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VHIG Digest: Vol. 3, No. 1

This Week’s Top 3 Stories in Patient Safety and Quality Improvement in Healthcare

By Scott Hagan, School of Medicine, Class of 2013

1. Michigan Keystone ICU Patient Safety Program Reduces Infections, Saves Money

With one in 20 hospitalized patients acquiring a healthcare-associated infection (HAIs) in the United States, HAIs are a leading cause of mortality, and the cost of treating HAIs has been estimated by the HHS to be up to $33 billion annually. In a study released this week from the American Journal of Medical Quality, six intensive care hospitals in Michigan, carrying out a program designed to reduce the number of central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonias (VAPs), were able to prevent these infections and reduce costs. The program, called the Michigan Keystone ICU Patient Safety Program, was created by leading patient safety expert Peter Pronovost, and has a two-fold purpose: 1) to improve teamwork and communication in ICUs by instilling a culture of safety, and 2) to improve compliance to infection-prevention strategies such as the use of checklists before inserting central line catheters. After initiating the program in 2006, researchers found that, on average, 29.9 CLABSIs and 18.0 VAPs were prevented per hospital per year. The cost of theprogram was estimated to be $3,375 per infection avoided, while the cost per treatment of an episode of CLABSIs/VAPs was estimated to be in a range of $12,208 to $56,167. When the costs of the program are weighed against its savings, the average hospital could save $1.1 million per year through this intervention.

Study: The Business Case for Quality: Economic Analysis of the Michigan Keystone Patient Safety Program in ICUs
Articles: MedPage Today; Johns Hopkins press release

2. CMS Announces Bundled Payment Program- 8/23/11

Last Tuesday, the Center for Medicare and Medicaid Services (CMS) announced a pilot initiative to bundle insurance payments for multiple procedures. CMS is offering physician participants a choice between from 4 models of care: 1) a single inpatient acute care episode; 2) a single inpatient care episodes plus associated post-acute inpatient care; 3) only post-acute inpatient care; and 4) a single prospective payment for all services rendered in an inpatient stay. Providers must submit a letter of intent for these models by November 4, 2011. Applicants are allowed to propose a specific episode of acute and post-acute inpatient care for the bundled payment.
The purpose of the new program is to incentivize provider networks to coordinate the care of a patient’s inpatient stay in a cost-effective manner. If provider networks are able to provide the inpatient care within the costs of the bundled payment, they retainthe excess payment of the bundle, thus encouraging cost-conscious care. The pilot project is one of several demonstration projects of the CMS Innovation Center, which made news this summer for releasing promising results of a Physician Group Practice (PGP) demonstration that reduced costs and increased quality of care in several clinical environments.

Articles: CMS releaseReutersInitial Thoughts on the CMS Bundling Program, Advisory Board Company [subscription required, free for Vanderbilt students and faculty]; Medscape

3. Use of CT Scans Rise, Hospitalization Rates Drop in Emergency Departments- 8/10/11

A study in the Annals of Emergency Medicine finds that use of computed tomography (CT) scans on patients in U.S. emergency departments has risen dramatically in the past 10 years while rates of hospitalizations have dropped in the same period. In 1996, an estimated 3% of patients in EDs received a CT scan, while in 2007 that rate jumped to 14%. However, for patients who received a CT scan in the ER, the percentage admitted to an inpatient service after the scan dropped from 26% in 1996 to 12% in 2007. The American College of Emergency Physicians has defended to four-fold increase in scan rates by arguing that these scans give ED doctors the diagnostic certainty needed to send patients home. Others argue that thedecrease in hospital admissions leveled off after 2003 in the study while CT scan use in that period continued to rise, suggesting that a number of factors have affected the decline in hospitalization rates.

Study: National Trends in Use of Computed Tomography in Emergency DepartmentAnnals of Emergency Medicine
Articles: Kaiser Health NewsMedpage TodayThe Hunting of the Snark, 2011 (Editorial released with study)



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