Partnership for Patients and the Hospital Improvement Innovation Networks:
Continuing Forward Momentum on Reducing Patient Harm
The Centers for Medicare & Medicaid Services (CMS) awarded $347 million to 16 national, regional, or state hospital associations and health system organizations to serve as Hospital Improvement Innovation Networks (HIINs). These awards will integrate the Partnership for Patients (PfP) Hospital Engagement Networks (HEN) into the Quality Improvement Network-Quality Improvement Organization (QIN-QIO) program in order to maximize the strengths of the QIO program and the PfP HENs to sustain and expand current national reductions in patient harm and 30 day readmissions for the Medicare program. The period of performance for the HIINs begins in September 2016 and consists of one 24-month base period and one 12-month option year, during which they will support 4,000 hospitals. The contracts stem from one of the first models tested under the authority of section 1115A of the Social Security Act (the Act), the Partnership for Patients, a nationwide public-private collaboration striving to prevent patients from being harmed while in the hospital and heal without complication once they are discharged.
Launched in April 2011, the PfP worked to engage as many of the short-stay acute care hospitals across the nation as possible. Each of these hospitals has strived to improve the quality of care provided to patients in conjunction with continuing partnerships with physician, nursing, and pharmacy organizations; consumers and consumer groups; and employers with which they have aligned their efforts. In addition, private health plans, Area Agencies on Aging, and State and federal government officials pledged to work together to meet the PfP initiative’s goals.
The Hospital Engagement Networks were originally established as part of the Partnership for Patients Program by the CMS Innovation Center to help hospitals deliver better care, spend dollars more wisely, and improve patient safety. Last year, a HHS report showed an unprecedented decline in preventable patient harm in U.S. hospitals compared to the 2010 baseline. This has resulted in an estimated 2.1 million fewer harms experienced by patients, 87,000 lives saved, and nearly $20 billion in cost savings from 2010 to 2014 as well as substantial reductions in the 30-day Medicare fee-for-service all-cause readmission rate. To better distinguish this new work from the PfP HEN Model, organizations contracted to support these hospitals will be called HIINs. The HIINs will support the 11th Statement of Work of the QIOs in an effort to enhance the quality of care to Medicare beneficiaries.
The focus of the HIINs work going forward will be to sustain and accelerate national progress and momentum towards continued harm reduction in the Medicare program. Additionally, an essential element of this work is a commitment to improving health equity, and organizations will give specific attention to identifying and reducing health care disparities.
HIINs: Working to Reduce Hospital Acquired Conditions and Hospital Readmissions
The goals of the HIINs to be achieved by the end of 2019 are:
- A 20 percent reduction in overall patient harm (to 97 Hospital-Acquired Conditions [HACs]/1,000 discharges) from 2014 baseline (of 121 HACs/1,000 patient discharges); and
- A 12 percent reduction in 30-day readmissions as a population-based measure (readmissions per 1,000 people).
The HIINs will continue to engage the hospital, provider and broader care-giver communities to quickly implement well-tested and measured best practices to improve the quality of care in the Medicare program. The HIINs will work at the national, regional, state, or hospital system level to develop learning collaboratives for hospitals so that they can implement the changes and innovations necessary to integrate and achieve the PfP safety and care transitions goals while focusing on the Medicare program. The HIIN community will coordinate with the QIN-QIOs to identify and recruit hospitals in communities where patient safety improvement efforts have been underway in an effort to continue to pursue additional harm reductions in those facilities. Additionally, collaboration is expected with the QIN-QIOs who lead care transitions work in the community to reduce readmissions and community-based Adverse Drug Events reduction work in an effort to support improvement across the care continuum for the Medicare program.
In an effort to bring about improvement in patient safety, the HIINs will continue to evaluate the capacity of large improvement networks by focusing on the following required 11 core areas of harm:
1. Adverse drug events (ADE), to focus on at least the following three medication categories:
opioids, anticoagulants, and hypoglycemic agent
2. Central line-associated blood stream infections (CLABSI) in all hospital settings, not just Intensive Care Units
3. Catheter-associated urinary tract infections (CAUTI) in all hospital settings, including avoiding placement
of catheters, both in the emergency room and in the hospital
4. Clostridium difficile ( difficile) bacterial infection, including antibiotic stewardship
5. Injury from falls and immobility
6. Pressure Ulcers
7. Sepsis and Septic Shock
8. Surgical Site Infections (SSI), to include measurement and improvement of SSI for multiple classes of
9. Venous thromboembolism (VTE), including, at a minimum, all surgical settings
10. Ventilator-Associated Events (VAE), to include Infection-related Ventilator-Associated Complication (IVAC)
and Ventilator-Associated Condition (VAC)
In addition to these core eleven topics, HIINs are expected to address all other forms of preventable patient harm most impactful to their respective populations in the Medicare program. HIINs are expected to detail their plans to address these other forms of harm, including the targeted goals of achievement, measures, and evidence-based best practices they propose to put in place.
The following are some additional harm topics and measurement approaches HIINs may consider:
- Multi-Drug Resistant Organisms, such as VRE (Vancomycin-resistant enterococcus), CRE (Carbapenem-resistant enterobacteriaceae), and MRSA (Methicillin-resistant Staphylococcus aureus)
- Diagnostic Errors
- Addressing Malnutrition in the Inpatient Setting
- Airway Safety
- Iatrogenic Delirium
- Undue Exposure to Radiation
- Hospital Culture of Safety
- Developing a metric to measure and report on all-cause harm within the HIIN network, directly reflecting the metric used to track progress on the national aims
Data Tracking and Reporting
Each HIIN will identify and use appropriate process and outcome measures for each area of focus to track hospital progress on quality improvement. While continuing to report on the mandated list of measures identified in the Statement of Work, the HIINs will establish and implement a system to track and monitor all hospital progress towards the operational and quality improvement goals. HIINs will also be strongly encouraged to establish a set of improvement measures based on lessons learned from previous experience, as well as to use any additional measures that align with existing measurement activity already underway within their community, or that they feel would be most impactful to the populations they serve.
To support hospital submission of measurement data, the HIINs are required to utilize their existing systems to collect, track, and monitor hospital quality data, including the receipt, collection, and analysis of quality improvement metrics from participating hospitals. Through these existing systems, the HIINs will have access to hospitals’ measurement data, and will use that information to evaluate progress and focus attention on efforts or hospitals that have yet to see improvement. All HIINs must collect operational and quality improvement metrics from their participating hospitals and utilize this information to design and deliver the appropriate technical assistance needed by the hospital to improve.
The HIINs will support approximately 4,000 hospitals during this upcoming base period of performance of 24 -months. This competitive procurement enables support for a diverse group of acute care hospitals across the nation in an effort to recruit the active participation of as many of the short-stay acute care hospitals in the U.S. as possible.
Selected Hospital Improvement Innovation Network Organizations
The 16 Hospital Improvement Innovation Networks (listed in alphabetical order) are:
- Carolinas Healthcare System
- Dignity Health
- Healthcare Association of New York State
- The Health Research and Educational Trust of the American Hospital Association
- Health Research and Educational Trust of New Jersey
- Health Services Advisory Group
- The Hospital and Healthsystem Association of Pennsylvania
- Iowa Healthcare Collaborative
- Michigan Health & Hospital Association (MHA) Health Foundation
- Minnesota Hospital Association
- Ohio Children’s Hospitals’ Solutions for Patient Safety
- Ohio Hospital Association
- Premier, Inc.
- Vizient, Inc.
- Washington State Hospital Association