QIO Program National Partners Help Drive Success of QIN-QIO Initiatives

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Doctor taking an elderly woman's blood pressure
Doctor taking an elderly woman's blood pressure

Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) are well known for their connections and collaboration on health care quality improvement projects with a variety of agencies and organizations at the state, local and community levels. They also work closely with several QIO Program national partner initiatives that lend added credibility, specialized expertise and extensive resources to projects where they share common goals.

Following are four QIO Program national partner initiatives and recent examples of how QIN-QIOs have collaborated with them:

Advancing Excellence in America’s Nursing Homes

Founded in 2006 by a coalition of 28 organizations ranging from nursing home providers to quality improvement experts to government agencies, the Advancing Excellence in America’s Nursing Homes Campaign aims to make nursing homes better places to live, work and visit. The Campaign provides free, practical and evidence-based resources to support quality improvement efforts in America’s nursing homes.

Advancing Excellence’s tracking tools for HospitalizationsMedications and Staff Stability have been particularly helpful to Telligen, the QIN-QIO for Colorado, Illinois and Iowa. In an effort to decrease hospital readmissions and improve care coordination, Telligen recently asked hospitals in four communities in Iowa to identify nursing homes they frequently use or readmit patients from the most. The QIN-QIO soon learned that the nursing homes were measuring readmissions differently. To make sure that everyone started using consistent data, Telligen and Advancing Excellence held a webinar with the homes to train them on Advancing Excellence’s tracking tools. Telligen asked the homes to sign a data usage agreement that enables the affiliated hospitals and the QIN-QIO to see the data that the homes are submitting via Advancing Excellence; Telligen will receive an analytic file with the homes' data each month and can use this to monitor the success of their efforts. Among other interesting discoveries, Telligen was able to trace excessive hospital readmissions on a particular weekday afternoon to the actions of a single nursing home staff member who simply needed more training on communicating with the physician’s office. Nursing home leadership has been impressed with the improved data tracking and has inquired whether sister facilities can take part as well. Indeed, Telligen is rolling out the Advancing Excellence tools to nursing homes in three more Iowa communities and hopes to expand their usage to Colorado and Illinois in the near future.

Centers for Disease Control and Prevention’s TAP Strategy

One of the Centers for Disease Control and Prevention’s (CDC’s) goals is to eliminate healthcare-associated infections (HAIs) by using data to drive prevention efforts and measure progress. The CDC created the Targeted Assessment for Prevention (TAP) strategy to help health care facilities and specific units within facilities identify gaps in infection prevention and prioritize prevention efforts. The strategy involves the generation of a TAP report using a metric called the cumulative attributable difference (CAD) to show the number of infections that must be prevented in order to achieve an HAI reduction goal. TAP reports are available for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), and Clostridium difficile infections (CDI). The CDC is working with a number of partners, including QIN-QIOs, to incorporate the TAP strategy into their quality improvement work with hospitals.

Health Services Advisory Group (HSAG), the QIN-QIO for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, is working closely with the CDC to implement the TAP strategy with hospitals in its QIN area. HSAG’s longstanding relationships with hospital partners—and these partners’ willingness to confer National Healthcare Safety Network (NHSN) rights to HSAG—has proven invaluable in effectively using TAP reports to recruit hospitals for collaboratives, to identify which units within those facilities need the most help with HAI reduction, and to set up peer mentor relationships between struggling units and those units that are winning the HAI battle. Together with the CDC, HSAG has met virtually or in-person with hospital executives to walk them through the data in their facility’s TAP report, discuss related patient stories, and help build the business case for participating in collaboratives. Once specific hospital units have been identified for improvement, HSAG and the CDC will implement the mentorship program, enabling the sharing of best practices among peer groups. The partners also will provide resources and interventions to help hospital units improve their overall patient safety and avoid future financial penalties. The CDC is using feedback from HSAG and other QIN-QIOs to continually refine the TAP strategy, which it plans to expand to other HAI types and health care settings in the future.

Home Health Quality Initiative

Launched in 2007 by the Centers for Medicare & Medicaid Services (CMS), the Home Health Quality Initiative (HHQI) is a national campaign that offers free, evidence-based educational resources, individualized data reports, networking opportunities and assistance for home health and cross-setting providers to reduce avoidable hospitalizations and improve care quality. In the past couple of years, HHQI has expanded its clinical focus to include cardiovascular health improvement initiatives that support Million Hearts® by introducing cardiovascular best practices and data reports to the home health community. These initiatives are the cornerstone of HHQI’s current nationwide collaboration with QIN-QIOs.

Part of the Lake Superior Quality Innovation Network (QIN) serving Michigan, Minnesota and Wisconsin, Stratis Health has worked with HHQI on quality improvement projects in Minnesota since the inception of the campaign. This partnership has blossomed in the past year as Lake Superior QIN has begun recruiting home health agencies and clinics for its QIO Program initiative to improve cardiac health and reduce cardiac disparities. As a prelude to the Minnesota HomeCare Association’s annual meeting in May 2015, HHQI collaborated with Lake Superior QIN’s Minnesota team to host a workshop called “Building and Sustaining Data-Driven Improvement.” The workshop – which provided continuing education credits to the 150 attendees – was designed to help home health agencies and other stakeholders learn how to interpret data and identify opportunities for improvement. During the workshop, HHQI also shared information on its cardiac initiative and introduced attendees to its Home Health Cardiovascular Data Registry – a tool designed to help CMS-certified home health agencies identify disparities in care and show the impact of their improvement efforts. Workshop participants provided overwhelmingly positive evaluations for the jointly sponsored event and were directed to contact their QIN-QIO for questions about cardiac prevention initiatives.  Later in May, HHQI helped launch the Lake Superior QIN’s Home Health initiative through a webinar highlighting HHQI resources and the Home Health Cardiovascular Data Registry. Lake Superior QIN continues to encourage home health agencies to attend HHQI’s monthly webinars on home health quality improvement-related topics.

Million Hearts®

Million Hearts® is a national initiative that was launched by the U.S. Department of Health and Human Services (HHS) in 2012 to prevent one million heart attacks and strokes by 2017. The initiative will achieve this goal by engaging providers, patients, communities and other stakeholders to implement evidence-based policies and strategies that are known to have a positive impact across the spectrum of prevention and care, facilitate excellence in the "ABCS" of clinical prevention (Aspirin when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation), and encourage healthier lifestyles and supportive communities.

In January 2015, the National Association of Chronic Disease Directors awarded three states, including Nevada’s Division of Chronic Disease Prevention and Health Promotion, a technical assistance contract to implement a Million Hearts Stakeholder Workshop. The purpose of the workshop was to get statewide partners engaged in creating a system to improve hypertension identification, treatment and control. HealthInsight – the QIN-QIO for Nevada, New Mexico, Oregon and Utah – was a natural workshop planning partner for the state due to the QIN-QIO’s longstanding work with the Million Hearts initiative. Along with other key organizations like the American Heart Association, HealthInsight helped organize and promote a two-day conference on cardiac care and prevention at the University of Nevada, Las Vegas in May 2015. The workshop featured educational panel presentations and breakout sessions, the unveiling of Nevada’s strategic plan for heart attack and stroke prevention, information on how to start a Million Hearts program, and tabletop exercises to set priorities and prepare action plans. About 30 to 40 stakeholders attended the conference, including physicians, nurses, pharmacists, community health activists, patients and representatives of congregations. Attendees provided positive feedback about the workshop and plan to reconvene in a virtual forum in July to discuss progress and next steps.