Anita Thomas, Pharm.D is the QIO Program’s Patient Safety Program lead. In this role, she supports work on improving coordination of care, reducing healthcare-associated infections (HAIs) in hospitals, reducing healthcare-acquired conditions (HACs) in nursing homes, and improving medication safety across care settings. Dr. Thomas is a trained clinical pharmacist specializing in pharmacoeconomics and outcomes research, and was part of the CMS team that helped implement the Medicare Drug benefit. She also has worked in the areas of data analysis, program-wide performance and strategy at CMS, as well as in clinical patient care and health policy consulting in the private sector. She has a passion for improving quality of care and patient safety.
Q. The CMS QIO Program had some notable success in helping reduce healthcare-associated infections (HAIs) such as central line-associated blood stream infections from 2011-2014. What factors contributed to that success?
A. Some important factors included using a data-driven strategy to identify key areas of recruitment for hospitals and units that had the greatest need for improvement, as well as using data to track progress and inform quality improvement interventions. Another factor was the collaboration that occurred at both at the local and national levels, which helped to coordinate efforts and leverage strengths. Also, using evidence-based strategies that targeted the needs of each participating hospital provider, and spreading, monitoring and sustaining best practices were critical to success.
Q. In August 2014, Quality Innovation Network (QIN)-QIOs began pursuing new quality improvement goals and activities than run through July 2019. How does their current mission and work in the area of HAI reduction align with or differ from their past work?
A. Our goals to decrease the national HAI Standardized Infection Ratio in hospital acute care settings for Medicare beneficiaries and to prevent the occurrence of HAIs in hospital provider settings using evidence-based HAI prevention strategies are consistent with our past work. We also are continuing our past efforts to reduce central line-associated blood stream infections and catheter-associated urinary tract infections. What is different is that we have expanded the scope of our Clostridium difficile infection reduction activities and will start targeting ventilator associated events. All of our current work has been informed by lessons learned and best practices. One good example of that is our involvement in the Centers for Disease Control and Prevention’s (CDC) Targeted Assessment for Prevention (TAP) strategy. A few QIN-QIOs successfully piloted the program with providers last year, so we have expanded the CDC TAP partnership to include all QIN-QIOs.
Q. QIN-QIOs are known for collaborating with national, state and local partners on quality improvement initiatives. What are some best practices in collaboration that organizations involved in HAI reduction can employ as they team to work with individual hospitals?
A. Open communication is necessary for effective collaboration. It’s important for organizations and partners to recognize that every stakeholder makes unique contributions toward the overall goal and that they are essential to maximizing synergy and advancing change on a large scale. It is important to value the individual contributions that each partner can make while simultaneously seeing the bigger picture and pooling necessary resources and knowledge to achieve success.
Q. Can you tell us about the QIN-QIOs’ Coordination of Care activities and how they contribute to improving patient safety?
A. QIN-QIOs are working to improve coordination of care by working with and using community-organizing strategies. They convene key leaders and advocates at the local and national levels, conduct root analyses to determine the primary drivers of poor care and apply interventions to improve it. Creating and helping foster local level change and improvement can help fully integrate and sustain best practices to improve patient safety in the long term. We often think about patient safety improvements within individual care settings, but if we focus on patients -- especially ones with multiple chronic conditions -- they tend to interact with many care settings, so it is important to make sure that there is a systemic and coordinated approach to improvement.
Q. Can you tell us about the QIO Program’s alignment with the Adverse Drug Events National Action Plan?
A. The work that the QIN-QIOs are doing to improve medication safety and reduce and prevent adverse drug events (ADE) is directly aligned with the U.S. Department of Health and Human Services' (HHS) National Action Plan for ADE Prevention. QIN-QIOs are targeting the high priority drug classes identified in the plan: diabetic agents, anticoagulants and opioids. What is unique is that the QIN-QIOs are working on medication safety through a coordination of care community model. ADEs can occur in any setting and often during transitions of care. Knowing that adverse events related to medications are a key driver of readmissions, the QIN-QIOs are going to make a big impact in preventing them and improving medication safety for Medicare beneficiaries. The framework of the national action plan gives us a unified vision and the momentum to prevent adverse drug events; in many cases, they can be avoided with simple steps and education on proper medication use and patient engagement.
Q. Anything else you’d like QIO News readers to know?
A. We have seen real improvements in patient safety in the past few years due to the work of many stakeholders, including the QIN-QIOs. Their quality improvement work spans all health care settings with a community-based and collaborative approach, so they have a real opportunity to transform health care in a positive way. It is a pivotal time in health care due to the integration of multiple focused efforts to improve patient safety for Medicare beneficiaries.
I personally try to keep the patient/beneficiary at the heart of my work. Each data point found in patient safety work has a patient story behind it. While we have had many successes, there is still an opportunity to make care safer for everyone who touches the health care system.
Lastly, I want to acknowledge that we have a great team of people working on improving quality of care and patient safety -- both internally at CMS, at the QIN-QIOs, and our partners, including beneficiaries and their families.