The Quality Improvement Support Collaborative: Working together

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The Quality Improvement Support
CollaborativeWorking together!
Leslie Schultz, PhD, CPHQ, Director, Premier
Healthcare Informatics
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Why a Support Collaborative?
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Challenge

• Front line healthcare workers see themselves as
  relatively unsupported in their efforts to
  improve care.
• Meanwhile, a number of organizations see
  themselves as supporting improvement and seek to
  be more supportive.

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Response

• In December 2001, CMS, IHI, Premier and VHA met
  to find ways of working together in January 2002
  they joined with JCAHO and NCQA to form the
  Quality Improvement Support Collaborative (QISC).

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Goals

• Conduct pilot collaborative projects to support
  specific improvement goals.
• Collaborate in providing information to support
  improvement.
• Reduce the burden of data collection and quality
  improvement.
• Make frontline providers more aware of ways in
  which QISC organizations and others can support
  them.

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Pilot Collaborative Improvement Support Projects

• Heart attack and heart failure
• Inpatient settings
• Maryland and Louisiana (two States where QIOs,VHA
  and Premier were interested and capable).

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Information Web Sites

• CMS, IHI, AHRQ, Premier, VHA, JCAHO and NCQA run
  or are building web sites to support improvement.
• To date -- few efforts to link support of
  improvement information.
• The QISC organizations committed to collaborating
  to make web sites easier for frontline workers to
  use.

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Reduce Burden

• CMS and JCAHO have converged their measures (a
  hospital collecting Oryx (JCAHO) measures can use
  them directly to participate in QIO (CMS)
  improvement efforts CMS tools collect Oryx data.
• All QISC organizations support the National
  Quality Forum effort to identify and endorse
  national measure sets for multiple settings.

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Awareness

• Most hospitals are (vividly) aware of Oryx
  requirements!
• They may be less aware of the existence of either
  regional or national programs supporting
  improvement activities.

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The QISC Pilots
Louisiana Maryland
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Louisiana QISC

• Background Environment
• 118 Acute Care Hospitals in Louisiana
• 70 JCAHO accredited and working on one or more
  core measure projects
• NO legislative mandate on quality reporting
• high utilization (Medicare expenditure) per
  hospital bed

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LA QISC Goals of collaborative

• Improve the quality of cardiac care provided to
  citizens of Louisiana.
• Provide hospitals an opportunity to give input on
  national measures, given near inevitability of
  public reporting.
• Contribute to an understanding of the real data
  burden involved in creating a public data set.

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LA QISC Challenges

• Recruitment
• requires individual soliciting - getting the
  right mix of players
• hospitals concerned about added burden
• Public reporting
• working through the cycle of fear

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MD QISC Challenge of the Local Environment

• Public reporting already in place-administrative
  data and chart data
• Regulated environment-MHCC, HSCRC, Office of
  Health Care Quality, JCAHO, Delmarva
• Decreasing profitability
• Increasing demand for accountability
• Increasing resistance from hospitals for unfunded
  mandates

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Quality Improvement Overload

• Get With the Guidelines
• Guidelines Applied in Practice
• National Registry for Myocardial Infarction
• Crusade Registry
• CMS 7th SOW (Delmarva)
• And more

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MD QISC Goals of collaborative

• Coordination One coordinated project for chosen
  topic area
• Burden Commitment to use of existing data where
  possible and link to Core Measures
• Linkage Focus QI efforts on publicly reported
  measures
• Executive Involvement steering group composed of
  senior leadership
• Cost/Benefit Involvement of state rate setting
  agency

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Status of Pilots

• LA QISC
• recruited work group from interested hospitals
  to provide input and direction in the planning of
  the collaborative
• first work group meeting scheduled for Feb. 03
• first full collaborative group meeting
  anticipated in May 03
• MD QISC
• recruited steering committee from interested
  hospitals to provide input to the type and nature
  of assistance the QISC could provide
• convening two work groups a data management
  group and a paying for quality group

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Challenges for the Pilots!

• Multiple quality agendas with pride of ownership
• Too many cooks
• Competitive environment
• Uncertainty of what else they will dream up
• Ability to maintain focus and momentum
• Engagement of senior leadership and Board

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Questions???

• Leslie Schultz, PhD, CPHQ,
• Director, Premier Healthcare Informatics
  704.733.5209
• leslie_schultz_at_premierinc.com