Kentucky AHA/HRET Hospital Engagement Network Charisse Coulombe, MS, MBA, CPHQ; Senior Director, HEN Hospital Engagement Network Health Research & Educational Trust American Hospital Association

Hospital Leadership Clinicians & Front Line Staff (Teams) THE PATIENT ACA considerable focus on quality Created the CMS Innovation Center Public-private partnership Set 40/20 goal Tool: Hospital Engagement Networks 26 contracts awarded Contracted with 31 state and regional hospital associations 1,600 + hospitals Hospital Engagement Network

Partnership for Patients The 40/20 Goal Keep patients from getting injured or sicker Reduce preventable hospital-acquired conditions by 40 percent 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years Help patients heal without complication Reduce all hospital readmissions by 20 percent 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge 3

4 Where We’ve Been: November, 2012

Data Submission as of February 11, 2013

HEN Progress to Date EEDs/OB ADVERSE EVENTS Number of hospitals with hard stop policies 42% - Average percent reduction (from baseline to months 9 through 12) in elective births < 39 weeks admitted to NICU for 286 hospitals 38% - Average percent reduction (from baseline through month 12) in EED > =37 weeks and <39 weeks for 271 hospitals $40.8 m - Estimated projected cost savings for avoided NICU admissions for 2012 CAUTIs 15 percent reduction in CAUTIs since 2011 for 290 hospitals 27 CAUTIs prevented each month $325,000 estimated projected costs avoided by end of 2012 CLABSIs 28% percent reduction of CLABSIs for 302 hospitals 5 CLABSIs prevented each month $4 m estimated projected costs for avoided CLABSIs by end of 2012

HEN Progress to Date ADEs 32% - Average percent reduction (from baseline through month 12) in excessive anticoagulation in inpatients with warfarin treatment for 80 hospitals $1.32 m Estimated projected cost savings for avoided ADEs in 2012 FALLS WITH OR WITHOUT INJURY 4% - Average percent reduction (from baseline through month 12) in falls with or without injury for 550 hospitals $19.0 m Estimated projected cost savings for avoided falls in 2012 PRESSURE ULCERS 2% - Percent reduction (from baseline through month 12) in percent of patients with at least one Stage II or greater pressure ulcer for 152 hospitals $1.7 m Estimated cost savings for avoided pressure ulcers in 2012 (annualized) SSIs <1.2% Average surgical site infection rate (within 30 days following procedure) for over 500 hospitals in months 1 through 12

HEN Progress to Date VTEs 11% Average percent reduction (from month 1 to month 12) in potentially preventable VTE rate for 88 hospitals $11.7 m - Estimated projected cost savings for avoided VTEs in 2012 (annualized) VAPs <1.23 Average ventilator-associated pneumonia rate in the ICU (per 1,000 device days) for 390 hospitals in months 1 through 12 READMISSIONS 16% Average percent reduction (from baseline to month 12) in 30 Day All- Cause Readmission rate for 420 hospitals 24 - Average number of fewer readmissions per month, per hospital for 351 hospitals (from baseline to November 2012) $80.9 m Estimated projected cost savings for avoided readmissions in November 2012

CMS Goals 40% reduction in all harm topics 20% reduction in readmission Have 60% or more hospitals (in HEN/state) submitting data in all applicable topics and attaining reduction goals for potential renewal in 2014

CMS Commitments At least 70 percent of AHA HEN birthing hospitals will implement hard- stop policies or have an EED rate less than 3 percent by April 1st of 2013; 80% as of 5/31/13: AHA/HRET HEN currently at 63% as of 2/18/13; KY currently at 47% as of 2/18/ percent of AHA HEN hospitals will be submitting data on at least six HACs by January 31st of 2013: AHA/HRET HEN currently at 71% as of 2/25/13; KY currently at 88% as of 2/25/13 (68/77) Make transparent the hospitals part of the HRET HEN on the HRET website: AHA/HRET HEN has posted the names of all of the HEN hospitals by state. Make transparent all hospitals working on 10 HACs on the HRET HEN website: AHA/HRET HEN has posted the names of all of the CMS HEN hospitals by HEN that are working on the 10 HACs (or all that are applicable). There are currently 292 hospitals that fit this criterion. Kentucky has 1 hospital: Fleming County Hospital Doubling the number of hospitals showing a 20 percent improvement in readmission; AHA/HRET currently at 124 hospitals as of 2/8/13;

Kentucky Summary Table TopicMost Popular Outcome Measure Avg # Hospitals Reporting Total Eligible Hospitals Percent Reporting BaselineQ or last 3 monitoring months Percent Reduction ADEExcessive Anticoagulation 97712%5%8%N/A CAUTICAUTI Rate - ICU % % CLABSICLABSI Rate - ICU % N/A EEDTJC EED133438% OB* FallsFalls with or without injury % % Pressure Ulcer Stage III or IV467760% % * KY hospitals submitting 13 different OB measures

Kentucky Summary Table TopicMeasureAvg # Hospitals Reporting Total Eligible Hospitals Percent Reporting BaselineQ or last 3 monitoring months Percent Reduction Readmission30 Day All Cause %12.34%10.07%18.38% SSISSI Rate within 30 Days of Procedure % N/A VAPVAP Rate - ICU % % VTEPost Op PE/DVT % N/A

Kentucky’s Progress to Date ADE

Kentucky’s Progress to Date CAUTI

AHA/HRET HEN Progress to Date CLABSI

Kentucky’s Progress to Date CLABSI

AHA/HRET HEN Progress to Date Falls

Kentucky’s Progress to Date Falls

AHA/HRET HEN Progress to Date Early Elective Delivery

Kentucky’s Progress to Date Early Elective Deliveries

AHA/HRET HEN Progress to Date Pressure Ulcers

Kentucky’s Progress to Date Pressure Ulcers

AHA/HRET HEN Progress to Date Readmissions

Kentucky’s Progress to Date Readmissions

AHA/HRET HEN Progress to Date SSI

Kentucky’s Progress to Date SSI

AHA/HRET HEN Progress to Date VAP

Kentucky’s Progress to Date VAP

AHA/HRET HEN Progress to Date VTE

Kentucky’s Progress to Date VTE

Results to Date CMS understands that all of the hospitals are making rapid improvement in multiple areas The results at both the HEN and Kentucky levels are showing improvement and areas that need focus For areas of focus - Talk to your teams, see what other improvements can be tested and what will work for your hospital/culture to improve patient safety and quality of care – Participate on webinars, LISTSERVs, networking events For areas showing improvement – ensure that your processes are hard wired and the culture has shifted to allow for this improvement to be sustained long after the HEN project is completed 31

Next Milestones for the HEN Project Continue to focus on improvement strategies to help hospitals reduce harm and prevent readmissions Work with hospitals to expand their improvement work across all (applicable) topics (2->5->All) Work with hospitals to continue to input data into the CDS and evaluate improvement to date – Confer rights via CDC NHSN 32

Thank You! AHA/HRET HEN is proud of the accomplishments that have occurred to date and continue to look forward to accelerating the improvement across all topics! We are here to support KHA and you in any way possible – General – Data Specific Questions: 33