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Key Indicators Show Hospitals Improving Care Quality

The Agency for Healthcare Research and Quality (AHRQ) reports hospitals are outpacing other healthcare settings in improvements to quality of care. Three quarters of hospital quality measures are showing improvement, compared with 60 percent for home health and nursing home care, and about half for ambulatory settings, according to the 2013 National Healthcare Quality Report.

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released a report showing “major strides” have been made in patient safety, including a 9 percent decrease in harms experienced by patients in hospitals in 2012 compared to the 2010 baseline.

“The two reports released by the Agency for Healthcare Research and Quality clearly demonstrate that America’s hospitals and health systems are leading the way in quality improvement and patient safety,” said Rich Umbdenstock, president and CEO of the American Hospital Association (AHA), based in Chicago.

The AHRQ study showed hospitals improved on 29 of 39 measures, stayed the same on nine and were worse on only one. Home health and hospice improved on nine of 15 measures and held steady on six. Ambulatory settings improved on 45 of 86 measures, 34 stayed the same and seven were worse.

Richard Kronick, AHRQ: Hospital quality efforts are paying off.
Richard Kronick, PhD, said the national focus on hospital quality is starting to pay off.

Although AHRQ Director Richard Kronick, PhD, acknowledged that the national focus on quality improvement in hospitals is starting to pay off, he added that “much work remains to make sure that all Americans have access to high-quality care in every setting.”

AHRQ credits the U.S. Department of Health and Human Services (HHS) Partnership for Patients initiative, CMS quality reporting programs and private-sector initiatives, such as those sponsored by the Institute for Healthcare Improvement, for being catalysts for the current quality effort in hospitals. Fourteen of the 16 quality measures that reached a 95 percent performance level were publicly reported by CMS, and four more CMS measures are among those improving at the fastest pace.

“The AHA is partnering with HHS, several quality‐focused organizations and state hospital associations to actively engage hospitals and health systems in quality improvement activities,” Umbdenstock added. “The result is safer patient care and healthcare cost savings for individuals and institutions. The progress hospitals are making in quality is only part of the hard work they are undertaking to transform so that they can continue to meet the needs of their communities.”

CMS estimates reductions in adverse drug events, falls, infections and other forms of adverse events resulting in patient harm have prevented close to 15,000 deaths in hospitals and saved $4.1 billion in costs. The CMS study showed that the incidence of hospital-acquired conditions decreased from 145 per 1,000 discharges in 2010 to 132 in 2012. Ventilator-associated pneumonia is down 53.2 percent, pressure ulcers down 25.2 percent and falls down 14.7 percent. All-cause 30-day readmission rates for Medicare fee-for-service beneficiaries fell 8 percent to approximately 17.5 percent in 2013.

“Quality care initiatives transcend settings and are as significant in post-acute care as acute care,” said Zane Schott, vice president of business development at BlueStep/BridgeGate Health in Salt Lake City. “Maintaining quality care in transitions of care is key to better patient outcomes. From skilled nursing to home health, the AHRQ initiatives are realized when coordinated care, facilitated by an electronic exchange of patient data, becomes the norm.”

John Gobron, president and CEO of Aventura, a technology company in Denver, said information technology tools aligned with clinicians’ needs are still needed to reduce documentation errors and improve communication.

“‘Awareness computing’-type tools can be used at the point of care or at any location across the health enterprise to enhance care coordination among providers,” Gobron said.

AHRQ’s 2013 National Healthcare Quality Report states that electronic health records “can improve the quality and safety of care in all types of hospitals and in departments within hospitals.”

Andrew Agwunobi: Many factors have helped improve hospital quality.
Andrew Agwunobi, MD, MBA, attributes much of the progress in hospital quality to information technology, Medicare’s not paying for errors and focusing on preventing readmissions, and a commitment to value.

Andrew Agwunobi, MD, MBA, a leader of the hospital performance improvement practice at Berkeley Research Group in Washington, D.C., and former secretary of the Florida Agency for Health Care Administration, said one of the key drivers of improvement was The American Recovery and Reinvestment Act of 2009, which made available $17 billion in funding for qualified hospitals and physicians meaningfully using electronic health records.

Other drivers, Agwunobi said, were Medicare’s decision to stop paying for certain hospital-acquired conditions or “never events,” because they should never happen, and to penalize excessive readmissions.

“CMS’s stance led to an increased awareness of the frequency of ‘never events’ and the associated financial risk,” Agwunobi said. “This posed a strong incentive for health systems to redouble their efforts to improve quality.”

Other drivers of the improvements in quality exist, but Awunobi said, “perhaps the most important has been a focus on value--quality and cost--rather than just decreasing costs. I believe the future will see further improvements in quality, not just because of implementation of Affordable Care Act provisions, but because health systems are employing more physicians and in so doing are better aligning the quality improvement efforts of hospitals and physicians.”

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