Kentucky

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

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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

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Where Weve Been November, 2012
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Data Submission as of February 11, 2013
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HEN Progress to Date

• EEDs/OB ADVERSE EVENTS
• 449 - Number of hospitals with hard stop policies
  
• 42 - Average percent reduction (from baseline
  to months 9 through 12) in elective births lt 39
  weeks admitted to NICU for 286 hospitals
• 38 - Average percent reduction (from baseline
  through month 12) in EED gt 37 weeks and lt39
  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

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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
• lt1.2 Average surgical site infection rate
  (within 30 days following procedure) for over 500
  hospitals in months 1 through 12

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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
• lt1.23 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

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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

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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 2/18/13
• 100 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

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Kentucky Summary Table
Topic Most Popular Outcome Measure Avg Hospitals Reporting Total Eligible Hospitals Percent Reporting Baseline Q4 2012 or last 3 monitoring months Percent Reduction
ADE Excessive Anticoagulation 9 77 12 5 8 N/A
CAUTI CAUTI Rate - ICU 40 77 52 1.58 1.33 28
CLABSI CLABSI Rate - ICU 40 68 59 1.13 1.26 N/A
EED TJC EED 13 34 38
OB
Falls Falls with or without injury 29 77 38 3.47 3.46 0.28
Pressure Ulcer Stage III or IV 46 77 60 0.06 0.00 100
KY hospitals submitting 13 different OB measures
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Kentucky Summary Table
Topic Measure Avg Hospitals Reporting Total Eligible Hospitals Percent Reporting Baseline Q4 2012 or last 3 monitoring months Percent Reduction
Readmission 30 Day All Cause 22 77 28 12.34 10.07 18.38
SSI SSI Rate within 30 Days of Procedure 37 67 55 1.83 2.69 N/A
VAP VAP Rate - ICU 21 66 32 3.89 0.19 95
VTE Post Op PE/DVT 18 77 23 1.85 2.80 N/A
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Kentuckys Progress to DateADE
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Kentuckys Progress to DateCAUTI
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AHA/HRET HEN Progress to Date CLABSI
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Kentuckys Progress to DateCLABSI
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AHA/HRET HEN Progress to Date Falls
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Kentuckys Progress to DateFalls
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AHA/HRET HEN Progress to Date Early Elective
Delivery
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Kentuckys Progress to DateEarly Elective
Deliveries
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AHA/HRET HEN Progress to Date Pressure Ulcers
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Kentuckys Progress to DatePressure Ulcers
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AHA/HRET HEN Progress to DateReadmissions
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Kentuckys Progress to DateReadmissions
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AHA/HRET HEN Progress to Date SSI
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Kentuckys Progress to DateSSI
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AHA/HRET HEN Progress to Date VAP
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Kentuckys Progress to DateVAP
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AHA/HRET HEN Progress to Date VTE
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Kentuckys Progress to DateVTE
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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

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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-gt5-gtAll)
• Work with hospitals to continue to input data
  into the CDS and evaluate improvement to date
• Confer rights via CDC NHSN

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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 Email hen_at_aha.org
• Data Specific Questions hendatasupport_at_aha.org