Welcome to THE QUALITY SOURCE – a Web site hosted by the North Carolina AHEC Program in partnership with the NC Center for Hospital Quality and Patient Safety. This Web site will keep you up to date on significant education offerings and information about Quality and Patient Safety. There is lots of activity in the state and this site can be your ONE PRIMARY SOURCE to identify the many valuable resources. It is also a way for you to communicate what interests you may have so that the AHEC can work with you and our community partners to target your specific needs. Please contact us with any questions or suggestions.
Quality Improvement 101: A Toolbox for Improvement (formerly the Quality Improvement Institute). Charlotte AHEC, in collaboration with the NC AHEC Program and the North Carolina Center for Hospital Quality and Patient Safety, is partnering to offer a training program to develop and improve skills in quality improvement. Quality Improvement 101 (QI 101) is an interactive learning opportunity for teams and organizations leading initiatives to improve health care quality. This program includes an action-oriented curriculum in which participants learn about systems improvement principles and immediately apply what they are learning to specific local projects.
REGISTRATION CLOSED. For more information about the course or to be added to the interest list for future courses, please email Edward Curran with Charlotte AHEC.
NC Eliminating MRSA Collaborative
Background: Health care-associated infections continue to be a major cause of morbidity, mortality, and excess health care cost despite concerted infection control efforts over the past 50 years. Recently, treatment of these infections has become more difficult due to a rise in antibiotic resistance. Infections caused by methicillin-resistant S. aureus (MRSA) are particularly problematic: their incidence has increased greatly over the past decade, and, compared to methicillin-susceptible staphylococcal infections, they are more lethal. MRSA infections are resistant to the usual antibiotics, the beta lactams, used to treat S. aureus infections.
In 2004, MRSA accounted for greater than 50% of hospital-acquired S. aureus infections and 63% of S. aureus infections acquired in intensive care units (ICUs) in the United States. The very rapid emergence of community-acquired MRSA (CA-MRSA) in patients with no prior exposure to health care institutions or other risk factors poses a serious new challenge to the nation’s hospitals. Patients with CA-MRSA are presenting to hospital emergency departments and outpatient clinics in increasing numbers, and in-hospital spread has been documented following their admission.
The human and financial impact of MRSA is high:
- Over 126,000 hospitalized persons are infected by MRSA annually.
- In 2005 hospital stays for MRSA more than tripled from 2000 and increased nearly tenfold from 1995. From 2004 to 2005 hospital stays increased 30 percent.
- In-hospital mortality is more than double for MRSA patients over non-MRSA patients. Over 5,000 patients die as a result of these infections.
- Over $2.5 billion excess health care costs are attributable to MRSA infections. Length of stay is increased by 10 days and over $20,000 in additional cost is incurred per patient
Congress is considering ways to link performance on infection measures with Medicare and Medicaid reimbursement. Starting with FY 2009 CMS will not provide higher payments for hospital-acquired infections, including vascular catheter associated infections, which can be caused by MRSA. Several states have highlighted reduction of MRSA infections as a major opportunity to improve hospital care. Pennsylvania, for example, is one of several states that have made public each hospital’s data on MRSA infection rates.
Impact in North Carolina: The statewide MRSA infection rate for North Carolina hospitals is unknown. The Centers for Disease Control estimate MRSA infections in hospitalized patients account for 3.95 per 1,000 discharges (0.4 percent). A recent study by ARHQ, using 2004 discharge data, found a rate of 7.48 per 1000 discharges (0.75 percent) for both hospital MRSA and CA-MRSA. Using discharge data for North Carolina non-VA, acute care hospitals an estimated 4,345 - 7,701 MRSA infections occurred in hospitalized patients during 2006. This results in $86.7 – $154.7 million excessive costs for NC hospitals.
For several years the NC General Assembly has considered mandatory reporting of hospital-acquired infection rates. House Bill 1738, recently ratified by the NC General Assembly and awaiting signature by Gov. Easley, calls for the establishment of an advisory commission to develop a process to ensure information and data on hospital-acquired infections are reported to the public. The bill also calls for the General Assembly to enact legislation requiring hospitals to report hospital-acquired infection rates by 2010.
Improvement Activities: Several hospitals, both in the US and in Europe, have implemented programs to reduce hospital MRSA infections. Interventions implemented include standard precautions, hand hygiene, active surveillance cultures, contact precautions, an emphasis on culture change using briefings on patient care units, leadership involvement and bundling of known interventions. MRSA infections rates dropped up to 75% in the hospitals.
VHA is leading a national effort to bring together industry leading subject matter experts, data measurement tools, and a broad network of peer organizations to facilitate reduction of MRSA infections. Entering its second year, this efficient program is designed to produce sustainable results through tracking, benchmarking, networking, and sharing insights/behaviors.
VHA Central Atlantic in partnership with the North Carolina Center for Hospital Quality and Patient Safety (Quality Center) and the Statewide Program for Infection Control and Epidemiology (SPICE) is offering the Eliminating MRSACollaborative program to all North Carolina Hospitals. Components include:
- In-person learning sessions to educate and collaborate with others.
- Use of Performance Improvement Model – rapid cycles of change with identified pilot units/areas to develop a process that is individualized to a hospital’s current systems and processes.
- Periodic individual telephone consults to assist the hospital teams in overcoming process barriers.
- Series of six conferences, delivered at your location via internet, to continue learning and drive process momentum
- Custom access to secure data tool and hospital self-assessment, with enhanced reporting and benchmarking to demonstrate improvement
- Aggregate data to understand overall participant progress.
- Project time lines to move the performance improvement process.
- CD of the five recorded content webinars from the first year’s program
- Enrollment in the VHA MRSA national listserv to exchange ideas and receive current information
- Links to MRSA password-secured community of practice on vha.com’s Share & Learn portal
- Notification of pertinent vhatv satellite broadcast(s)
On Sept 12, 2007 the collaborative kicks off with an orientation webinar followed by an in person learning session and VHA webinar on Nov 7, 2007. Space is limited to 25 hospitals.
The cost to participate in the collaborative is: VHA members: $1,800 per hospital. $1,700 per hospital for 3 or more hospitals from the same system. Non-VHA members: $1,900 per hospital. $1,800 per hospital for 3 or more hospitals from the same system. Program participation includes one license to each live web conference per hospital. To register contact: VHA Hospitals: Terri Bowersox at 704-377-7116 or TBOWERSO@vha.com / Non-VHA Hospitals: Dr. Carol Koeble at 919-677-4211 or firstname.lastname@example.org
ABC-123: Applying Best Practice in Child Developmental Services: Charlotte AHEC has been awarded a grant from Smart Start of Mecklenburg County in support of this pediatric developmental screening initiative. This quality improvement and outreach initiative aims to advance the concept of the medical home by integrating a standardized screening tool into well child visits and enhancing the communication between primary care practitioners, parents, referral sources, and other community service agencies in the early identification and management of children with special needs/chronic conditions and other at-risk populations. Collaborating partners include Community Care Partners of Greater Mecklenburg, Mecklenburg County Health Department, Carolinas HealthCare System, Carlton G. Watkins Center, Charlotte-Mecklenburg Schools , and Reach Out and Read Charlotte. Participating physicians will receive developmental screening office guides, tools, and assistance to redesign office workflow to promote early intervention, surveillance, and follow-up. Continuing Medical Education credit will also be awarded for participation and practice-based quality improvement efforts. For more information contact Mary Webster, assistant director for quality initiatives at Charlotte AHEC.
The Quality and Patient Safety Special Collection is now available on the AHEC Digital Library (ADL). You can access the collection clicking on the link, "Quality and Patient Safety," under the "Special Collections" heading on the home page of the ADL. The ADL is very excited about providing this collection and hope that health professionals across the state will benefit from it. Please send any feedback or comments to Jill Mayer.
A1R/1000 is a partnership for Asthma Improvement and Resources (A1R) that seeks to reduce pediatric, asthma-related hospitalizations and emergency room visits. Specifically, the aim of A1R/1000 is to reduce asthma-related hospitalizations among children to less than one hospitalization per 1000 children per year. To achieve this, Southern Regional and Charlotte AHECs are working in partnership with individual practices and practice networks, as well as other state and local agencies, to implement 20 high-leverage strategies for improving asthma care. A secondary aim of A1R/1000 is to support the NC AHEC Program in integrating practice-based, outcome oriented approaches to continuing medical education as part of the AHEC infrastructure. NC AHEC intends to spread this innovative approach throughout its system to position itself to play a key role in ongoing health care improvement efforts throughout North Carolina . The Center for Health Care Quality will train and support AHEC staff in the implementation and management of the program activities.
Improving Performance in Practice (IPIP)
IPIP is designed as a state-based approach that can support efforts by primary care physicians, including internists, family physicians and pediatricians and their care teams, to improve the way chronic illness and preventive care is provided to patients. The program is a national effort supported by the Robert Wood Johnson Foundation, and is a collaborative effort among the boards of the three specialties as well as their professional societies. North Carolina and Colorado have been chosen as the two pilot states and the project is in its design phase. There will be three major components to the project, including:1) the creation of collaborative improvement networks of practices; 2) Web-based improvement modules; and 3) collection reporting of data at the practice and physician level.
Major partners in North Carolina include the NC Academy of Family Physicians, the NC Pediatric Society, Community Care of North Carolina, The Carolina Center for Medical Excellence, and NC AHEC. Warren Newton, MD, MPH, chair of the Department of Family Medicine at the UNC School of Medicine, chairs the NC Steering Committee.
In the first year of the IPIP project, 24 practices will be recruited to participate. In years two and three, 50 more practices will be recruited in each year. NC AHEC is seen as playing a key role through the use of the statewide AHEC network to educate physicians about the project, provide support to physicians and practices implementing quality improvement methods, and serving as an information resource through the AHEC Digital Library and other means for the content that will form the basis for the project. A key part of the project involves staff called “field agents” who will support physician practices in their work in performance improvement. In the first year, two field agents will be placed to work jointly with NC AHEC and CCNC networks. Two regions of the state will be selected to serve as pilot sites in the first year.
Other Internet Resources
www.ihi.org is the Web site for the Institute of Healthcare Improvement, founded by Dr. Don Berwick. It includes many downloadable resources including "How-to Guides" for areas such as Rapid Response Teams. In addition, IHI is a current resource on national Quality and Patient Safety information and resources.