MHA 2019 Annual Quality Report – Rural Health Dana Dahl, Vice President of Membership Services Introduce myself. I wanted to take a few minutes to introduce to you a new report by the Missouri Hospital Association. You should each have a copy. If you would like additional copies, please let me know. August 21, 2019

Rural Hospitals in Missouri There are 69 rural hospitals in Missouri. Breakdown by type: 35 Critical Access Hospitals 34 Non-Critical Access Hospitals Highlight the two additional closures last week – one in the Central region and yet another in the Southeast region. The hospital that closed in the Central region has not been seeing patients for a few months – their CMS license has been permanently suspended. Patients are now forced to travel to nearby hospitals, which are XX miles away. The hospital in the Southeast converted from an acute care facility to an urgent care, imaging center and clinic system. There is another hospital in the same community so they are establishing patients there. As we continue to see our rural hospitals close, the association is taking a closer look at how we ensure that the existing hospitals thrive and survive. One of the keys to sustainability is high quality care.

Rural Hospitals in Missouri The opportunities and obstacles faced by providers and patients in rural areas are different than those in urban areas. These include: Socioeconomic challenges Behavioral health risk factors Lower rates of insurance coverage Fewer health amenities One thing that most of us in this room can agree on is that the opportunities and obstacles faced by providers and patients in rural areas is different than in urban areas. These challenges include socioecomonic challenges, behavioral health risk factors, lower rates of insurance coverage and fewer health amenities. Those reasons are why its so crucial for conferences like this, where very smart people come together to combine the power of their minds and learn from each other.

Rural Hospitals in Missouri MHA 2019 Annual Quality Report – Rural Health illustrates performance on several clinical measures tracked by rural hospitals. Many measures demonstrate progress in quality improvement and harm reduction However, significant and ongoing variation still exists This report provides baseline and comparison-year data for infection and safety measures, readmissions and patient safety data MHA’s newest report illustrates performance on several clinical measures that are tracked by Missouri rural hospitals. Many of the quality and harm outcomes have demonstrated progress however there are still areas for improvement. Tell a story about how a rural hospital has committed to quality – Amanda giving me examples.

Performance Change Over Time Measure Current Trend Since 2015 Acute Myocardia Infarction (AMI) Readmissions Improved Hip and Knee Replacement Readmission Stroke Readmissions Post-Operative Pulmonary Embolism or Deep Vein Thrombosis Pressure Ulcer Rate Unexpected Patient Deaths During Hospital Stay Hospital-onset MRSA Bacteremia Post-operative Sepsis Surgical Site Infections – Colon Surgeries Facility-wide C. difficile Through various quality improvement initiatives, MHA and our member hospitals have been tracking set measures since 2015. Of those outcomes, these listed measures have improved over that 4 year period. This is not without dedication from our amazing hospital teams – a lot of hard work has gone into changing processes in order to provide the best care for patients.

Opportunities for Improvement Measure Injuries from Falls and Trauma Increased Surgical Site Infections – Abdominal Hysterectomies Catheter-Associated Urinary Tract Infection Central Line-associated Bloodstream Infection Hospitalwide Readmissions Coronary Artery Bypass Grafting Congestive Heart Failure Chronic Obstructive Pulmonary Disease Pneumonia And these are the opportunities for improvement. I’m happy to report that this list is far shorter than those that have improved since 2015. Read list out loud.

Data Sources Below are initiatives and programs aimed at improving processes and outcomes for all measures used in the rural report analysis. Hospital Improvement Innovation Network High Reliability Organizations Improvement Sprints Immersion Projects Medicare Rural Hospital Flexibility Program Patient and Family Advisory Council Small Rural Hospital Improvement Program In order to support our rural hospitals, MHA provides support one-on-one, encourages collaboration amongst peers and participates in state and national initiatives that bring resources to our members. This is a listing of initiatives and programs that have been created to support our rural hospitals to improve processes and outcomes. These programs are explained in greater detail in the actual report.

Contact Information Stephen Njenga, MPH,  MHA, CPHQ, CPPS Director of Performance Measurement Compliance Missouri Hospital Association 573/893-3700, ext. 1325 snjenga@mhanet.com Terrie Bauer, R.N., MHA, CPHQ, LSSBB Vice President – Process Improvement 573/893-3700, ext. 1421 tbauer@mhanet.com Stephen and Terrie were the masterminds behind this report. Their contact information is listed here for you in the case that you have questions, feedback or would like additional information. Thank you for your time!