Partnership for Patients and Hospital Engagement Networks: Continuing Forward Momentum on Reducing Patient Harm

Partnership for Patients and Hospital Engagement Networks: Continuing Forward Momentum on Reducing Patient Harm

On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) awarded $110 million to 17 national, regional, or state hospital associations and health system organizations to serve as the second round of Hospital Engagement Networks. The period of performance for this second round of Hospital Engagement Networks is one year and begins in September 2015. The contracts are part of the Partnership for Patients, a nationwide public-private collaboration to keep patients from being harmed while in the hospital and heal without complication once they are discharged.  

Launched in April 2011, the Partnership for Patients strives to engage short-stay acute care hospitals across the nation in improving the quality of care delivered to patients. Along with the Hospital Engagement Networks, partnerships with physician, nursing, and pharmacy organizations, consumers and consumer groups, and employers have emerged to align their efforts. In addition, private health plans, Area Agencies on Aging, and State and federal government officials pledged to work together to meet the initiative’s goals.

The Partnership for Patients and the Hospital Engagement Networks are one part of an overall framework established by the Affordable Care Act to deliver better care, spend dollars more wisely, and improve care. The Department of Health and Human Services has estimated that 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. Nationally, patient safety is improving, resulting in 1.3 million adverse events and infections avoided in hospitals in that time period. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period. In addition, 30-day hospital readmissions in Medicare decreased by nearly 8 percent between January 2012 and December 2013 – translating into 150,000 fewer readmissions.

The focus of the Partnership for Patients’ work going forward will be in two key dimensions: sustaining national progress and momentum, while conducting the necessary evaluation work to more fully assess its contribution to the national improvements in patient safety.

Partnership for Patients: Working to Reduce Hospital Acquired Conditions and Hospital Readmissions
The two goals of the Partnership for Patients are:

• Keep patients from getting injured or sicker. Decrease preventable hospital-acquired conditions by 40 percent compared to 2010.  
• Help patients heal without complication. Decrease preventable complications during a transition from one care setting to another so that 30-day hospital readmissions are reduced by 20 percent compared to 2010.  

Hospital Engagement Networks
The Hospital Engagement Networks will continue to identify solutions already working to reduce healthcare acquired conditions, and work to spread them to other hospitals and health care providers.  

Hospital Engagement Networks 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 achieve the Partnership for Patients’ safety and care transitions goals.  They engage in a wide array of initiatives and activities to spread established, evidence-based interventions to rapidly improve patient safety in hospitals.  

The Partnership for Patients will continue to evaluate the capacity of large improvement networks to bring about improvement in patient safety. Hospital Engagement Networks are required to focus on the following core areas of harm:

• Adverse drug events (ADE)
  1. HENs with participating hospitals that have a primarily adult population must report measures related to opioid safety, anticoagulation safety, and glycemic management, at a minimum
  2. HENs with participating hospitals that have a primarily pediatric population must report measures related to opioids and two additional measures impactful to pediatric patients, at a minimum. Hospitals with a primarily adult population are also encouraged to report on these pediatric-related areas, in addition to those listed in (a)
• Catheter-associated urinary tract infections (CAUTI), in all hospital settings, including avoiding placement of catheters, both in the emergency room, and in the hospital
• Central line-associated blood stream infections (CLABSI), in all hospital settings, not just Intensive Care Units (ICUs)
• Injuries from falls and immobility
• Obstetrical adverse events, including Early Elective Delivery (EED) reduction. Obstetrical adverse events are to include, at a minimum, obstetrical hemorrhage, and preeclampsia treatment and management to prevent morbidity and mortality
• Pressure ulcers
• Surgical site infections (SSI), to include measurement and improvement of SSI for multiple classes of surgeries
• Venous thromboembolism (VTE), including, at a minimum, all surgical settings
• Ventilator-Associated Events (VAE), to include Infection-related Ventilator-Associated Complication (IVAC) and Ventilator-Associated Condition (VAC)
• Readmissions

In addition to these core ten topics, Hospital Engagement Networks are expected to address all other forms of preventable patient harm in pursuit of safety across the board. Hospital Engagement Networks are expected to detail their plans to address these other forms of harm, including at a minimum the aims, measures, and evidence-based best practices they propose to put in place. The Partnership for Patients recognizes that the pediatric population has unique needs as they relate to these other forms of preventable harm. Therefore, Hospital Engagement Networks supporting pediatric hospitals and pediatric wards within general hospitals may choose to augment and delineate an alternative program of work to address highest risk harms specific to the pediatric population, including readmissions.

Additionally, the following are some topics Hospital Engagement Networks may consider in addressing other harms:

1. Severe Sepsis and Septic Shock
2. Hospital Culture of Safety that fully integrates patient safety with worker safety
3. Iatrogenic Delirium
4. Clostridium Difficile (C. diff.), including antibiotic stewardship
5. Undue Exposure to Radiation
6. Airway Safety
7. Failure to Rescue

Data Tracking and Reporting
Each Hospital Engagement Network, in consultation with the Partnership for Patients, will identify and use appropriate process and outcome measures for each area of focus to track hospital progress on quality improvement. A new requirement in this second round of Hospital Engagement Networks will mandate that they submit data on a standard list of measures. Hospital Engagement Networks will also be strongly encouraged 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.

The Hospital Engagement Networks will also submit monthly reports to CMS describing their activities and progress of their quality improvement efforts, including hospital progress on improvement measures for each core area. Hospital Engagement Networks will submit final reports to CMS at the conclusion of the 12-month period of performance detailing the successes, failures, lessons learned, and areas of improvement in each focus area.

To support hospital submission of measurement data, the Hospital Engagement Networks will be required to establish a secure, web-based data collection and management portal. Through this portal, the Hospital Engagement Networks 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. Data collected by the Partnership for Patients will not be used to evaluate hospital performance for existing quality programs such as the Hospital Value-based Purchasing Program and the Hospital Readmissions Reduction Program.  

The Hospital Engagement Networks will support approximately 3,400 hospitals during this upcoming 12-month period of performance.  The competitive procurement process enabled 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 country as possible.   

Selected Hospital Engagement Network Organizations
The 17 Hospital Engagement Networks (listed in alphabetical order) for round two are:

• American Hospital Association;
• Ascension Health;
• Carolinas HealthCare System;
• Dignity Health;
• Healthcare Association of New York State;
• Health Research and Educational Trust of New Jersey;
• Hospital & Healthsystem Association of Pennsylvania;
• Iowa Healthcare Collaborative;
• LifePoint Health;
• Michigan Health & Hospital Association Health Foundation;
• Minnesota Hospital Association;
• Ohio Children’s Hospital Solutions for Patient Safety;
• Ohio Hospital Association (OHA);
• Premier, Inc.;
• Tennessee Hospital Association;
• VHA-UHC Alliance NewCo Inc.; and
• Washington State Hospital Association.

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