The Quality Improvement Support Collaborative: Working together!

1. The Quality Improvement Support Collaborative:Working together! Leslie Schultz, PhD, CPHQ, Director, Premier Healthcare Informatics

2. Why a Support Collaborative?

3. Challenge • Front line healthcare workers see themselves as relatively unsupported in their efforts to improve care. • Meanwhile, a number of organizations see themselves as supporting improvement and seek to be more supportive.

4. Response In December 2001, CMS, IHI, Premier and VHA met to find ways of working together; in January 2002 they joined with JCAHO and NCQA to form the Quality Improvement Support Collaborative (QISC).

5. Goals • Conduct pilot collaborative projects to support specific improvement goals. • Collaborate in providing information to support improvement. • Reduce the burden of data collection and quality improvement. • Make frontline providers more aware of ways in which QISC organizations and others can support them.

6. Pilot Collaborative Improvement Support Projects • Heart attack and heart failure • Inpatient settings • Maryland and Louisiana (two States where QIOs,VHA and Premier were interested and capable).

7. Information & Web Sites • CMS, IHI, AHRQ, Premier, VHA, JCAHO and NCQA run or are building web sites to support improvement. • To date -- few efforts to link support of improvement information. • The QISC organizations committed to collaborating to make web sites easier for frontline workers to use.

8. Reduce Burden • CMS and JCAHO have converged their measures (a hospital collecting Oryx (JCAHO) measures can use them directly to participate in QIO (CMS) improvement efforts; CMS tools collect Oryx data. • All QISC organizations support the National Quality Forum effort to identify and endorse national measure sets for multiple settings.

9. Awareness • Most hospitals are (vividly) aware of Oryx requirements! • They may be less aware of the existence of either regional or national programs supporting improvement activities.

10. The QISC Pilots Louisiana Maryland

11. Louisiana QISC • Background & Environment • 118 Acute Care Hospitals in Louisiana • ~70% JCAHO accredited and working on one or more core measure projects • NO legislative mandate on quality reporting • high utilization (Medicare expenditure) per hospital bed

12. LA QISC: Goals of collaborative • Improve the quality of cardiac care provided to citizens of Louisiana. • Provide hospitals an opportunity to give input on national measures, given near inevitability of public reporting. • Contribute to an understanding of the real data burden involved in creating a public data set.

13. LA QISC Challenges • Recruitment • requires individual soliciting - getting the right mix of players • hospitals concerned about added “burden” • Public reporting • working through the cycle of fear

14. MD QISC: Challenge of the Local Environment • Public reporting already in place-administrative data and chart data • Regulated environment-MHCC, HSCRC, Office of Health Care Quality, JCAHO, Delmarva • Decreasing profitability • Increasing demand for accountability • Increasing resistance from hospitals for unfunded mandates

15. Quality Improvement Overload • Get With the Guidelines • Guidelines Applied in Practice • National Registry for Myocardial Infarction • Crusade Registry • CMS 7th SOW (Delmarva) • And more…

16. MD QISC: Goals of collaborative • Coordination: One coordinated project for chosen topic area • Burden: Commitment to use of existing data where possible and link to Core Measures • Linkage: Focus QI efforts on publicly reported measures • Executive Involvement: steering group composed of senior leadership • Cost/Benefit: Involvement of state rate setting agency

17. Status of Pilots • LA QISC: • recruited “work group” from interested hospitals to provide input and direction in the planning of the collaborative; • first work group meeting scheduled for Feb. ‘03 • first full collaborative group meeting anticipated in May ‘03 • MD QISC: • recruited “steering committee” from interested hospitals to provide input to the type and nature of assistance the QISC could provide; • convening two work groups: a data management group and a “paying for quality” group

18. Challenges for the Pilots! • Multiple quality agendas with pride of ownership • Too many cooks • Competitive environment • Uncertainty of what else “they” will dream up • Ability to maintain focus and momentum • Engagement of senior leadership and Board

19. Questions??? Leslie Schultz, PhD, CPHQ, Director, Premier Healthcare Informatics 704.733.5209 leslie_schultz@premierinc.com