support to over 5,000 primary care physicians with the goal of improving the heart health of millions of patients and improving the capacity of the practices to incorporate new research findings and information into practice.
Healthcare Cost and Utilization Project – this initiative highlighted the opioid overdose epidemic and contributed to Health and Human Services' launch of a major multipronged initiative to reduce opioid abuse.
Re‐Engineered Discharge (RED) – this structured protocol and assortment of implementation tools help hospitals rework their discharge processes to reduce readmissions by determining patients' needs and designing and communicating discharge plans.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) provides tools and data to assist organizations on their journey toward high reliability. Their website includes information on diseases and conditions; healthy living; travelers' health; emergency preparedness; injury, violence and safety; environmental health; and workplace safety and health (CDC, 2019). CDC provides educational material for both consumers and health care workers. For example, the website includes a variety of tools and promotional materials available at no cost to enhance the performance of hand hygiene (Figure 4.9) (Centers for Disease Control and Prevention, 2019).
Source: Clean Hands Campaign, Centers for Disease and Control (2019). Retrieved August 29, 2019. Retrieved from: from www.cdc.gov/handhygiene/campaign/index.html
Centers for Medicare and Medicaid
As a major financial reimbursor for health care services in the United States, the Centers for Medicare and Medicaid (CMS), recognizes the escalation of health care costs, poor patient outcomes, health care errors, and waste. As such, CMS posts safety, quality, and patient experience data on the CMS website (www.medicare.gov/hospitalcompare/search.html). CMS created the Centers for Medicare and Medicaid Innovation as part of the Affordable Care Act to enhance the quality of health care and reduce costs through innovative approaches to health care delivery.
CMS ties financial incentives to reliability through pay for performance programs focused on care provided in hospitals, home care, physician practices, and skilled nursing settings (Centers for Medicare and Medicaid Services, 2018a, 2018b, 2018c, 2018d). The three hospital‐based pay for performance programs are the value‐based purchasing (VBP) program, the readmission reduction penalty program, and the hospital‐acquired conditions( HAC) reduction program. Hospitals with better than expected outcomes receive higher reimbursement for patients insured under Medicare, while those with worse than expected outcomes receive lower reimbursements.
Value‐Based purchasing
In value‐based purchasing (VBP), hospitals earn scores based on achievement of or improvement in their safety, quality, patient experience, and financial performance (Centers for Medicare and Medicaid Services, 2018a, 2018b, 2018c, 2018d). VBP evaluates a hospital on five domains: patient and caregiver centered experience of care and care coordination; clinical care outcomes; efficiency and cost reductions; safety; and clinical care processes.
Hospital Readmission Reduction Penalty Program
The hospital readmission reduction penalty program focuses on patients being readmitted to hospitals for six specific conditions: acute myocardial infarction, coronary artery bypass graft surgery, chronic obstructive pulmonary disease, heart failure, pneumonia, and total hip and knee arthroplasty. The hospital's actual readmission rate is compared to the expected rate of readmissions given the patient's comorbidities (Centers for Medicare and Medicaid Services, 2018a, 2018b, 2018c, 2018d). Comorbidities are two or more coexisting medical conditions or disease processes that are additional to an initial diagnosis. For example, a patient may be admitted for pneumonia. If the patient also has diabetes and heart failure, these coexisting conditions must be documented because they make patient care more complex.
HAC Reduction Program
The HAC reduction program examines hospitals' performance on safety indicators and hospital‐acquired infections. Safety indicators are based on physician, advanced practice registered nurse, and physician assistant documentation. The coded data are then analyzed as part of the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI‐90). For hospital‐acquired infections, hospitals are required to submit their data on central line‐associated bloodstream infections, CAUTI, surgical site infections for colon and hysterectomy surgeries; methicillin‐resistant Staphylococcus aureus bacteremia, and Clostridium difficile infections to the Center for Disease Control and Prevention National Healthcare Safety Network (NHSN) databases. Each hospital's performance is compared to the mean. Poor performing hospitals receive a 1 % penalty (Centers for Medicare and Medicaid, 2018).
CMS publicly reports each hospital's performance on these measures. In addition, many states require health care organizations to report specific adverse events and safety, quality, and staffing indicators. These indicators are available to the public at state websites.
Medical Product Safety Network
The Medical Product Safety Network (MedSun) is an adverse event reporting program within the U.S. Food and Drug Administration's Center for Devices and Radiological Health (FDA, 2018). MedSun's goal is to work collaboratively with the clinical community to identify, understand, and solve problems with the use of medical devices.
The Safe Medical Devices Act requires hospitals and other health care organizations to report medical device problems that result in serious illness, injury, or death. Once a problem is identified, MedSun clarifies the problem and shares information with the clinical community and the public, without facility and patient identification, so that other clinicians can take preventive actions. MedSun participants are also highly encouraged to voluntarily report problems with devices that resulted in actual or potential harm. By monitoring reports about problems and concerns before a more serious event occurs, the FDA, manufacturers, and clinicians can work together to prevent serious injuries and death. Sometimes, this results in a product redesign.Current Educator, Clinical Educator, Novasyte Health representing Hill‐Rom Figure 4.10
Source: Nancy Withers.
Real World Interview
Nancy Withers
I was providing care for a patient who had just been transferred
