Transforming health care through research and education.
Leveraging research and education to create a society of healthy communities, where all individuals reach their highest potential for health.
In 2012, the health care field was again challenged by political, economic and social pressures to provide better health care with fewer resources. Hospitals and health systems responded and made continous quality improvement part of their core mission and it demonstrated their success before the public. The Health Research & Educational Trust (HRET), the research and educational affiliate of the American Hospital Association (AHA), supports the field's work. Our vision to leverage research and education to create a society of healthy communities, where all individuals reach their highest potential for health, supports today's performance improvement call.
In partnership with the AHA, its affiliates, national stakeholders, allied hospital associations and our funders, we continue to impact the field. Using Hospitals in Pursuit of Excellence, the AHA's strategic platform to accelerate performance improvement in health care, we released 13 guides in 2012, covering topics that include readiness for accountable care, health care disparities and palliative care services. In addition, national engagement efforts like the Hospital Engagement Network and Comprehensive Unit-based Safety Programs have resulted in better care practices, more lives saved and cost savings.
HRET, which rapidly grew to a 65-plus-member team, is also committed to continuous performance improvement within our own organization using the Malcolm Baldrige national criteria. This year we were a recipient of the 2012 Bronze Award for “Commitment to Excellence” by Illinois Performance Excellence for demonstrating earnest efforts to adopt and apply continuous improvement principles, using the Baldrige Criteria for Performance Excellence. This recognition and our quality journey strengthen our ability to serve our customers, partners and constituencies.
In 2013, hospitals and health systems will be called upon to advance the work they do for communities and the care they provide to patients. HRET stands ready to help and will commit to improving in the overall delivery of care. Thank you for your work and for the opportunity to collaborate with you as we strive for excellence.
|Michael G. Rock, MD, Chair
Chief Medical Officer
Mayo Clinic Hospitals/Mayo Foundation
|Maulik S. Joshi, DrPH
Health Research & Educational Trust
Senior Vice President of Research
American Hospital Association
AHA/HRET Hospital Engagement Network
The Centers for Medicare & Medicaid Services awarded HRET a two-year contract to support the Partnership for Patients campaign. HRET is leading a Hospital Engagement Network that assist hospitals nationwide with the adoption of best practices with the goal of reducing inpatient harm by 40 percent and readmissions by 20 percent. The network represents 31 state hospital associations composed of nearly 1,600 hospitals. In 2012, the Oklahoma Hospital Association trained 34 new improvement leader fellows and decreased early elective deliveries by 65 percent. The Florida Hospital Association created online learning modules focused on quality improvement training. Participants earn continuing education units for completing the assessment. Further, AHRQ has shown a 40 percent reduction in CAUTI in participating hospitals in the On the CUSP: Stop HAI project.
On the CUSP: Stop HAI
CAUTI Highlights (first project year Aug 2011 to 2012)
With more than 1,000 registered hospitals in 29 states, the project continues to successfully expand, and does so in an inclusive manner involving rural and urban hospitals, teaching and non-teaching hospitals and hospitals of other varying characteristics. The project trained over 1,200 people through in-person learning sessions and more than 4,500 on conference calls or webinars.
CLABSI Highlights total project – finished September 29, 2012
Participating in six cohorts were 44 states, the District of Columbia, and Puerto Rico. Collectively, these states and regions recruited more than 1,000 hospitals and 1,800 hospital unit teams to participate in the project. Analysis of available data for the first five cohorts of states indicate these states reduced their rate from a baseline of 1.903 infections per 1,000 line days to one of 1.137 infections, or a relative reduction of 40 percent. On the CUSP: Stop BSI is estimated to save 294 to 613 deaths assuming a 25 percent CLABSI mortality rate and an estimated $89,909,566 to $238,426,030 in excess costs averted to date, figures that are projected to continue to increase over time. For the NCLABSI project, there are 100 units participating representing nine states. Through the course of the study, more than 17,000 central lines were placed. More than 127,000 maintenance notes were logged representing more than 8,400 unique patients. CLABSI rates decreased from 2.043 at baseline to 0.0855 in August 2012, a 58 percent relative reduction. During the course of the study, an estimated 131 infections were prevented which translates to an estimated 14-41 prevented deaths and more than $2.2 million costs averted.
In 2012, the National Implementation of TeamSTEPPS program trained 766 individuals representing more than 1,000 hospitals at five regional training centers. Developed by AHRQ and the Department of Defense, TeamSTEPPS is a set of evidence-based, practical tools that help hospitals and other health care providers strengthen teamwork among caregivers with the goal of improving patient safety. Implementation of the tool was supported by a website (teamsteppsportal.org) and a national conference. The conference was host to 400 members of both the military and civilian health care world in June in Nashville, Tennessee. HRET also began work redesigning and updating the current TeamSTEPPS materials and creating an entirely new toolkit for TeamSTEPPS in primary care settings.
Employer Health Benefits Survey
Findings from the 2012 annual survey, conducted from January through May 2012, highlighted employers' experiences with several provisions of the Patient Protection and Affordable Care Act. The survey found annual premiums for employer-sponsored family health coverage reached $15,745 this year, up four percent from last year, with workers on average paying $4,316 toward the cost of their coverage. Although most firms (61 percent) offered health insurance in 2012, the size of a business can be an accurate indicator of coverage levels. Just 50 percent of small businesses with three to nine workers offer benefits, compared to 73 percent of firms with 10 to 24 employees. Almost all (94 percent) of the largest companies — those with 50 to 199 employees — offer benefits in 2012. While the year-to-year increase is modest in comparison to a nine percent premium jump in 2011, the slight upswing this year is still outpacing wage growth, which has risen just 1.7 percent. The survey estimates that 2.9 million young adults are currently covered by employer plans this year as a result of a provision in the 2010 Affordable Care Act allowing young adults up to age 26, without employer coverage of their own, to be covered as dependents on their parents’ plan.
Equity of Care
HRET supports the National Call to Action to Eliminate Health Care Disparities. In 2012, HRET along with the Call to Action Founding Partners—Association of American Medical Colleges, American College of Healthcare Executives, American Hospital Association, Catholic Health Association of the United States and the National Association of Public Hospitals—developed a website providing free resources to improve the quality of care for every patient. Resources include best practices, case studies and national collaborative efforts. Commissioned in 2011 by the Institute for Diversity in Health Management, HRET conducted a national survey to determine the actions hospitals are taking to reduce care disparities. Overall, the survey results showed advancements in three core elements to increase the collection of race, ethnicity and language preference data; increase cultural competency training for clinicians and support staff; and increase diversity in governance and management. In 2013, the Call to Action will release goals for implementing the core elements, with milestones to guide the work and measure its success.
End of Stage Renal Disease
AHRQ awarded a two-year contract to HRET and its partners, the University of Michigan, Kidney Epidemiology and Cost Center and the Renal Network of the Upper Midwest, Inc. The goal of the project is to pilot the NOTICE change package to reduce vascular access infections in hemodialysis patients and improve safety culture in dialysis facilities. Efforts in 2012 focused on change package development and recruitment of 60 facilities from networks in two regions—the Upper Midwest and Southeast.
Hospitals in Pursuit of Excellence is the American Hospital Association's strategic platform to accelerate performance improvement and support delivery system transformation in the nation's hospitals and health systems.
During 2012, HPOE had eight webinars reaching more than 1,600 participants, 42,999 downloads of HPOE guides, and 3,162 downloads of the top five HPOE case studies
Committee on Performance Improvement
The AHA’s Committee on Performance Improvement (CPI) provides guidance to AHA’s strategy to support performance improvement across the membership, including further development of its strategic platform, Hospitals in Pursuit of Excellence (HPOE); and to support improved quality as defined by the six IOM aims (safe, effective, efficient, equitable, timeliness and patient-centered). In 2012, the committee released two report focused on advanced illness management strategies.
Committee on Research
AHA’s Committee on Research (COR) focuses on developing and monitoring progress towards answering the AHA research agenda questions and studying a topic in depth for dissemination to the field. In 2012, the committee recommended to the AHA Board the 2013-2015 AHA research and agenda and released Engaging Health Care Users: A Framework for Healthy Individuals and Communities.
AHA-NPSF Comprehensive Patient Safety Leadership Fellowship
[Description] The fellowship is a transformative learning experience consisting of four in-person learning retreats, periodic conference calls, webinars, various self and organizational assessments and individualized project mentoring. During the yearlong program, fellows complete an action-learning project to accelerate results within their organizations and demonstrate their ability to apply the concepts learned. More than 300 leadership fellows continue to serve the program and hospitals across the U.S. and abroad. During the 2012 AHA and Health Forum Leadership Summit in San Francisco, the AHA recognized the 11th class of AHA-NPSF Comprehensive Patient Safety Leadership Fellows.
Health Care System Transformation Fellowship
AHA's Health Care Transformation Fellowship is a highly interactive, collaborative program providing senior health care leaders with the implementation skills to help their organizations execute new care delivery and payment system transformation models. Sixteen senior executives were selected in 2012 for the second fellowship class.
Health Service Research
Published six times a year with two special supplements, Health Services Research is HRET's flagship publication and the official journal of AcademyHealth. In 2012, HSR published a special issue on methodological considerations for measuring health care disparities. Additionally, with support from the Robert Wood Johnson Foundation Clinical Scholars, a special issue was published on bridging the gap between research and health policy. For the first time ever, in 2012 HSR had a special section “Introducing the Best of the AcademyHealth Annual Research Meeting.
2012 Recipient Maureen Bisognano
For 10 years, HRET has presented its annual TRUST Award to honor individuals who have exhibited visionary leadership in the health care field and symbolize HRET’s vision of leveraging research and education to improve policy and practice. This past year, the TRUST Award recipient was Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement. A tireless advocate for health care change, Ms. Bisognano advises health care leaders around the world and is a frequent speaker at major health care conferences on quality improvement.
Meeting Our Mission: 2003–2012
Commemorating the 10th anniversary of the TRUST Award, past recipients shared insights about what the health care industry accomplished in the past 10 years and what will be required by health care leaders to advance the field over the next 10 years.