Illinois Hospital Association

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February 5, 2009

Illinois Hospital Performance Continues to Improve

While the economy is taking a downward trend, Illinois hospital performance on key quality measurements and patient outcomes continues to rise. Despite all of the challenges that Illinois hospitals are facing, they continue to focus on improving patient care and are demonstrating national leadership on performance improvement.

IHA Comparative Hospital Performance Initiative (IHA Initiative)
At the direction of the IHA Board of Trustees, IHA began collecting hospital performance measurement data in 2004. It was the intent of the Board that by sharing information and best practices among hospitals that the overall performance of hospitals would improve.

The IHA Initiative measurements on hospital processes and outcomes have expanded over the past few years and now include process measurements on heart attack, heart failure, pneumonia, surgical care and infection prevention, and most recently, outpatient measurements.

153 Illinois hospitals participate in the IHA Initiative with about 25% of Illinois hospitals not participating as they do not provide the services measured. Hospitals not included in the ICHPI include behavioral health, rehabilitation, long-term care, pediatric, and some critical access hospitals.

Recent Findings. In comparing the IHA Initiative results and to the national Hospital Compare results, Illinois hospitals on average overwhelmingly outperform the national averages. While the national averages are presented as a rolling year on the Hospital Compare web site, IHA Initiative also presents the most recent quarter of performance which is a stronger indicator of improvement. IHA Initiative has information available through 2nd quarter 2008 and the Hospital Compare has results on a rolling year through 1st quarter 2008. Both IHA Initiative and Hospital Compare include information on all patients, not just Medicare.

In reviewing the measurement "Bundle" scores which are only available through the IHA Initiative, Illinois hospitals have demonstrated rapid improvement in their performance. The "bundles" are a measurement of the hospital performance in providing all the appropriate services to all patients within the clinical service area. Bundles answer the question, "What percent of the patients received the appropriate care every time" for the select performance measurement area. To demonstrate rapid improvement interventions, once the "pneumococcal vaccination" was put in place in many hospitals as a standing order; our state performance went from an approximate low 40 percent, to a current 86% compliance rate with standards of care. At the same time the pneumococcal vaccination score increased, the "Bundle" performance score for pneumonia rapidly increased as well.

Hospital CEO and Board Involvement. Throughout the past few years, IHA has been providing hospital executives participating in IHA Initiative with quarterly dashboard and trend reports on their hospital compared to other hospitals within the state and at a national level. These reports also highlight performance in the top and lower deciles in Illinois as compared to other participating hospitals. Additionally, hospital executives can view their performance against state and national trend and also in comparison to the targeted standard of performance of 100% compliance.

Hospital executives and their clinical staff routinely review the reports internally but also share the results with their boards and discuss opportunities for improvement. It is through the sharing of performance results that hospital executives, clinicians, and board members all accept a shared responsibility to strive for performance improvement for the benefit of the patients and communities they serve.

IHA Support. Throughout the past few years, IHA has provided a spectrum of membership services targeted to different hospitals on key areas for improvement. These intervention services have included:

  • IHA Tools and Techniques series highlighting best performing hospital practices and providing hospitals with peer contacts
  • Engagement and involvement in the Institute for Healthcare Improvement (IHI) initiatives
  • Educational in-person and webinar conferences and seminars
  • Quality Encounter sessions
  • Quarterly quality conference meetings at hospitals sites for various member constituencies
  • Ongoing reports to assist hospitals in assessing their performance.
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    Our goal has been to facilitate the capacity building of hospitals themselves to improve quality and create sustainability through their own organizations in order to keep up with the demand for rapid cycle improvements. While we know there is still more work to be done, hospitals have advanced and taken leadership and ownership of their quality improvement initiatives.

    MRSA
    Illinois was one of the first states in the nation to understand the impact that MRSA was having on patients being cared for in our hospitals. When the number of MRSA cases continued to increase, rather than letting the trend continue, Illinois hospitals responded.

    In June 2007 the Association of Professionals in Infection Control and Epidemiology, Inc. released the results of their fall 2006 MRSA Prevalence Study - the results made headlines. Not only was MRSA increasing over the years in terms of sheer volume, but they were able to report their findings that on average 77% of MRSA infections and colonized patients were coming into the hospital and likewise, the remaining 23% of MRSA infections and colonizations were occurring during the patient’s stay.

    Illinois MRSA Trends. While the number of patients with MRSA infections continues to increase within Illinois hospitals, the number and percent of patients with hospital acquired MRSA continues to decline. From information from IHA’s COMPdata as reported to IHA and IDPH, there are some disturbing results from a public health perspective and some positive results from a hospital improvement perspective, including:

  • Starting with Jan. 1, 2008, inpatient cases, Illinois hospitals expanded their reporting of secondary diagnoses codes from 9 diagnoses to 25 diagnoses. With the expansion of diagnostic codes, the number of cases with 10 or more diagnostic codes have increased dramatically which results in an increase of secondary diagnostic conditions. For third quarter 2008, approximately one third of all inpatient cases had 10 or more diagnostic codes which is reflective of the intensity and complexity of patients.
  • In 2007 Illinois hospitals reported 11,375 cases of MRSA which represented an approximate 6% increase from 2006. During the first 9 months of 2007 there were approximately 7,875 MRSA cases in Illinois hospitals reported. With the expanded reporting of diagnostic codes and the implementation of MRSA screening laws in Illinois, the number of MRSA cases for the first 9 months of 2008 is 19,428 which represents an approximate 147% increase in MRSA cases from the same time period in 2007 (please note that the 2008 figure does not include the handful of hospitals that do not share info with IHA, but the 2007 figure does include all Illinois hospitals).
  • Also starting with Jan. 1, 2008, inpatient cases, hospitals are reporting whether a diagnostic condition was present on admission, occurred during the stay, not able to be clinically determined, or not recorded in medical record. While APIC reported in the 2007 MRSA Point Prevalence Study, that 23% of all MRSA infections and colonizations occurred during the hospital stay, Illinois hospitals are experiencing a downward trend with approximately 5.3% of all cases documented as MRSA infections occurring during the hospital stay for the first 9 months of 2008. For the most recently available data for 3rd quarter 2008, the downward trend continues with 4.5% of all MRSA cases in hospitals identified as occurring during the hospital stay.
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    While the volume of patients with MRSA infections entering our Illinois hospitals continues, the number and percent of all MRSA infections occurring during the hospital stay continues to rapidly decline. Illinois hospitals have mentioned that they are detecting more cases of MRSA coming into their hospitals since they began screening for at risk patients and patients being placed in ICUs. Additionally, hospitals have noted that they are more readily identifying patients with MRSA infections and colonizations and are implementing proper isolation protocols as a result; thereby controlling the spread of MRSA.

    While the downward trend of MRSA infections occurring during the hospital stay continues, the average charges for patients with MRSA occurring during the hospital stay is about triple the charges for patients identified with MRSA present on admission. Hospitals have found that investing in MRSA screening has served to reduce the number of patients acquiring MRSA during the hospital stay and has also reduced the number of length of stay outlier cases.

    While it is sometimes challenging to celebrate during these rough and turbulent economic times, Illinois hospitals collectively and individually are making strides in improving the quality of care provided to their patients and communities -- and that is something we can all celebrate.

    Staff Contact: Pat Merryweather