1. HOSPITAL ENGAGEMENT NETWORK (HEN) – QUALITY IMPROVEMENT THROUGH REDUCING HARM AND READMISSIONS Introducing Truven Health Center for Innovation: Performance Improvement, Care Delivery and Innovation Presented by: Enrique Baquero Navarro, MHSA, FACHE, Vice President, PRHA Yanira Valle, RN, MSN, Project Manager, PRHA Vanderbilt Hotel – San Juan, P.R. August 13, 2015

3. Hospital Engagement Network (HEN) Affiliation between the American Hospital Association (AHA), the Health Research & Educational Trust (HRET), and State Hospital Associations including the Puerto Rico Hospital Association (PRHA) through the Partnership for Patients (PfP) 32 participating state hospital associations More than 1,600 participating hospitals nationwide 62 participating hospitals in Puerto Rico

4. Purpose of the HEN The 40/20 goal: * Reduce inpatient harm by 40% * Reduce readmissions by 20% Working with hospitals to implement best practices to reduce harm and readmissions. Provide best practice resources, education, implementation support and build improvement capacity.

5. CMS Quality Net Conference –December 2-4, 2014  17% reduction in hospital safety events (2010-2013)  Reduction of 1.3 million events  Estimated savings of $12B  50,000 lives saved

6. Guide to Safety Across the Board

7. Purpose of the Safety Across the Board Guide Developed by the HENs with support from PfP Summary of collective experience of 26 HENs (3,700 hospitals) Describe a framework of concepts/ways to guide hospital executives Guide to provide safe care and achieve Safety Across the Board

8. Safety Across the Board is Driven by Four Imperatives 1. Establish a culture of safety 2. Engage the Patient and their Family 3. Create Safety Across the Board 4. Count All Harms

9. Lessons from the HEN Project Safety Across the Board occurs when hospitals take a systemic approach to measuring, monitoring and continually improving care. Shift to systems thinking to reduce all harm. Leadership commitment and board of directors engagement.

10. Lessons from the HEN Project Organizational infrastructure and comprehensive reporting and measurement system. Analysis and response to the data collected. Continuous improvement – investigation and assessment

11. HEN Project: Topics Addressed Adverse drug events (ADE) Catheter-associated urinary tract infections (CAUTI) Central line-associated blood stream infections (CLABSI) Injuries from falls and immobility Obstetrical adverse events Pressure ulcers Surgical site infections Venous thromboembolism (VTE) Ventilator-associated pneumonia (VAP) Preventable readmissions

12. HEN Measures HEN measures were selected based on the CMS criteria of the most common hospital acquired conditions, change packages and were included on the encyclopedia of measures The encyclopedia of measures aligned hospitals measures in a effort to demonstrate the reduction throughout the project

13. Measures per topic TopicMeasure ADEAll ADEs per 1,000 patient days ADEs due to opioids Excessive Anticoagulation with Warfarin Hypoglycemia in Inpatients Receiving Insulin CAUTICatheter-Associated Urinary Tract Infections Rate - All Tracked Units Catheter-Associated Urinary Tract Infections Rate in ICU CLABSICLABSI Rate - All Units CLABSI Rate - ICU Pressure ulcersPatients with at least One Stage II or Greater Nosocomial Pressure Ulcer ReadmissionsReadmission within 30 days (All Cause)

14. Measures per topic TopicMeasure Surgical site infectionsSurgical Site Infection Rate (In-Hospital) Surgical Site Infection Rate (within 30 Days after Procedure) Ventilator-associated pneumonia (VAP) Ventilator-Associated Pneumonia Rate IVAC Rate-All Units VAC Rate-All Units Venous thromboembolism (VTE)Potentially Preventable VTE Post-op PE or DVT (All Adults) Injuries from falls and immobilityFalls With or Without Injury Obstetrical adverse eventsElective Deliveries at >=37 Weeks and <39 Weeks C-Section Delivery Rate

15. HRET HEN Initiatives Launched HRET HEN website: www.hret- hen.org, including:www.hret- hen.org -The Encyclopedia of Measures -Change Packages per topic Launched Comprehensive Data System (CDS) -System designed to submit and analyze the data measures provided by hospitals

16. HRET HEN Initiatives Fostered peer-to-peer learning through LISTSERVs® and monthly progress reports Affinity Groups Incorporated Coaching: - Improvement Advisors (IAs), with Cynosure Health -HRET state leads -HRET data leads

17. HRET HEN Initiatives CMS and NCD introduced Eliminating Harm Across the Board (HAB) as a PfP tool to understand overall harm at each hospital participating in HEN Taught the hospitals that the HAB tool would help: -Shift the organization culture by tracking the overall harm per discharge, which in turn helps the team see where the greatest opportunity is in eliminating harm -Put a face on harm by telling a compelling story to support change -Promote transparency

18. Puerto Rico HEN Initiatives Puerto Rico Kick-Off Meeting 6 Collaborative Meetings 1 Improvement Leader Fellowship 1 HEN Summit 9 Regional Meetings 12 Webinars 10 On-line Learning Modules based on the 10 HEN Core Areas

19. Highlights of PR-HEN 1,313 hospital participants in our local collaborative meetings. 339 hospital participants in regional meetings. 40 hospital participants in national collaboratives. 13 healthcare professionals certified as Fellows in PR. 7 participants in AHA Leadership Summit in San Diego, California. 1,400 healthcare professionals were trained through educational activities presented by our Quality Coordinators in the hospital setting. 952 healthcare professionals took and approved the online learning modules.

20. Puerto Rico HEN Initiatives Hospital in-site coaching Quality Coordinators hospital site visits Data Collection coaching and follow-up Leadership site visits

21. Data Reporting 96% of the PR participating hospitals submitted data in all applicable topics between 2012 & 2014 ADE: 100% hospitals CAUTI: 100% hospitals CLABSI: 100% hospitals Falls: 100% hospitals EED: 100% hospitals OB Harm: 100% hospitals Pressure Ulcers: 98% hospitals Readmissions: 96% hospitals SSI: 100% hospitals VAP: 100% hospitals VTE: 98% hospitals

22. PR HEN Results We reached the 40/20 goal on the following areas: -53% CAUTI all units -61% CAUTI ICU -71% CLABSI all units -77% CLABSI ICU -40% Early Elective Deliveries (EED) -20% Readmissions 30 days all cause -49% VAP in ICU -53% Post-Op PE or VTE -78% Potentially Preventable VTE

23. PR HEN Results We reached the 40/20 goal on the following areas: -21% Adverse Drug Events -10% C-sections -13% Falls with or without injury -30% Hospital Acquired PU Stage 2 or more -25% Surgical Site Infections

24. PR HEN Results The PR hospitals were able to prevent an estimate of over 28,319 events of harm with an estimated cost savings of $218,026,484.00 millions.