Effects of Compliance With the Early Management Bundle (SEP-1) on Mortality Changes Among Medicare Beneficiaries With Sepsis: A Propensity Score Matched Cohort Study.

BACKGROUND: US hospitals have reported compliance with the SEP-1 quality measure to Medicare since 2015. Finding an association between compliance and outcomes is essential to gauge measure effectiveness. RESEARCH QUESTION: What is the association between compliance with SEP-1 and 30-day mortality among Medicare beneficiaries? STUDY DESIGN AND METHODS: Studying patient-level data reported to Medicare by 3,241 hospitals from October 1, 2015, to March 31, 2017, we used propensity score matching and a hierarchical general linear model (HGLM) to estimate the treatment effects associated with compliance with SEP-1. Compliance was defined as completion of all qualifying SEP-1 elements including lactate measurements, blood culture collection, broad-spectrum antibiotic administration, 30 mL/kg crystalloid fluid administration, application of vasopressors, and patient reassessment. The primary outcome was a change in 30-day mortality. Secondary outcomes included changes in length of stay. RESULTS: We completed two matches to evaluate population-level treatment effects. In standard match, 122,870 patients whose care was compliant were matched with the same number whose care was noncompliant. Compliance was associated with a reduction in 30-day mortality (21.81% vs 27.48%, respectively), yielding an absolute risk reduction (ARR) of 5.67% (95% CI, 5.33-6.00; P < .001). In stringent match, 107,016 patients whose care was compliant were matched with the same number whose care was noncompliant. Compliance was associated with a reduction in 30-day mortality (22.22% vs 26.28%, respectively), yielding an ARR of 4.06% (95% CI, 3.70-4.41; P < .001). At the subject level, our HGLM found compliance associated with lower 30-day risk-adjusted mortality (adjusted conditional OR, 0.829; 95% CI, 0.812-0.846; P < .001). Multiple elements correlated with lower mortality. Median length of stay was shorter among cases whose care was compliant (5 vs 6 days; interquartile range, 3-9 vs 4-10, respectively; P < .001). INTERPRETATION: Compliance with SEP-1 was associated with lower 30-day mortality. Rendering SEP-1 compliant care may reduce the incidence of avoidable deaths.

Response to survey directed to patient portal members differs by age, race, and healthcare utilization.

Health care systems are increasingly utilizing electronic medical record-associated patient portals to facilitate communication with patients and between providers and their patients. These patient portals are growing in recognition as potentially valuable research tools. While there is much information about the response rates and demographics of internet-based surveys as well as the demographics of patients who are portal members, not much is known about the response rate of internet-based surveys directed to a group of patient portal members or the demographics of which portal members respond to internet-based surveys issued within that specific population. The objective of these analyses was to determine the demographics of patient portal users who respond to an internet-based survey request. We hypothesized that respondents would more likely be: (1) older (65+), (2) European American, (3) married, (4) female, (5) college educated, (6) have higher medical care utilization, (7) have more comorbidities, and (8) have a private practice primary care physician (as opposed to a salaried group practice primary care physician). We found that our respondents tended to be older, of European geographic ancestry, and more frequent users of healthcare. While patient portal members are an easily identifiable and contactable group that are potentially valuable participants for research, it is important to understand that respondents to surveys solicited from this sampling frame may not be entirely representative. It will be important to develop strategies to more fully engage populations that represent the target population in order to increase overall and subgroup response rates.

2011 John M. Eisenberg Patient Safety and Quality Awards. The Henry Ford Health System No Harm Campaign: a comprehensive model to reduce harm and save lives. innovation in patient safety and quality at the local level.

BACKGROUND: In 2008 Henry Ford Health System launched its "No Harm Campaign," designed to integrate harm-reduction interventions into a systemwide initiative and, ultimately, to eliminate harm from the health care experience. METHODS: The No Harm Campaign aims to decrease harm events through enhancing the system's culture of safety by reporting and studying harm events, researching causality, identifying priorities, and redesigning care to eliminate harm. The campaign uses a comprehensive set of 27 measures for harm reduction, covering infection-, medication-, and procedure-related harm, as well as other types of harm, all of which are combined to comprise a unique global harm score. The campaign's objective is to reduce all-cause harm events systemwide by 50% by 2013. A wide range of communication processes, from systemwide leadership retreats to daily e-mail news sent to all employees and physicians, is used to promote the campaign. In addition, the campaign is on the intranet "Knowledge Wall," where monthly dashboards, meeting minutes, and best practices and the work of our teams and collaboratives are documented and shared. RESULTS: From 2008 through 2011, a 31% reduction in harm events and an 18% reduction in inpatient mortality occurred systemwide. DISCUSSION: Building infrastructure, creating a culture of safety, providing employee training and education, and improving work process design are critical to systemwide implementation of harm-reduction efforts. Key actions for ongoing success focus on leadership, disseminating performance, putting everyone to work, and stealing ideas through national and local collaborations. A financial model was created to assess cost-savings of reducing harm events; early results total nearly $10 million in four years.

Large multispecialty group practices and quality improvement: what is needed to transform care?

The objective of this study was to use successful quality improvement initiatives in large multispecialty medical groups to identify the organizational factors that were the most important to improvement. The study analyzed the most successful quality improvement initiatives from those submitted by the 24 members of the Council of Accountable Physician Practices. Twelve initiatives from 8 groups were selected that met the study criteria for large improvement for large numbers of patients. An independent group used these initiatives to identify potentially important factors and then asked key local leaders to rate the importance of these factors on a scale of 1 to 4, importance rating (1-4 scale) for each of 18 identified factors. Eighteen factors were identified and 5 stood out as ranked a 4 (Very Important) for at least 80% of the initiatives: Communication, Use of Evidence-Based Medicine, Leadership, Measurement, and Reporting. Another 7 of the 18 factors were ranked a 4 for more than 50% of the initiatives. All the factors are related to the 6 challenges in the Institute of Medicine report. It was concluded that any organization striving to greatly improve the quality of its healthcare delivery should consider these factors when planning improvement initiatives.

Back to basics: giving attention to surgical infection prevention.

When it comes to postoperative infection, there should be no argument about the business case for quality. Postoperative infection is a major cause of patient injury, mortality and health care cost. An estimated 2.6 percent of the nearly 30 million operations each year are complicated by surgical site infections, and patients with infections have twice the incidence of mortality.