Quality and Safety Collaborative The Value of a State Collaborative

Driving Forces Shift to Pay for Performance Medicaid managed care quality improvement strategy - Pay 4 Quality Potentially Preventable Events (PPEs) - penalty and incentive program 1115 Waiver Delivery System Reform Projects (DSRIP) Public reporting by government entities -- DSHS Hospital-Acquired Infections (HAI) reports -- Texas Healthcare Information Council (THCIC) published outcome reports Resource Constraints and Common Needs -- Learn together faster -- Pool data for stronger conclusions -- Share best practices -- Providers, staff and patients move around Texas -- Viability of children’s hospitals/advocacy

National Pediatric Quality and Safety Collaboratives Children’s Hospital Association (CHA) Quality Transformation Network Solutions for Patient Safety (SPS) Vermont Oxford Network (VON) American College of Surgeons, National Surgical Quality Improvement Program for Pediatrics (NSQIP) Cystic Fibrosis Foundation Care Center Network National Pediatric Cardiology Quality Improvement Collaborative (NPC QIC) Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) Pediatric Anesthesia Wake Up Safe Collaborative Pediatric Gastroenterology Improve Care Now (ICN) Network

What are QI Collaboratives? Quality improvement collaboratives: Networks for shared learning Translate research into practice Discover new knowledge Close quality gaps/improve care and outcomes One model for systems and capabilities requirements: Evidence informed content Quality improvement Project management IT infrastructure Data management Analytics Research capabilities/generation of new knowledge Lannon Pediatrics 2013

CHAT Quality and Safety Collaborative Rationale Standardization of practice within an institution will improve efficiency and effectiveness of care. Standardization of practice throughout the CHAT hospitals will allow for: -- aggregate learning; -- economies of scale in data management; and -- acceleration of discovery for best practices. Rapid cycle improvement will occur in multiple cycles. Data will drive improvement and demonstrate value. Is the red part correct?

CHAT’s Vision Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012 . In 2008 Don Berwick, Tom Nolan, and John Whittington first described the Triple Aim of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost. The Institute for Healthcare Improvement (IHI) developed the Triple Aim as a statement of purpose for fundamentally new health systems that contribute to the overall health of populations while reducing costs.

CHAT Members Partnership of 7 non-profit Texas children’s hospitals Children’s Health The Children’s Hospital of San Antonio Cook Children’s Covenant Children’s Dell Children’s Driscoll Children’s Texas Children’s

Timeline & History 2010 - CHAT Quality Steering Team Established 2012 - CHAT Asthma Collaborative Started 2/2016 - Texas Regional SPS Collaborative Started 6/2016 - CHAT Asthma Collaborative Completed 7/2016 - CHAT Bronchiolitis and Sepsis Collaboratives Started Est. 6/2018 - CHAT Bronchiolitis and Sepsis Collaboratives Complete

CHAT Quality and Safety Collaborative journey Phase I: Asthma collaborative- proof of concept Phase IIa: Expand disease-specific collaboratives (bronchiolitis & sepsis) Phase IIb: Incorporate SPS safety collaborative Phase III: Utilize outcomes to demonstrate value, model for pediatric payment and healthcare reform 2017-2018 2016 2016 2012

Project Selection & Prioritization High volume patient visits High cost cases High degree of variation (with opportunity for standardization of care through evidence based practice, existing national initiatives, etc.) High risk for patient harm

CHAT: Asthma Quality Collaborative Goals and Objectives Overarching goal: to improve quality and safety of care in CHAT hospitals Development and adoption of evidence-based pathways for ED and inpatient management Formation of an intervention bundle for patient care Identification of disease-related and financial performance measures Data collection, analysis, and reports to drive iterative rapid cycle improvement Proof of concept for state collaborative model

Taskforce Deliverables Implementation Taskforce Implementation key driver diagram Intervention bundle (ED and IP/OBS) Asthma best practice matrix ED and IP/OBS discharge checklist Education Taskforce Education key driver diagram Education primer Pre and post assessments Additional data primers (YouTube videos) Metric Taskforce Identification of metrics (ED and IP) Culture Taskforce Strategies to enhance the promotion of quality improvement-related culture among CHAT hospitals Talking points for the collaborative Information about CHAT for brief media snippets and for legislators

Asthma Outcomes Deliverables: Emergency Medicine Algorithm Inpatient Algorithm Reflects continuum of care from initial ED evaluation through discharge from inpatient unit Collaborative reduced: 14 day readmission rate by a relative 58% 6 month readmission rate by a relative 70% Decreased Average Length of Stay (ALOS) Decreased overall costs for most participating hospitals

Current Initiatives Disease-specific Safety Bronchiolitis management improvement project Sepsis recognition and management improvement project Safety Texas Regional Solutions for Patient Safety

Aim Statements Global AIM: Achieve the Institute for Healthcare Improvement’s Triple AIM for children in Texas: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. Strategic AIM1: Lead and facilitate process and outcomes improvement for disease- specific quality collaboratives to achieve the Triple AIM elements. Strategic AIM2: Lead and collaborate with safety initiatives, like Solutions for Patient Safety, to eliminate preventable harm. Strategic AIM3: Leverage collaborative learning and outcomes to partner with state and national agencies and payors for … Specific AIMs: Reduce cost of pediatric healthcare (PPEs & Asthma) - July 2018 Reduce waste in pediatric healthcare (Bronchiolitis) - July 2018 Improve outcomes/ morbidity & mortality for pediatric patients (Sepsis) - July 2018 Align definitions for state reports and collaborative efforts - July 2019 Improve safety in pediatric healthcare (SPS) - Establish Texas Regional SPS structure & process Jan. 2017; outcome eliminate harm

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