Executive Summary and Recommendations

• More than half of all inpatient stays in Vermont include a diagnosis for at least one chronic illness.  For patients over 65, it is 84 percent.
  
• A hospitalization that includes treatment for chronic illness lasts longer than other stays and costs, on average, $7,000 more than a stay that does not include a chronic illness.
  
• Certain risk factors for chronic illness in Vermont have a geographic link; for example, hypertension and tobacco use are most prevalent in Bennington, Franklin, Orleans, and Rutland counties.
  
• National data suggests there is a socio-economic link to the prevalence of chronic disease, and more study should be undertaken to determine if this is the case in Vermont.
  
• Many chronic illnesses can be prevented, or their effects moderated, by a combination of effective outpatient treatment, medication, and healthier lifestyles.
  
• RECOMMENDATION—Vermont should build on the success of chronic care initiatives around the state and on the philosophy behind the Blueprint for Health and focus resources on proven efforts to treat people outside hospitals and step up prevention efforts, such as tobacco cessation.

• Vermont patterns for mental health treatment and substance abuse diagnosis are consistent with national trends.
  
• About 20 percent of hospitalizations in Vermont included a primary or secondary diagnosis for mental illness or substance abuse.
  
• Hospitalizations for complications from substance abuse and dependence, for example, average $17,000, more than double the cost of a hospitalization for a primary diagnosis of either mental illness or substance abuse.
  
• RECOMMENDATION—Vermont should emphasize early and effective identification and treatment of mental illness and substance abuse problems, as those are key to cost-savings in our health care system.

Most Vermonters experience their greatest health care costs in the last months of life.  Seventy-seven percent of Medicare beneficiary expenditures occur in the last year of their lives. These costs are largely the result of treatment in intensive hospital care. Vermont has generally been ahead of the rest of the nation in using home-health care and skilled nursing facilities (SNF) to provide care. To that end, VPQ has played an essential role in creating models for high-quality and cost-effective care outside hospitals.

• However, more needs to be done, particularly with regards to enrollment in hospice programs, along the lines of the End-of-Life Collaborative.
  
• RECOMMENDATION—The focus of policy reform in this area should be on shifting resources whenever possible from hospitalizations to hospice care, home-health care, and long-term care.

• Twelve Vermont hospitals are located in rural areas, and eight of those are designated Critical Access Hospitals.
  
• VPQ has been an active participant in the Flex Program since 2000, including providing staff support to advisory bodies and supporting networking among Critical Access Hospitals on quality improvement.
  
• One of VPQ’s contributions has been to provide independent assessments of quality of care which are necessary for meeting federal licensing requirements and funding for CAHs.
  
• VPQ continues to provide quality improvement grants to CAHs.
  
• RECOMMENDATION—That Critical Access Hospitals should continue to participate in, and expand upon, collaborative efforts on quality improvement.

• VPQ organized the Quality Improvement Collaborative, which provides a structure to help outpatient care teams around the state identify areas for improvement of health care delivery and tools to make those improvements.

VPQ continues to focus on efforts to prevent infection, particularly on quality improvement activities in hospitals to prevent infections associated with health care.

• As systemic improvements in the latter area are made, one noticeable result has been a 62 percent reduction in central line-associated bloodstream infections in medical intensive care units.
  
• RECOMMENDATION—Continued financial investment, effective facilitation, and maintenance of peer-to-peer learning and support are essential for maintaining progress on quality improvement.

Importantly, this year’s Report also illustrates the commitment to, and broad engagement in, quality improvement activities by Vermont’s provider community.  VPQ has provided intense systems improvement training with medical practices across the state through involvement with the Blueprint for Health.