If all of the nation’s hospitals could replicate these results, an additional 64,000 lives and $23 billion could be saved annually
WASHINGTON--(BUSINESS WIRE)-- Hospitals participating in the Premier healthcare alliance QUEST®: High Performing Hospitals national collaborative have saved an estimated 22,164 lives and reduced healthcare spending by $2.13 billion. If all hospitals in the country had been able to achieve similar results, estimates project an additional 64,000 lives and $23 billion could have been saved.
Hospitals in QUEST have achieved new standards of top performance that outpace national averages. When looking at a control group using Medicare data, QUEST participants’ observed mortality is 5 percent lower than non participants when compared to what was expected. At the same time, national costs for inpatient care have increased by 14 percent over the course of the project, compared to a mere 2 percent cost increase among the QUEST hospitals. In evidence-based care, QUEST participants have continued to improve performance and outperform peers by 1.5 percent, according to Hospital Compare data.
“QUEST hospitals have volunteered to be a test bed for what’s possible in terms of performance improvement. These hospitals are setting new standards of excellence based on real-world experiences,” Premier President and CEO Susan DeVore, said. “There is a national imperative to bend the healthcare cost curve while we continue to improve clinical quality. The hospitals in QUEST are achieving these goals. This effort testifies to the power of collaboration.”
QUEST is a voluntary, three-year project that includes urban/rural, large/small and teaching/non-teaching facilities from 34 states, including many safety net hospitals. Using the nation’s largest comparative database from Premier, QUEST participants and the Institute for Healthcare Improvement (IHI) identified the main drivers that lead to deaths, errors, improved patient experience and excessive costs. Hospitals in QUEST are specifically targeting improvement opportunities in these areas, comparing themselves against each other, carefully measuring progress and sharing best practices to significantly improve outcomes.
Seventy-six participants achieved top performance in the three measured areas in Year 2 of the project. Twenty-nine are top performers in years one and two of QUEST.
“QUEST is defining a holistic process to achieve the continuous quality improvement gains that American patients expect and deserve,” said IHI President and CEO Maureen Bisognano. “Together, QUEST hospitals have harnessed the power of collaboration, data and transparency to develop a formula for improvement that is working to create a future of exceptional care.”
Analysis of QUEST data has yielded a range of insights that could affect healthcare improvement and national policy. Specifically, the data show:
- Variation between the top and bottom performing hospitals has narrowed over time as all hospitals achieved improvements, proving that QUEST can work in any hospital, regardless of size, teaching status, safety net status or geography.
- When compared to what was expected, mortality rates among QUEST participants declined 23% since the baseline, with a large gain achieved in the area of sepsis. Other conditions that drove the mortality gains included prevention of respiratory infections and cardiac care improvements. This provides hospitals with evidence around the drivers of mortality, and shows that a focus on these conditions should be most effective in saving lives.
- In the first two years, the biggest opportunity areas to bend the healthcare cost curve were from maximizing labor productivity and eliminating supply costs. However, different types of hospitals bent the curve at different rates, with small teaching hospitals making the most significant gains, followed by large non-teaching and large teaching facilities.
- Looking at all QUEST hospitals, data show that as evidence-based care rates rise, both mortality and costs decline. Similarly, as mortality falls, costs decline. For payers such as Medicare, which look at performance and costs across all hospitals, this shows that policies incenting improved adherence to the evidence base should simultaneously reduce costs and mortalities. Understanding connections between quality improvement and cost reduction on an individual hospital basis is unclear, however, and further research is needed.
- Although we always want to strive for perfection and remain committed to delivering all evidence-based care measures, nine of the 19 measures within QUEST show no statistical significance in performance levels – in other words, there is no real “gap” between top and bottom performance. This is the case for measures such as aspirin upon arrival and discharge, and smoking cessation. In light of this trend, we don’t believe meaningful rankings of hospital performance can be established, and these measures should be omitted from a value-based purchasing program either now or when other hospitals achieve comparable performance levels.
QUEST has also established baseline performance levels and has started creating performance improvement standards for new measures introduced in year 2:
- Improve patient safety by preventing incidents of harm, including healthcare-acquired infections and birth injuries.
- Improve the patient experience by improving the patient's overall care and loyalty to the care providing facility.
QUEST 2.0, the next-generation of QUEST, will have additional measures and clinical conditions that align closely with the goals of health reform legislation, including readmissions. QUEST 2.0 also will add population health measures for diabetes, obesity, mental health and heart failure, conditions that typically require careful coordination across providers and begin building the capabilities required for accountable care.
Mountain States Health Alliance President and CEO Dennis Vonderfecht said, “QUEST creates a dynamic where the work is never done – a never ending journey in which quality goals keep getting more aggressive and we continue to take on new challenges. Mountain States Health Alliance and the 157 hospitals in QUEST are always stretching to achieve top performance. Together, QUEST hospitals are creating a quality framework that can be used to consistently deliver the most efficient, effective and caring hospital experience to every patient, every time.”
Members of the QUEST collaborative are committed to helping to answer important questions in healthcare, and will develop further performance improvement research as new measures and data become available. In particular, Premier will be working with academic researchers to study the qualities of top performing hospitals and the most successful strategies that have been deployed to achieve standards of excellence.
QUEST will also look more closely at cost trends to assess why some hospitals have been so successful in controlling costs relative to others. And the collaborative plans to analyze focused clinical interventions to determine which drove the greatest levels of improvement in the areas of pneumococcal vaccination, harm prevention and others.
About the Premier healthcare alliance, Malcolm Baldrige National Quality Award recipient
Premier is a performance improvement alliance of more than 2,400 U.S. hospitals and 70,000-plus other healthcare sites working together to achieve high quality, cost-effective care. Owned by hospitals, health systems and other providers, Premier maintains the nation's most comprehensive repository of clinical, financial and outcomes information and operates a leading healthcare purchasing network. A world leader in helping deliver measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services and the United Kingdom's National Health Service North West to improve hospital performance. Headquartered in Charlotte, N.C., Premier also has offices in San Diego, Philadelphia and Washington. http://www.premierinc.com. Stay connected with Premier on Facebook, Twitter and YouTube.
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