Looking Back, Moving Forward


Eloquest Healthcare is excited to welcome back Jo Ann Brooks PhD, RN, FAAN, FCCP to the Eloquest Healthcare Blog! Jo Ann is the System Vice President for Safety and Quality at Indiana University Health (a 16 hospital system) based in Indianapolis, IN. She is responsible for evaluating and aligning quality and safety activities/initiatives across the system for internal and external measure reporting. Dr. Brooks is also Director of the “Quality Thread” for the IU School of Medicine revised curriculum. She lectures frequently on quality and CMS pay for performance measures and presently serves on the National Quality Forum Admissions/Readmissions Steering Committee. Her clinical background is pulmonary and her research interest is hospital acquired pneumonia. She is a past Board Member of AACN and is active in the American College of Chest Physicians on numerous committees. She is an adjunct faculty member for Indiana University and Purdue University schools of nursing. Dr. Brooks has published extensively with both book chapters and articles.

2017 was a year of challenges in patient quality and safety, but hold on… 2018 is starting with a bang. I have identified some key areas in quality and patient safety and will do a review of 2017 and potentially what to expect in 2018.

Hospital-acquired Infections (HAI)
Hospital-acquired infections were and remain a major focus on everyone’s radar. The CDC posted a nice review of “Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress”. Some key points: hospitals have made significant progress in preventing CLABSIs–nationally, there has been a roughly 50% drop in CLABSIs between 2008 and 20161. See how some facilities are facilities are striving to sustain and maintain low CLABSI rates. Key to this progress is the strong focus that hospitals have had on this patient harm and national efforts among multiple organizations to improve care (CDC, state health departments, the Agency for Healthcare Research and Quality (AHRQ) Comprehensive Unit Based Safety Program (CUSP), and Centers for Medicare and Medicaid Services (CMS) Quality Improvement Networks and Organizations and Hospital Engagement Networks). Check on this reference for data on other HAIs. In 2018, HAIs will continue to be heavily weighted in the CMS Pay for Performance Programs (Value-Based Purchasing (VBP) and Hospital-Acquired Conditions (HAC) Programs).2 We need to continue the great work we are doing and sustain our improvements!

CMS Pay for Performance Programs
The three programs (VBP, HAC and Hospital Readmission Reduction Penalty Program (HRRP)) are still alive and well. Areas of focus continue to be HAIs plus efficiency and cost reduction will receive more focus in the future. Key to all these programs is looking ahead and being proactive versus reactive to new measures which may be added in coming years. Remember, for VBP a measure must be publicly reported on Hospital Compare for one year prior to becoming a measure for VBP. However, for the HRRP and HAC Programs, this caveat does not exist. In addition, be informed of changes in methodology that may impact your hospital’s results. One example is the Provision of the 21st Century Cures Act (December 13, 2016) which mandates that the HRRP include the socioeconomic adjustment methodology (defined as dual eligible patients). This will occur in FY2019 and onward.

Bundled Payments
CMS finalized a decision on November 30, 2017 to cancel two planned mandatory bundled payment models (Cardiac Bundles-Episode Payment Model and the Cardiac Rehabilitation Incentive Payment Model) and cut down the number of participants in the ongoing Comprehensive Care for Joint Replacement Program implemented during the Obama administration3. However, on January 10, 2018 CMS announced a new voluntary bundled payment model, which is the first advanced alternative payment model introduced by the Trump administration4. It is called the Bundled Payments for Care Improvement Advanced Model. This model includes 32 clinical episodes (29 inpatient setting, 3 outpatient setting).5 The first cohort starts October 1, 2018 and runs through December 31, 2023. The clinical episode includes a 90-day window of care and seven quality measures are included. These measures are familiar to the acute care setting and include all-cause hospital readmission, PSI-90, Advanced Care Plan and measures specific to a type of clinical episode. Details can be found at the CMS website.

Much more to come in safety and quality in 2018. Take a big breath, get some sleep and get ready for more change!

Check out some of Eloquest Healthcare’s other ACA-related blogs here!

Footnotes

  1. Centers for Disease Control and Prevention. Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress. January 5, 2018. https://www.cdc.gov/hai/surveillance/data-reports/data-summary-assessing-progress.html
  2. Centers for Medicare and Medicaid Services. Hospital-Acquired Condition Reduction Program Fiscal Year 2018 Fact Sheet. July 20, 2017. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/FY2018-HAC-Reduction-Program-Fact-Sheet.pdf
  3. Centers for Disease Control and Prevention. Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress. January 5, 2018. https://www.cdc.gov/hai/surveillance/data-reports/data-summary-assessing-progress.html
  4. Dickson, V. CMS makes it official: Two mandatory bundled-pay models canceled. Modern Healthcare. November 30, 2017. http://www.modernhealthcare.com/article/20171130/news/171139986
  5. Morse, S. CMS launches voluntary bundled payments model, first since spiking mandatory Bundles. Healthcare Finance, January 10, 2018. http://www.healthcarefinancenews.com/news/cms-launches-voluntary-bundled-payments-model-first-spiking-mandatory-bundles
  6. Centers for Medicare and Medicaid Services. BCPI Advanced. January 11, 2018. https://innovation.cms.gov/initiatives/bpci-advanced

CRBSIs: Reduce Infection Risks by Maintaining Integrity of Vascular Access Device Dressings

This is the first of a 3-part series focusing on catheter-related bloodstream infections (CRBSIs). As catheter use increases, bloodstream infections (BSIs) resulting from intravascular catheters have become a costly complication of health care.

To start, the terms CRBSI and central line–associated bloodstream infection (CLABSI) are often used interchangeably to describe intravascular device (IVD)–related bloodstream infections. However, there are differences. According to the Association for Professionals in Infection Control and Epidemiology (APIC)1:

  • CRBSI is a rigorous clinical definition, defined by precise laboratory findings that identify the central venous catheter (CVC) as the source of the BSI and that are used to determine diagnosis, treatment, and possibly epidemiology of BSI in patients with a CVC
  • CLABSI is a term used only for surveillance purposes to identify BSIs that occur in the population at risk (patients with central lines)

The costs of treating BSIs resulting from intravascular catheters range from $670 million to $2.68 billion annually in the US2, and up to $29,156 per incidence of a CLABSI.3 Unfortunately, CRBSIs are a common complication in patients admitted to the Intensive Care Unit. In fact, since 2008, hospitals are no longer reimbursed by the US Centers for Medicare and Medicaid Services for hospital-acquired infections (HAIs) like CRBSI.4 As a result, healthcare providers are under great pressure to decrease the rates of HAIs.

CRBSI Quality Improvement is a key objective for most practices and facilities. Because dressing disruption has been determined to be a major factor in the development of CRBSIs,5 the importance of ensuring the integrity of medical dressings and devices over extended periods of time cannot be overstated.

A large cohort of patients was studied in a randomized multicenter trial to determine the importance of dressing disruption on the risk for development of CRBSI.5 The results showed:

  • 67% (7,347 of 11,036) of the dressing changes were performed before the planned date due to soiling or undressing
  • When the final dressing was disrupted, the risk of catheter colonization or infection increased 12-fold

These results may have you questioning the durability of dressings. This was precisely what initiated another study, which evaluated the durability and associated costs of different CVC dressings.6

During the 12-month trial period, a total of 1229 CVC dressings were observed from 590 CVCs. The results demonstrated that few CVC dressing remained adherent for 7 days. While 1 dressing appeared to last longer than the others, it was still below the recommended standard and at increased cost. The study also considered the associated time and costs of the dressing changes.

While 1 dressing had a median duration of 68.5 [32-105] hours, the other 3 dressings compared at 43.5, 46.0 and 40.5 hours (P<0.001). There was no significant difference in the median dressing duration between the other 3 dressings (p=0.74).

The results of these studies demonstrate the need to ensure the integrity of vascular access device dressings between scheduled changes. It is clear this can’t be accomplished by a dressing alone. The superior adhesiveness of Mastisol® Liquid Adhesive has been clinically demonstrated. Using Mastisol®:

  • Reduces the likelihood of dressing disruption 7, 8
  • Minimizes the risk of infection by creating a lasting occlusive dressing barrier 9,10

For more information about Mastisol® Liquid Adhesive, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1-877-433-7626 or visit www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like a CAUTI, CLABSI, or SSI.

Join us next time for the second of this 3-part series where we’ll explore the impact of CHG-compatible products on CRBSIs in our post entitled, “CHG Compatibility and CRBSI Reduction: Does it Matter?

References

  1. Accessed September 18, 2017.
  2. Shah H, Bosch W, Thompson KM, et al. Intravascular catheter-related bloodstream infection. Neurohospitalist. 2013;3(3):144-151.
  3. Scott RD II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention. March 2009. Available at: http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf.
  4. Stone PW. Changes in Medicare reimbursement for hospital-acquired conditions including infections. Am J Infect Control. 2009;37:17A-18A
  5. Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med. 2012;40:1707-1714.
  6. Richardson A, Melling A, Straughan C, et al. Central venous catheter dressing durability: an evaluation. J Infect Prev. 2015;16(6):256–261.
  7. Pullen D. Quality Improvement Initiative to Improve Dressing Adherence Reveals Improved Dressing Adherence Observations on a Before-After Analysis. Presentation at AVA 2014 Annual Scientific Meeting, Washington DC, September 2014. Guide to the Elimination of Catheter-Related Bloodstream Infections. Association for Professionals in Infection Control and Epidemiology; Washington, DC: 2009. https://apic.org/.
  8. Niehaus S, McCord J. Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit. Presentation at Association for Vascular Access Annual Scientific Meeting in Orlando, FL, September 2016.
  9. Browne B, Moffo H. Quality Improvement Initiative Results in Fewer Dressing Disruptions and Improved Adherence to Best Practices. Presentation at Greater Cincinnati AACN Chapter, 28th Annual Trends in Critical Care Conference, Cincinnati, OH, April 2016.
  10. Boudreaux A. Ventriculostomy Dressing Process Improvement. Presentation at National Teaching Institute & Critical Care Exposition, Boston, MA, May 2013.