The Vermont Program for Quality in Health Care, Inc. (VPQHC) continues to participate in planning discussions to ensure that systems improvement are based in clinical soundness and deliver value to patients and providers alike.The focus of the Centers for Medicare and Medicaid Services (CMS) on the Triple Aim of Healthcare, Better Care, Smarter Spending, Healthier People, sets the tempo for reform efforts undertaken here in Vermont to make substantial system delivery reforms to align with the aspirations of the Triple Aim. Alignment of federal and state efforts will dramatically improve how care is delivered locally to effectively establish and grow a learning health care system.
To make health care more patient-directed, progressive, and non-episodic, an Integrated Care Management (ICM) model has been implemented in many communities throughout the country. In 2014, the Integrated Communities Care Management Learning Collaborative (ICCMLC) began helping communities implement ICM in Vermont.While the initial pilot involved the Burlington, Rutland, and St. Johnsbury communities, in 2015 the collaborative expanded to include eight additional communities. These initial efforts focused on high-need or high-utilizers of emergency services. As of May 2016, over 200 at risk persons are receiving care and services under the Integrated Care Management protocol. ICM participants receiving care and services report that they feel more involved in their own care; they also report feeling better listened to by their providers. Providers are reporting powerful and effective experiences from engaging care recipients in conversations about “what matters most to them?” instead of “what’s the matter with them?”While the ICCMLC is just beginning to look at outcomes in utilization, early results are promising: emergency room visits have decreased for some high risk recipients of care and services.
In Vermont, between 2012 and 2014 there were approximately 1,092 post-operative complications following surgery. American College of Surgeons (ACS)-NSQIP provides a risk adjusted clinical data collection method that hospitals can use to identify high-quality, actionable data with which to design improvement initiatives. As the statewide agency coordinating the implementation of ACS-NSQIP in Vermont hospitals,VPQHC worked closely with quality health professionals and surgeon champions to educate leadership in nine hospitals across the state. As of April 2016, Brattleboro Memorial Hospital, Mt. Ascutney Hospital, Rutland Regional Medical Center, and Southwestern Vermont Medical Center have enrolled in ACS-NSQIP.These hospitals are now extracting high quality data, which will enable them to design meaningful quality improvement activities as well as share best practices leading to better performance. Under this program, surgeons are better positioned to transition from a fee-for-service to a pay-for-performance payment model. This focus on improving outcomes will result in fewer surgical complications, improve the quality of patient care, and ultimately reduce costs.
In Vermont, stroke is the fifth leading cause of death behind cancer, heart disease, chronic lower respiratory diseases, accidents/ unintentional injuries, and Alzheimer’s.VPQHC has worked closely with physician leaders, the Vermont Department of Health, Emergency Medical Services (EMS), and Emergency Department (ED) Nurse Leadership since 2011 to standardize stroke protocols and tools, with the goal of improving treatment times.We have also implemented an electronic acute stroke chart audit tool to support continued evaluation of acute stroke care across the state. Seven Vermont hospitals reported that a nationally accepted, evidence-based set of guidelines for acute stroke care has been implemented at their facilities. Additional successes include: an expansion of Vermont EMS protocols to include more advanced stroke-specific education modules and care protocols; nine hospitals have processes in place to receive expert neurological consultation 24/7; and nine hospitals support enhanced communication with tertiary care facilities. Enhanced coordination of care beginning with EMS and continuing through the hospital setting, the implementation of standardized stroke assessment and treatment guidelines, and improved communication between transferring and receiving hospitals will enable more Vermont hospitals to provide the best possible stroke care for their patients.
VPQHC is collaborating with Maine Quality Counts and the University of New Hampshire/Citizens Health Initiative in the Northern New England Practice Transformation Network (NNE-PTN).The NNE-PTN was funded to support the Transforming Clinical Practice Initiative (TCPI), which is a new effort from the Centers for Medicare and Medicaid Services (CMS) to help ensure practices will be ready to participate in the new value-based payment models.The NNE-PTN’s recruitment target is 505 practices over four years, which we estimate will include over 1600 clinicians.Within Vermont, we have partnered with a variety of organizations, including the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), to help identify eligible and interested practices. As of June 2016, the NNE-PTN began focusing its efforts on assessing practices in order to develop their individualized, tailored transformation initiatives. Practices participating in the NNE-PTN will realize many benefits including: stronger relationships and operating processes with their referral bases, improved communication with primary care (particularly with regard to the referral process), increased efficiency of specialty visits, expanded networking opportunities, avoiding incurring CMS payment penalties, and possibly earning additional funds rewarding value based performance from CMS.
VPQHC works to improve patient safety across Vermont hospitals by supporting the implementation of the Patient Safety Surveillance and Improvement System (PSSIS).We routinely visit Vermont hospitals to evaluate their patient safety processes. VPQHC reviewed root cause analyses and corrective action plans for 38 patient safety events in Vermont hospitals. Our strong relationships with hospital staff and our knowledge of hospital safety processes across the state enable us to identify common system deficits and barriers and highlight systems that are effective in preventing harm.The successful initiatives are shared with other hospitals in order to continue to build safer environments for patients across the state.
As part of the Medicare Rural Hospital Flexibility Grant Program (Flex),VPQHC visits Vermont’s small rural hospitals to review the quality-related regulations established by CMS. VPQHC’s work with the CoPs program and mock surveys supports hospital compliance with federal CMS regulations, ensuring its small rural hospitals receive payment for services. Without government and private insurance payments, many organizations would be forced to close, leaving communities without hospitals. Patients benefit from the improvements in safety and care delivery made when hospitals thoroughly review their systems and processes.
MBQIP is a quality improvement activity under the Medicare Rural Hospital Flexibility (Flex) grant program of the Health Resources and Services Administration’s Federal Office of Rural Health Policy. In December 2015,VPQHC and the Office of Rural Health and Primary Care in the Vermont Department of Health, began supporting hospitals to report MBQIP measures. As of May 2015, seven of eight Critical Access Hospitals (CAHs) in Vermont have agreed to participate in the MBQIP program. The MBQIP system will be collecting performance data in four domain areas: Patient Safety, Emergency Department Transfer Communication, Patient Satisfaction and Outpatient.While still in the early phases, this project provides an opportunity for individual hospitals to look at their own data, measure their outcomes against other CAHs, and partner with other hospitals in the state around initiatives to improve outcomes and provide the highest quality patient care.While MBQIP reporting is currently voluntary, progress toward full reporting will allow for an easier transition should reporting become mandatory for CAHs in the future.
VPQHC supports the State of Vermont in the annual production of the Hospital Community Reports, also known as the Hospital Report Card.Through our work with individual hospitals and the State, we compile data on healthcare associated infections (HAI) and nurse staffing, ensuring data are accurate and presented in an accessible way to healthcare consumers. The individualized training, technical assistance, and support we provided hospitals enabled hospital staff to utilize National Health Care Safety Network (NHSN) data more effectively for internal monitoring and reporting processes. High quality data empower healthcare consumers to make informed decisions about where to obtain their care in Vermont and encourages hospitals to support quality improvement projects.
The Vermont Program for Quality in Health Care (VPQHC)/ Vermont Association of Hospital and Health Systems (VAHHS) peer review process includes the routine review of patient charts to identify potential quality concerns that can be used to educate and evaluate physician performance.VPQHC, as a state designated peer protected organization, facilitates this process by hosting a statewide peer review portal on its website.This portal enables physician to physician connections and represents 64 different specialties. Hospitals have used the portal to augment their internal peer review processes, to ensure high quality medical care for their patients.