1. Quality and Safety Collaborative
The Value of a State
Collaborative

2. 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

3. 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

4. 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

5. 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?

6. 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.

7. 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

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

9. 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
2016
2016
2012

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. Questions?