Quality Improvement Activities

Improving quality of care requires a tailored approach. This year's Quality Report provides examples of two quality improvement activities implemented across the state: the VPQ Quality Improvement Collaborative working with primary care practices and another focused on Infection Prevention, specifically, Healthcare-Associated Infections (HAI).

 

VPQ Quality Improvement Collaborative
This year VPQ organized the largest Quality Improvement (QI) Collaborative to date. Twenty-six outpatient care teams committed to making their work more patient-centered and enjoyable.

The VPQ Collaborative provides a structure to help teams identify what they need to work on and gives them the tools to improve. It is a bottom-up approach that encourages and celebrates teams sharing not only their successes but their “failures” so that all the Collaborative participants can learn from the experience.

Teams focused on practice and system improvements, ranging from implementing an Electronic Medical Record (EMR) or becoming a Medical Home; to reducing wait times, no shows and telephoning issues.

In one participating practice the “no show” rate for one of their physicians decreased from 26.7% to 10.3%; for another the rate decreased from 10.5% to .66%. With these reductions, the practice projects an increase in net revenue averaging $35,000 dollars per provider over the course of the next year.

Spotlight on Quality Improvement in Infection Prevention

Healthcare-associated infections are at the center of patient safety initiatives and a focus of wide-spread attention from healthcare organizations, consumers, insurers, legislators, and the media at local, regional, and national levels. This focused attention has lead to the creation of several national healthcare-associated infection prevention initiatives which offer support, guidance, recommendations, and strategies for reducing HAIs both to infection prevention professionals as well as to educate the public.

Infection prevention is a top priority in all Vermont hospitals. Vermont hospitals have implemented evidence-based “best practices” and utilize national guidelines for reducing and preventing HAI. Every Vermont hospital has implemented and adheres to the Institute for Healthcare Improvement's (IHI) recommendations for prevention of central line-associated bloodstream infections. Similarly, most hospitals have implemented all of the routine recommendations from the Centers for Disease Control (CDC) for preventing multi-drug resistant organisms; and twelve of the fourteen hospitals also have policies and methods in place to implement more intensive recommendations if needed.

Several hospitals have embarked on quality improvement activities focused on reducing and preventing HAIs. One notable result has been a 62% reduction in central line-associated bloodstream infections in medical intensive care units.

Recommendations and Next Steps

The three critical types of support that practices need to successfully transform their care delivery include financial, facilitation, and peer-to-peer learning and support. As we move forward with health reform in Vermont, these three components must be a significant part of the process and must be fully funded.

VPQ plans to continue working with primary care practices to enhance their safety, effectiveness and efficiency. We hope to continue our relationship with the Vermont Rural Health Alliance (VRHA) and the Vermont Department of Health's Blueprint practices.

VPQ also anticipates using the same improvement methodologies to assist practices, who are recipients of health information technology grants from Vermont Information Technology Leaders (VITL) for implementing electronic medical records.

If significant and sustained progress towards health care reform is the State's expectation, then funding for support to practices engaged in transformation to true medical homes for their patients will be required. Currently those resources are not aligned with expansion expectations for health reform.

Chapter Outline