1. HVHC Sepsis Safety Team October 14, 2015 CONFIDENTIAL - Internal Use Only

2. Introductions Transitioning from CMMI sepsis to Safety Program: Differences and Parallels Dissemination/Implementation project overview HVHC Fall Conference Agenda CONFIDENTIAL - Internal Use Only 1

3. Introductions CONFIDENTIAL - Internal Use Only 2 Andreas Taenzer, MD, MS –Physician SME for Sepsis Safety Team –Andreas.H.Taenzer@dartmouth.eduAndreas.H.Taenzer@dartmouth.edu Lucy Savitz, PhD, MBA –Chair of HVHC Safety Program –Lucy.savitz@imail.orgLucy.savitz@imail.org Jason Scott, MPH, MPP –Project Manager for HVHC Safety Program –Jason.Scott@imail.orgJason.Scott@imail.org Jillian Bath, BA –Project Coordinator for HVHC Safety Program –Jillian.bath@imail.orgJillian.bath@imail.org

4. Continuity of the CMMI sepsis work CONFIDENTIAL - Internal Use Only 3 Safety and Dissemination CMMI enrollment ends CMMI starts 2012 2015

5. HVHC 2.0 Governance Structure Chairs of Board subcommittees Finance Committee Discovery & Dissemination Chair – L. Savitz Population Health Episode-Based Care Safety Programs Chair – L. Savitz V. Chair –J. Tatman Dissemination Chair – S. Kraft V. Chair – L. Savitz Data Governance Data Stewardship Security & Privacy Scientific Committee Measures Stewardship Scientific Review Board Advocacy & Affinity Groups Affinity Groups Advocacy Program Management Office (PMO) Board Committees Executive Committee

6. Work over the last 3 years is continued under the Safety Program Collecting the same data means continuity and creating a longitudinal data set that has no equal due to the linkage to CMS data (Current n = 6,452 patients) We are building on the success of the work accomplished under the CMMI award period by disseminating to additional units and beyond Differences and parallels 5

7. 6 Three Hour Bundle Adherence by Quarter (enrolled patients meeting criteria) CONFIDENTIAL – Internal Use Only

8. 7 Standardized 90-day post sepsis episodes cost CONFIDENTIAL – Internal Use Only

9. 8 90-day post discharge mortality (unadjusted) CONFIDENTIAL – Internal Use Only

10. 9 Dissemination & Implementation (D&I) Project Aims 1.Design a Collaborative D&I Conceptual Model Design generic conceptual model for broad-scale dissemination across HVHC members 2. Apply this conceptual model to our Sepsis Care Model for D&I HVHC-wide and beyond Apply the model to the Sepsis Care Model implementing evidence-based care across HVHC members and beyond Note: Ongoing work on the Sepsis clinical model will fold into the HVHC Safety Program (formerly Intermountain HEN) Confidential - Internal Use Only

11. Framework CONFIDENTIAL - Internal Use Only 10 Framework to share and collaborate on tools and resources across HVHC

12. 11 Dissemination & Implementation (D&I) Project Aims 1.Design a Collaborative D&I Conceptual Model Design generic conceptual model for broad-scale dissemination across HVHC members 2. Apply this conceptual model to our Sepsis Care Model for D&I HVHC-wide and beyond Apply the model to the Sepsis Care Model implementing evidence-based care across HVHC members and beyond Note: Ongoing work on the Sepsis clinical model will fold into the HVHC Safety Program (formerly Intermountain HEN) Confidential - Internal Use Only

13. 12 New Efforts and Level of Participation Overview EDICUInpatients Current State/Level of Participation Total% % % Sustaining34(50%)34(64%)12(22%) New Effort or in Progress33(50%)10(32%)33(78%) Full Data (time stamps)25 (75%) 22 (91%) 18 (88%) Simple Data (Y/N flags)231817 No Data19(25%)4(9%)10(22%) N774445

14. Members choose from 3 participation levels 13 Level of Participation InputData ElementsOutput Dissemination Level Simple Study Level Full Study Level Surveys only: Leadership and unit sepsis leads Surveys plus: 3-hour bundle process measures with timestamps Site ID % participating units % employees trained per unit Above plus: Patient ID Process elements Y/N Surveys plus: 3-hour bundle process measures no timestamps Web-based training tools Customizable materials CMS regional comparators CMS outcomes Publications – dissemination/QI level Above plus: Change over time internal performance Comparison to other institutions Cohort CMS outcome data Publications - quantitative Above plus: Patient ID Process elements Y/N ED, ICU, inpatient unit start time Process element and time Above plus: Continuation of CMMI level sepsis data Longitudinal data, outcomes, publications Deeper analytics of outcomes over time

15. Project Targets 14 Q3’15 Q4’15Q1’16 Q2’16 – Q1’17 80% of hospitals complete current state & readiness assessment 80% of participating units complete readiness steps (tailored to current state of sepsis bundle) 80% of participating units implement sepsis bundle 80% of participating units complete quarterly dissemination surveys Targets based on current state of sepsis bundle: Not started / planning: 10% increase in bundle adherence 10% relative reduction in mortality rate 5% decrease in cost of care In progress: 5% increase in bundle adherence 5% relative reduction in mortality rate 2.5% decrease in cost of care Sustaining: Sustain bundle adherence Sustain performance

16. Readiness Tasks for Implementation CONFIDENTIAL - Internal Use Only 15 TypeReporting needsCompleted by Identify the individual local leader for each participating unit Name October 26 Core improvement teams established to drive implementation of the Sepsis Care Model. Improvement team to include the following role functions (1) project management, one (1) physician champion, and one (1) quality improvement specialist. Complete? Yes/No December 15 Improvement targets have been established according to readiness track. Complete? Yes/No March 25 Current state and future care model roles and workflows have been defined. Complete? Yes/No December 15 Training and learning capacity has been established using options provided by program office. Options may include, but are not limited to, identification of local trainers, completion of the “train-the-trainer” program, and customization of training curricula. Complete? Yes/No December 15 Tools and templates have been configured using starter kits provided by the program office. Kits may include implementation guides, posters outlining Sepsis Care Model steps, and communication templates. Complete? Yes/No December 15 Anticipated implementation start date per unit Date December 15

17. HVHC Sepsis Bundle Dissemination and Implementation Program: Identifying your team RoleRepresentingResponsibilities PMO Point of Contact System levelDistribute quarterly surveys to appropriate respondents Serves as the primary contact for PMO reporting needs e.g., launch date, progress, changes in participation, escalate risks Serves as the primary contact for project communications Clinical champion System level or hospital level* Expert clinical knowledge on sepsis Work with HVHC collaborative experts reviewing evidence and best practices for sepsis care model Participate on HVHC calls/webinars and conferences Willing to serve as a resource for other HVHC members seeking information Project manager System level or hospital level* Monitors and maintains project timelines and deliverables Participates on relevant HVHC sepsis D&I collaborative calls Data coordinator System level or hospital level* Maintains measurement plan Data collection *Due to variations in organizational structures, there may be more than one person in this role at your system.

18. HVHC Sepsis 3-Hour Bundle Dissemination and Implementation Program: Identifying your team RoleRepresentingResponsibilities Quality improvement or implementation coach System or hospital*Provides support for implementation activities using standard methodology at that system/hospital Adapt implementation plans as needed based on local context IT AnalystSystem or hospital*Adapt EHR clinical decision support tools for sepsis detection and treatment Training and education Deploy EHR tools Site leaders for implementation Each participating unit (ED or ICU) Lead local implementation of sepsis care model Complete HVHC survey regarding sepsis implementation efforts (anticipated time to complete survey is <10 mins) Coordinates HVHC-related communications with local team *Due to variations in organizational structures, there may be more than one person filling in this role at the system

19. Distributed in August for a mid-September return Purpose of these assessments: –Inform the development of a framework and model for rapid wide scale dissemination and implementation –Better understand system/hospital/unit level readiness for implementation of the 3-hour bundle for sepsis Thank you!! Current State & Readiness Assessments CONFIDENTIAL - Internal Use Only 18

20. Purpose –Understand adherence at the dissemination level as a proxy for patient level data submission –Obtain more information about what you perceive to be barriers and facilitators to implementation to inform quarterly webinars with the Sepsis Safety Team Frequency –Quarterly 6 simple questions Survey respondent –Local unit leader responsible for 3-hour bundle implementation First survey will come from PMO to Program Leads November 2 for a return by November 16 Quarterly “pulse check” of unit reps CONFIDENTIAL - Internal Use Only 19

21. Framework request CONFIDENTIAL - Internal Use Only 20 Please send tools and resources for sepsis 3-hour bundle implementation to hvhc.tdi.program.office@dartmouth.edu hvhc.tdi.program.office@dartmouth.edu

22. When: Tuesday, October 27 at 9:30 to 11:30am MST Agenda: –Sepsis Dissemination/Implementation Implementation timeline (November 2015 through March of 2017) Member expectations and readiness tasks Participating units by member Website Quarterly collaborative calls through the Safety Program –Evaluation Plan Data collection Site visits –Safety Program Topics (30 minutes) HVHC Fall Conference CONFIDENTIAL - Internal Use Only 21

23. Quarterly webinars scheduled for: –January 13, 3pm Eastern –April 13, 3pm Eastern –July 13, 3pm Eastern To join the meeting, go to: https://intermountainmeetings.webex.com/intermountainme etings/j.php?MTID=mb306c54bf5eb6ca46839189e59f69a7a To join the AUDIO portion of the meeting, dial: 1-866-713- 7506 Enter the Meeting ID: 622 416 472 followed by the (#) pound sign https://intermountainmeetings.webex.com/intermountainme etings/j.php?MTID=mb306c54bf5eb6ca46839189e59f69a7a Upcoming Sepsis Safety Webinars CONFIDENTIAL - Internal Use Only 22

24. CONFIDENTIAL - Internal Use Only 23