Driving down harm

New HHS figures have shown that hospital-acquired conditions fell by 1.3 million in 2010 to 2013. What has driven these improvements and what more needs to be done? HRMR investigates.

Some 50,000 fewer patients died in hospitals and approximately $12 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions (HACs) from 2010 to 2013. These are key findings of a new report from the Department of Health and Human Services (HHS).

It says this progress toward a safer healthcare system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act (ACA) including Medicare payment incentives to improve the quality of care, according to an Agency for Healthcare Research and Quality (AHRQ) spokesperson.

“Multiple provisions in the ACA are impacting patient safety and HACs,” she says. “For example, the work of the Partnership for Patients and Hospital Engagement Networks is a direct product of the new model testing authority and resources provided under the CMS Innovation Center which was established under section 3021 of the ACA.

“Additionally, other provisions of the ACA have enabled better and more comprehensive safety measurement, expanded transparency and public reporting on Hospital Compare, new tools and interventions, and linkage of HAC payment incentives and penalties through hospital value-based purchasing.”

A dramatic fall

Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer HACs from 2010 to 2013. This translates to a 17 percent decline in HACs over the three-year period.

“The results are welcome news for patients and their families,” says HHS secretary Sylvia Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our healthcare dollars more wisely. HHS will work with partners across the country to continue to build on this progress.”

The data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

HACs include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others. AHRQ analyzed the incidence of a number of avoidable HACs compared to 2010 rates and used as a baseline estimates of deaths and excess healthcare costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal—improving patient care,” says Rich Umbdenstock, president and CEO of the American Hospital Association.

“We have built an ‘infrastructure of improvement’ that will aid hospitals and the healthcare field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

To drive progress on the way care is provided, HHS says it is focused on improving the coordination and integration of healthcare, engaging patients more deeply in decision-making and improving the health of patients, with a priority on prevention and wellness.

“These major strides in patient safety are a result of strong, diverse public-private partnerships and active engagement by patients and families,” it said in a release. 

Partnership for Patients

In 2011, HHS set a goal of improving patient safety through the Partnership for Patients, which targets a specific set of HACs for reductions.

Public and private partners are working collaboratively—including hospitals and other healthcare providers—to identify and spread best practices and solutions to reduce HACs and readmissions.

“The two goals of the Partnership for Patients are to reduce preventable HACs by 40 percent and 30-day hospital readmissions by 20 percent between 2010 and 2014. We estimate that about 44 percent of HACs are preventable, therefore our target is 44 percent of a 40 percent reduction, or about an 18 percent reduction overall,” says AHRQ’s spokesperson.

“HHS has committed up to $800 million in ACA funding to help achieve the aims of the Partnership for Patients. To date, the CMS Innovation Center has invested approximately $430 million in 26 Hospital Engagement Networks (HENs) to help hospitals implement proven strategies to reduce preventable HACs and make care safer.”

The Partnership for Patients—including the HENs—is one part of a larger effort to reduce HACs and readmissions. While the HENs are one of its core elements, Partnership for Patients is teaming with many federal and private partners, including the CMS Quality Improvement Organization program, which together are making substantial progress in improving healthcare quality that is lowering costs for taxpayers and patients.

Significant progress

All the major measurement streams used by the Partnership for Patients (AHRQ National Scorecard data, reports from the HENs, Medicare fee-for-service) are showing substantial improvements across multiple HACs. A preliminary evaluation found clear evidence for decreased rates of harms for four HACs (obstetrical early elective deliveries, adverse drug events, ventilator-associated pneumonia, and central line-associated bloodstream infections). Based on these preliminary results, the Partnership for Patients is on target for achieving its goals for reducing HACs. 

Patrick Conway, CMS deputy administrator for innovation and quality and chief medical officer says: “As a practicing physician in the hospital setting, I know how important it is to keep patients as safe as possible. These collaborative efforts are rapidly moving healthcare safety in the right direction.”

“AHRQ has developed the evidence base and many of the tools that hospitals have used to achieve this dramatic decline in patient harms,” adds AHRQ director Richard Kronick.

“Additionally, AHRQ’s work in measuring adverse events, performed as part of the Partnership for Patients, made it possible to track the rate of change in these harms nationwide and chart the progress being made.”

Efforts for improvement also include Medicare payment incentives to improve the quality of care. HHS has announced that it has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements, by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.

HHS has also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as hospital value-based purchasing and hospital readmissions reduction initiatives. 

AHRQ has produced a variety of tools and resources to help hospitals and other providers prevent HACs, such as reducing infections, pressure ulcers, and falls. The tools and resources include the Comprehensive Unit-based Safety Program, the Re-Engineered Discharge Toolkit, TeamSTEPPS, and more.

More to be done

HHS says it will continue working with partners to capitalize on its promising results and continue on the path of improving patient safety and reducing healthcare costs while providing the best, safest possible care to patients.

“Despite the early and promising results, more work needs to be done,” says AHRQ’s spokesperson. “Specifically, the ACA has enabled better and more comprehensive safety measurement, expanded transparency and reporting on Hospital Compare, new tools and interventions, and linkage of HAC payment incentives and penalties through hospital value-based purchasing.”