and to stop the spread of hospital-acquired infections. In September 2016, the Centers for Medicare & Medicaid Services (CMS) selected 16 national, regional or state hospital associations and health system organizations to lead a four-year quality improvement effort known as the Hospital Improvement Innovation Network (HIIN). Four Superior Health Quality Alliance member organizations were among the HIIN awardees: Illinois Health and Hospital Association, Michigan Health & Hospital Association, Minnesota Hospital Association and Wisconsin Hospital Association.

HIINs stemmed from the Partnership for Patients (PfP), a nationwide public-private collaboration striving to prevent patients from being harmed while in the hospital and heal without complication once they are discharged. The HIIN awards integrated existing PfP Hospital Engagement Networks into the Quality Improvement Network-Quality Improvement Organization program to maximize the strengths of both programs to sustain and expand national reductions in patient harm and 30-day readmissions for the Medicare program.

The HIINs had a goal to achieve the following:

• 20 percent reduction in overall patient harm (to 97 hospital-acquired conditions [HACs]/1,000 discharges) from 2014 baseline (of 121 HACs/1,000 patient discharges).
• 12 percent reduction in 30-day readmissions as a population-based measure (readmissions per 1,000 people).

To bring about improvement in patient safety, HIINs focused on 11 required core areas of harm:

• Adverse drug events, to focus on at least the following three medication categories: opioids, anticoagulants and hypoglycemic agent.
• Central line-associated blood stream infections in all hospital settings, not just intensive care units.
• Catheter-associated urinary tract infections in all hospital settings, including avoiding placement of catheters, both in the emergency room and in the hospital.
• Clostridium difficile infection, including antibiotic stewardship.
• Injury from falls and immobility.
• Pressure ulcers.
• Sepsis and septic shock.
• Surgical site infections (SSI), to include measurement and improvement of SSI for multiple classes of surgeries.
• Venous thromboembolism, including, at a minimum, all surgical settings.
• Ventilator-associated events, to include Infection-related Ventilator-Associated Complication and Ventilator-Associated Condition.

In addition to these core topics, HIINs addressed all other forms of preventable patient harm most impactful to their respective populations in the Medicare program. Minnesota saw a 16% reduction in sepsis and septic shock and a 22% reduction in opioid adverse drug events. Illinois, Michigan and Wisconsin achieved 31% improvement in central line-associated blood stream infections and 28% improvement in catheter-associated urinary tract infections.

The state hospital associations will continue to work with members in the core areas of harm, with increased focus on behavioral health outcomes, patient safety and care transitions. Additionally, emphasis will be placed upon supporting quality improvement efforts towards public health emergency response.