National Quality Program Achieves Improvements in Safety Culture and Reduction in Preventable Harms in Community Hospitals  Karen Frush, MD, BSN, CPPS, Cynthia Chamness, RN, BSN, CPPS, Barbara Olson, RN-GA, MS, CPPS, Sandi Hyde, MSPS, Cynthia Nordlund, RN, MSN, CPPS, Harry Phillips, MD, Russell Holman, MD  Joint Commission Journal on Quality and Patient Safety  Volume 44, Issue 7, Pages 389-400 (July 2018) DOI: 10.1016/j.jcjq.2018.04.008 Copyright © 2018 The Joint Commission Terms and Conditions

Figure 1 Several components and phases of the LP quality journey with Duke University Health System, which led to the development of the National Quality Program (NQP), are shown. HEN, Hospital Engagement Network. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 2 The aggregate number of preventable hospital-acquired harms per 1,000 inpatient-says, based on administrative claims data. decreased by 62.5% compared to a baseline rate in 2010, (p < 0.000; one-tailed, two-sample t-test,of non-pooled variance). Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 3 Reductions in the number of annual central line–associated bloodstream infections (CLABSIs) and in the standardized infection ratio (SIR) across all inpatient units since 2015 are shown. The data were reported to the National Healthcare Safety Network. (For individual hospital SIR outcomes, p = 0.035; one-tailed, two-sample t-test of non-pooled variance.) Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 4 Some 73% of LifePoint and Duke LifePoint Healthcare hospitals have reported zero central line–associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network (NHSN) for 12 consecutive months, as have 60% of hospitals for 24 months or more. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 5 The aggregate number of hospital-acquired pneumonia cases per 1,000 inpatient-days decreased by 73.0% from January 2011 through December 2017, compared to a baseline rate in 2010, based on administrative claims data (p value < 0.000; one-tailed, two-sample t-test of non-pooled variance). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) codes used to define this measure were based on the pneumonia diagnosis codes used by the Centers for Medicare & Medicaid Services for pneumonia readmissions. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 6 The aggregate number of hospital-acquired urinary tract infections per 1,000 inpatient-days decreased from January 2011 through December 2017 by 78.9%, compared to a baseline rate in 2010, based on administrative claims data (p value < 0.000; one-tailed, two-sample t-test of non-pooled variance). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) codes used to define this measure were obtained from the Centers for Medicare & Medicaid Services Deficit Reduction Act Hospital-Acquired Conditions program for catheter-associated urinary tract infections (UTIs) and input from clinicians. The measure includes all hospital-acquired UTIs, with and without catheter placement. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 7 The aggregate number of hospital-acquired sepsis cases per 1,000 inpatient-days decreased by 58.5% from January 2011 to December 2017, compared to a baseline rate in 2010, based on administrative claims data (p value = 0.046; one-tailed, two-sample t-test of non-pooled variance). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) codes defined by the Agency for Healthcare Research and Quality for Patient Safety Indicator 13 were used for this measure. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 8 The aggregate number of venous thromboembolism (VTE) cases per 1,000 inpatient-days from January 2011 through December 2017 decreased by 40.6%, compared to a baseline rate in 2010. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) codes defined by the Agency for Healthcare Research and Quality for Patient Safety Indicator 12 and the Deficit Reduction Act Hospital-Acquired Conditions program were used for this measure. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 9 The aggregate rate of elective vaginal or cesarean deliveries, not medically necessitated, occurring for infants between 37 and 39 weeks of completed gestation, decreased by 85.5% in 2017, compared to a baseline rate in 2013 (p < 0.000; one-tailed, two-sample t-test of non-pooled variance). Q, quarter. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 10 The rate of all-cause hospitalwide readmissions per index admissions, January 2011–December 2017, decreased by 11.6% across LP and DLP hospitals compared to a baseline rate in 2010. An index admission is the first admission for a patient without a prior admission within 30 days, which aligns with the Centers for Medicare & Medicaid Services Readmissions Reduction Program methodology. LP, LifePoint Health®; DLP, Duke LifePoint Healthcare, LLC. All-Cause Hospitalwide Readmissions per Index Admissions, January 2011–December 2017 Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Figure 11 Teamwork and safety climate index scores from a survey of 35,000 staff members increased by 29% between 2012 and 2016 (p value < 0.000, one-tailed, two-sample t-test of non-pooled variance). Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions

Left to right: David Dill, President and Chief Operating Officer, LifePoint Health; Cindy Chamness, Rusty Holman, Harry Phillips, and Barbara Olson, all of whom accepted the 2017 John M. Eisenberg Patient Safety and Quality Award on behalf of LifePoint and Duke. Joint Commission Journal on Quality and Patient Safety 2018 44, 389-400DOI: (10.1016/j.jcjq.2018.04.008) Copyright © 2018 The Joint Commission Terms and Conditions