Topics on this page: Goal 1. Objective A | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary
Goal 1. Objective B: Improve healthcare quality and patient safety
HHS is committed to improving health care quality and patient safety by ensuring safe and effective medical products, promoting professional practices focused on improving quality of client care, and reducing healthcare-associated infections (HAI).
Several HHS components focus on achieving goals that improve health care quality. FDA protects the nation’s health by ensuring the safety, effectiveness, and security of human and veterinary drugs, vaccines, and other biological products and medical devices. HHS also ensures quality of care and patient safety through HAI surveillance and prevention activities at AHRQ and CDC. CDC’s HAI program protects patients receiving care in U.S. healthcare settings through outbreak detection and control, identifying emerging threats, establishing prevention guidelines and supporting staffing to improve healthcare practitioner and hospital system practice. AHRQ develops tools and strategies to strengthen quality and patient safety practices and promotes improved practices through Patient Safety Organizations. The IHS Improving Patient Care (IPC) initiative is implementing the patient centered medical home model to help transition IHS facilities to more continuous quality improvement and a greater focus on improvement through the use of performance measurement.
CMS is transforming into an agency that positively promotes and incentivizes the quality of care for its beneficiaries through payment policy. Examples include continued development of physician, hospital, and post-acute care provider value based purchasing programs that will link payments to the quality and efficiency of care, while also reducing healthcare-associated infections. In addition, CMS is promoting state efforts to report on core sets of measures related to quality of care in Medicaid and the Children’s Health Insurance Program (CHIP). ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, OCR, ONC, and SAMHSA are working together to improve healthcare quality and patient safety for all Americans. Below are some key performance measures demonstrating HHS progress. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.
Objective 1. B Table of Related Performance Measures
Increase the percentage of hospitals reporting implementation of antibiotic stewardship programs fully compliant with CDC Core Elements for Hospital Antibiotic Stewardship Programs (Lead Agency - CDC; Measure ID - 3.2.5)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | Set Baseline | 50.0% | 59.0% | |||
| Result | 39.2% | Jul 31, 2017 | Jul 31, 2018 | |||
| Status | Baseline | Pending | Pending |
Decrease by 10 percent the total morphine milligram equivalents (MME) dispensed (Lead Agency - FDA; Measure ID - TBD)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | TBD | TBD | ||||
| Result | TBD | TBD | ||||
| Status | TBD | TBD |
Increase by 15 percent the number of prescriptions dispensed for naloxone (Lead Agency - FDA; Measure ID - TBD)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | TBD | TBD | ||||
| Result | TBD | TBD | ||||
| Status | TBD | TBD |
Increase by 10 percent the number of unique patients receiving prescriptions for buprenorphine and naltrexone in a retail setting (Lead Agency - FDA; Measure ID - TBD)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | TBD | TBD | ||||
| Result | TBD | TBD | ||||
| Status | TBD | TBD |
Reduce the central line-associated bloodstream infection (CLABSI) standardized infection ratio (SIR) (Lead Agency - CDC; Measure ID - 3.3.3)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 0.6 | 0.5 | 0.4 | 0.35 | 0.33 1 | 0.31 |
| Result | 0.56 | 0.54 | 0.50 2 | Nov 30, 2016 | Nov 30, 2017 | Nov 30, 2018 |
| Status | Target Exceeded | Target Not Met but Improved | Target Not Met but Improved | Pending | Pending | Pending |
Increase the number of hospitals and other selected health care settings that report into the National Healthcare Safety Network (NHSN) (Lead Agency - CDC; Measure ID - 3.3.4)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 6,500 | 12,000 | 13,500 | 17,000 | 19,000 | 20,000 |
| Result | 10,900 | 12,400 | 14,450 | 18,300 | Jan 1, 2017 | Jan 31, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
Reduce by 10 percent hospital-acquired catheter-associated urinary tract infections (CAUTI) by the end of FY 2015 (Lead Agency - CMS; Measure ID - MCR28.2) 3
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 10%4 | 20%5 | 5% | 10% 6 | 5% 7 | 10% 8 |
| Result | -17% | -12% 9 | -4.9% 10 | Mar 31, 2016 | Mar 31, 2017 | Mar 31, 2018 |
| Status | Target Not Met | Target Not Met but Improved | Target Not Met but Improved | Pending | Pending | Pending |
Decrease the prevalence of pressure ulcers in nursing homes (Lead Agency - CMS; Measure ID - MSC1)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 6.9% | 6.9% | 6.7% 11 | 5.7% 12 | 5.5% | 5.5% |
| Result | 6.5% | 6.1% | 5.9% | Feb 28, 2016 | Feb 28, 2017 | Feb 28, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
Decrease the Percentage of Long-Stay Nursing Home Residents Receiving an Antipsychotic Medication (Lead Agency - CMS; Measure ID - MSC5)
| CY 2012 | CY 2013 | CY 2014 | CY 2015 | CY 2016 | CY 2017 | |
|---|---|---|---|---|---|---|
| Target | N/A | N/A | 19.1% 13 | 17.9% 14 | 16.7% | 16% |
| Result | 19.8% | 20.3% | 19.1% | Jan 31, 2016 | Jan 31, 2017 | Jan 31, 2018 |
| Status | Historical Actual | Historical Actual | Target Met | Pending | Pending | Pending |
Improve Children's Health Care Quality Across Medicaid and the Children's Health Insurance Program (Lead Agency - CMS; Measure ID - MCD6) Status
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | Work with states to ensure that 80 percent of states report on at least five quality measures in the CHIPRA core set of quality measures | Work with states to ensure that 85 percent of states report on at least seven quality measures in the CHIPRAcore set of quality measures. | Work with states to ensure that90 percent of states report on at least eight quality measures in the CHIPRAcore set of quality measures. | Work with states to ensure that 90 percent of states report on at least nine quality measures in the CHIPRAcore set of quality measures | Work with states to ensure that 90 percent of states report on at least ten quality measures in the CHIPRA core set of quality measures | Work with states to ensure that 90 percent of states report on at least eleven quality measures in the CHIPRA core set of quality measures |
| Result | 92% of states reported on at least five quality measures | 88% of states reported on at least seven quality measures 15 | 88% of states reported on at least eight quality measures. | Mar 31, 2016 | Mar 31, 2017 | Mar 31, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Not Met but Improved | In Progress | Pending | Pending |
Improve Adult Health Care Quality Across Medicaid (Lead Agency - CMS; Measure ID - MCD8)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | Publish initial core set of adult quality measures in the Federal Register. | Work with states to ensure that 60 percent of states report on at least three quality measures in the Affordable Care Act Adult Medicaid core set of quality measures | Work with states to ensure that 65 percent of states report on at least five quality measures in the Affordable Care ActAdult Medicaid core set of quality measures. | Work with states to ensure that 70 percent of states report on at least seven quality measures in the Affordable Care Act Adult Medicaid core set of quality measures | Work with states to ensure that 70 percent of states report on at least nine quality measures in the Affordable Care Act Adult Medicaid core set of quality measures | Work with states to ensure that75 percent of states report on at least eleven quality measures in the Affordable Care Act Adult Medicaid core set of measures. |
| Result | Target Met | 59% of states reported on at least three quality measures. 16 | 67% of states reported on at least five quality measures. | Mar 31, 2016 | Mar 31, 2017 | Mar 31, 2018 |
| Status | Target Met | Target Not Met | Target Exceeded | In Progress | Pending | Pending |
Percentage of health centers with at least one site recognized as a patient centered medical home (Lead Agency - HRSA; Measure ID - 1.I.A.3)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 13% | 25% | 40% | 60% | 65% | 70% |
| Result | 13% | 33% | 58% | 65% | Dec 31, 2016 | Dec 31, 2017 |
| Status | Target Met | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
Review and act on original Abbreviated New Drug Application (ANDA) submissions within the established time frame. (Lead Agency - FDA; Measure ID - 223215) Target Result
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | N/A | N/A | N/A | 60% within 15 months | 75% within 15 months | 90% within 10 months |
| Result | N/A | N/A | N/A | Feb 28, 2017 | Feb 28, 2018 | Feb 28, 2019 |
| Status | In Progress | Pending | Pending |
Increase the number of users of research using AHRQ-supported research tools to improve patient safety culture (Lead Agency - AHRQ; Measure ID - 1.3.38)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 1032 users of research | 1300 users of research | 1350 users of research | 2050 users of research | 2200 users of research | 2275 users of research |
| Result | 1128 users of research | 1627 users of research | 1851 users of research | 2106 users of research | Oct 30, 2016 | Sep 30, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
100 percent of hospitals and outpatient clinics operated by the Indian Health Service are accredited or certified (excluding tribal and urban facilities). (Lead Agency - IHS; Measure ID - 20)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 100% | 100% | 100% | 100% | 100% | 100% |
| Result | 100% | 100% | 100% | 99% | Jan 15, 2017 | Jan 15, 2018 |
| Status | Target Met | Target Met | Target Met | Target Not Met | Pending | Pending |
Analysis of Results
Antibiotics have been a critical public health tool since the discovery of penicillin in 1928, saving the lives of millions of people around the world. Today, however, the emergence of drug resistance in bacteria is reversing the miracles of the past eighty years, with drug choices for the treatment of many bacterial infections becoming increasingly limited, expensive, and, in some cases, nonexistent. The CDC estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. Thus, combatting antibiotic resistance has become a priority for both the White House and the HHS Secretary. In response to President Barack Obama's Executive Order: Combating Antibiotic-Resistant Bacteria (CARB), and the National Strategy, the National Action Plan for CARB was developed to provide a roadmap to guide the nation in rising to this challenge. One of the core strategies within the action plan is improving the use of antibiotics, also known as antibiotic stewardship, in hospitals where complications of and risk factors for antibiotic resistance are most concentrated. In pursuit of this goal, CDC will track the percentage of hospitals that report having an antibiotic stewardship program that complies with all CDC Core Elements for Hospital Antibiotic Stewardship Programs. CDC is collecting this data annually as a part of the National Healthcare Safety Network (NHSN) facility survey. In 2014, only about 40 percent of U.S. acute care hospitals report having an antibiotic stewardship program that incorporates all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs.
Opioid abuse and overdose present a nationwide public health challenge. Death by drug overdose is the leading cause of injury death in the United States, with deaths from opioids in particular increasing precipitously in the twenty-first century. Overdose deaths from prescription opioids, such as oxycodone, hydrocodone, and morphine, have quadrupled over the period 1999-2013. Overdose deaths involving heroin have increased significantly in recent years, with an 88 percent increase between 2011 and 2013. Agencies across HHS recognize the urgency of halting the rise of opioid use disorder and overdose, and are working to develop and implement the most effective interventions, from prevention through treatment.
In March of 2015, the HHS Secretary introduced the Secretary’s Opioid Initiative to accelerate progress toward two broad goals: 1) decreasing opioid overdoses and overall overdose mortality and 2) decreasing the prevalence of opioid use disorder. This unifying strategy is designed to focus implementation efforts on action steps most likely to yield rapid and meaningful results. Specifically, the Initiative focuses on the three areas of reforming of opioid prescribing practices to reduce excess prescribing; improving naloxone development, access, and distribution; and expanding access to medication-assisted treatment (MAT). This new Agency Priority Goal for FY 2016 and accompanying metrics align with the three emphasis areas of the Initiative. Further, this opioid APG represents targeted assessment of the near-term progress that will be essential for achieving the broader Initiative goals of overall reduction in the morbidity and mortality associated with opioid use.
Healthcare-associated infections (HAIs) are a significant cause of death in the United States. Of these, central line-associated bloodstream infections (CLABSI) have a strong potential to cause serious illness or death and catheter-associated urinary tract infections (CAUTI) are among the most common. The HHS National Action Plan to Prevent Healthcare-Associated Infections identified CLABSIs as a priority for prevention with national 5-year prevention targets and metrics proposed. Likewise, new Healthy People 2020 objectives have been proposed to address the substantial human suffering and financial burden attributable to healthcare-associated infections, one of which is to reduce CLABSIs. CDC’s National Healthcare Safety Network (NHSN) is a surveillance system used for tracking and prevention of HAIs across healthcare settings, including hospitals in all 50 states, and non-hospital settings (e.g. hemodialysis and long-term acute care facilities). Exceeding its goal for FY 2015, CDC extended tracking capacity to more than 18,000 facilities. Although CDC did not meet its 2014 CLABSI target, between CY 2008 and CY 2014, CLABSIs decreased 50% to a 0.50 Standardized Infection Ratio (SIR) nationally in U.S. hospitals. .
The CDC changed the CAUTI definition in response to input from stakeholders and scientific data. The new definition is designed to improve the clinical relevance while remaining objective. The national CAUTI SIR data, which was reported in March of 2015, reflects a SIR of 0.98, a 4.9 percent reduction just shy of target goal. There are a number of reasons for the increase, including the addition of new hospitals reporting into the National Healthcare Safety Network as part of CMS’s Hospital Inpatient Quality Reporting Program. These new reporters were shown to have a consistently higher SIR than previous facilities. Also, better quality of reported data as a result of CDC outreach and education regarding reporting requirements in the Hospital Inpatient Quality Reporting program may have resulted in an increase in the number of CAUTIs reported, raising the SIR among this group of hospitals. In addition, ICUs have a higher prevalence of CAUTI and ICU reporting of CAUTI is incentivized by CMS' Hospital Inpatient Quality Reporting (HIQR) program, which is not the case for non-ICU reporting.
Pressure ulcers or "bed sores" can cause damage to a patient's tissues and other serious complications like infection. Since 2007 there has been a steady decrease in the reported prevalence in pressure ulcers. A decrease of even 0.1 percent represents more than 1,000 fewer nursing home residents with pressure ulcers, not only reducing the cost of care but also improving nursing home residents’ quality of life. The FY 2014 result is 5.9 percent, which exceeds the target of 6.7 percent.
The National Partnership to Improve Dementia Care in Nursing Homes is committed to improving the quality of care for individuals with dementia living in nursing homes. The Partnership has a mission to deliver health care that is person-centered, comprehensive, and interdisciplinary with a specific focus on protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual’s need. CMS supports this effort and reports the percentage of long-stay nursing home residents that received an antipsychotic medication with a quality measure (QM) derived from the Minimum Data Set (MDS). For FY 2014 CMS met its target of 19.1 percent, an improvement over the previous year’s result.
CMS continues to work closely with states to improve children’s health care quality across Medicaid and CHIP, as required by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). In collaboration with states, CMS developed and published the Child Core Set of quality measures. CMS is encouraging all states to use and report on the Child Core Set to collect data that will lead to improved health outcomes and to enhance the accuracy and applicability of the pediatric quality measures program specific to the Medicaid and CHIP programs. In FY 2014, 88 percent of states reported on at least eight quality measures in the Child Core Set, falling just short of the target of 90 percent. In addition, the Affordable Care Act requires that HHS develop a core set of adult quality performance measures for voluntary use by states to assess the care received by adults in the Medicaid program. By encouraging states to report the core measures in a standardized manner, CMS is creating a foundation for a national system of quality measurement, reporting, and improvement for adults in Medicaid. With 67 percent of states reporting on at least five quality measures in FY 2014, CMS exceeded its target of 65 percent.
A Patient Centered Medical Home (PCMH) is a delivery model designed to improve the quality of care through enhanced access, planning, management and monitoring of patient care. In FY 2010 about 1 percent of HRSA-funded health centers had at least one site recognized as a PCMH. Through a series of quality improvement efforts, by the end of FY 2015 65 percent of HRSA health centers had at least one site recognized as a patient centered medical home, exceeding the target of 60 percent.
Generics play an important and increasing role in providing safe, effective, and affordable drugs to the American public and thereby in controlling health care expenditures. FDA’s Center for Drug Evaluation and Research has launched initiatives to streamline and modernize the generic review program. The Generic Drug Review performance measure focuses on process enhancements resulting from the GDUFA program. The goal of the GDUFA program is to enhance efficiency in the generic drug review process, promote transparency between FDA and generic drug sponsors, and enhance access to high-quality, lower cost generic drugs. This investment in the Generic Drug Review program is reflected in the performance target which increases from 75 percent of Abbreviated New Drug Application (ANDA) submissions reviewed in 15 months in FY 2016 to 90 percent.
AHRQ developed the Hospital Survey on Patient Safety Culture so hospitals could determine how well they were doing in establishing a culture of safety in comparison to other similar hospitals. In FY 2015, 2,106 hospitals indicated in this survey that they use AHRQ-supported tools to improve patient safety, exceeding the target as the program has consistently for years. Interest in other AHRQ tools and resources has also remained strong, based on for example, on-going participation in webinars describing resources, electronic downloads, and orders placed for various products.
IHS uses outside accrediting bodies, such as the Joint Commission, the Accreditation Association for Ambulatory Health Care, or the Centers for Medicare & Medicaid Services, to develop national standards of quality of care and manages IHS-operated hospitals and ambulatory health centers to meet these standards. This is one of the most demanding measures to meet, given the growing clinical quality of care assessments that are required as well as issues related to health facilities maintenance and renovation that are critical to accreditation or certification. As of September 30, 2015, 75 IHS federal facilities are fully accredited, 3 are certified by CMS, and 1 is a new facility currently seeking accreditation. In 2015, one facility status changed to without deeming status by the Det Norske Veritas Accrediting Body (DNV), meaning CMS does not deem the survey as a certifying survey. The FY 2015 result is 99 percent.
Plans for the Future
HHS will highlight the problem of antibiotic-resistant bacteria and work toward improved antibiotic stewardship in hospitals in part through the establishment of a new Agency Priority Goal for FY 2016 – 2017. HHS has established a working group to support the priority goal and analyze challenges to antibiotic stewardship. HHS will hold quarterly meetings to review progress toward the goal.
There have been significant investments in the expansion of the NHSN and HAI prevention by the CDC. CDC will expand NHSN's Antibiotic Use and Resistance reporting to additional hospital and non-hospital settings for rapid detection of antibiotic resistant pathogens causing HAIs, develop a new surveillance definition for sepsis that is based on automated data collection, and promote innovation through collaboration with academic research centers in CDC’s Prevention EpiCenters network, which conducts applied research on interventions for infection prevention.
CDC plans to increase the number of health care organizations reporting into the National Healthcare Safety Network to 20,000 facilities by FY 2017. CLABSI reporting from hospital wards and other non-ICU locations is still growing with mostly voluntary reporting from facilities (CMS IPPS facilities began required CLABSI reporting from wards in January 2015), and existing prevention efforts are being refined for use outside of ICUs. CDC is further working to prevent CLABSI in all locations by using HAI data to identify specific hospitals and locations that can benefit from enhanced infection control practices and expertise. 17
CMS has established FY 2016-2017 targets for national CAUTI SIR reductions in hospitals. CDC reset the national CAUTI SIR baseline back to 1.0 at the end of FY 2015, which affected the FY 2016 and FY 2017 targets. The 2016 CAUTI SIR target calls for a 5 percent reduction in the national CAUTI SIR which equates to a SIR of 0.95 (from 1.0 to 0.95) and the 2017 target goal is a 10 percent reduction equating to a national CAUTI SIR of 0.90.
CMS has goals to improve quality in both Medicaid and CHIP and has a phased in approach that allows states to take an iterative approach to quality improvement. CMS will continue to work closely with states to improve children’s health care quality across Medicaid and CHIP, as required by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). In collaboration with states, CMS developed and published a Child Core Set of quality measures. CMS is encouraging all states to use and report on the Child Core Set to collect data that will lead to improved health outcomes and to enhance the accuracy and applicability of the pediatric quality measures program specific to the Medicaid and CHIP programs.
In April 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which provides an additional $20 million in funding for the Pediatric Quality Measures Program for use in FY 2016 and FY 2017. This funding will help CMS achieve its FY 2017 target of 90 percent of states reporting on at least eleven of the quality measures. As the technical assistance program continues to mature, CMS is also expanding the scope of CMS’s technical assistance to help states understand how to use the data they collect to drive quality improvement. CMS seeks also to understand the quality of care that adults in Medicaid receive, improve how this care is measured, and create opportunities to impact health quality. It plans to work with states to ensure that 75 percent of states report on at least eleven quality measures from the Medicaid Adult Core Set in FY 2017. CMS will continue to provide technical assistance and analytic support to states collecting and reporting the measures. As with the Child Core Set, CMS is creating a foundation for a national system of quality measurement, reporting, and improvement for adults in Medicaid.
The FY 2017 target for the reduction of pressure ulcers in nursing homes is set at 5.5 percent. CMS' 11th Scope of Work for the Quality Improvement Organizations has established the National Nursing Home Quality of Care Collaborative and has a specific task related to reducing healthcare acquired conditions in nursing homes, including pressure ulcers. CMS is also collaborating with the Advancing Excellence in America's Nursing Homes campaign which lists pressure ulcer reduction and improved mobility as two of its five clinical goals. All of these efforts should help continue the momentum.
CMS staff has been working with partners, including state coalitions, provider associations, nursing home resident advocates, and stakeholders to decrease the use of antipsychotic medications in nursing homes. Some of this work includes developing and conducting trainings for nursing home providers, surveyors, and consumers; conducting research, raising public awareness, using regulatory oversight, improving surveyor guidance, conducting focused dementia care surveys in selected states, and by public reporting to increase transparency. A number of evidence-based non-pharmacological interventions and approaches have been reviewed by national scientists and thought leaders through the National Partnership to Improve Dementia Care. These have been incorporated into clinical practice guidelines and various tools and resources and are now posted on the Advancing Excellence website (in the public domain) at www.nhqualitycampaign.org. State coalitions are reaching out to providers in every state and encouraging the use of these resources, as well as Hand in Hand, the training for nursing home staff developed by CMS. A number of meta-analyses have reviewed the use of non-pharmacological approaches to behaviors in people with dementia. Studies have shown that these interventions may be effective in reducing behaviors associated with dementia that may be distressing to residents or families.
HRSA is continuing its Patient Centered Medical Home (PCMH) Initiative to improve the quality of care in health centers and support health center efforts to achieve national PCMH recognition. The Initiative has included funding to cover health center costs associated with surveys for PCMH recognition, technical assistance, and other quality improvement supports to help health centers in the transformation of their practices needed to receive recognition as a PCMH. The IHS Office of Information Technology is working toward implementation of a patient portal and a secure messaging platform between patients, providers, and care teams. These two platforms will greatly enhance communications between patients and caregivers via HIPAA secure mechanisms. They will also assist facilities in achieving a critical milestone of the Patient Centered Medical Home and meeting recognition standards for such.
SAMHSA will continue to help adults with serious mental illness and youth with severe emotional disturbances by helping states and communities to develop capacity and deliver effective treatment services. SAMHSA will accomplish this by leveraging its grant portfolio and technical assistance capabilities to provide funding and policy direction which helps grantees to make the necessary changes to policies, organizational structure, and delivery methods needed to realize the possibilities created through the Affordable Care Act. SAMHSA will actively monitor the effectiveness of these efforts.
In FY 2016, IHS plans to work with The Joint Commission to assist facilities in meeting full accreditation. The FY 2016 target is to maintain 100 percent accreditation or certification at IHS-operated hospitals and outpatient clinics (excluding tribally operated facilities).
FY 2014 Strategic Review Objective Progress Update Summary
Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015. Due to this constraint, the following may not be the most current information available.
Conclusions: Progressing
Analysis: HHS continues to make progress in strengthening health care by guiding and supporting national efforts to improve health care quality and patient safety, but opportunities for improvement remain, and the need for this work continues. Health care quality and disparities have improved in some areas, but additional focus and attention are necessary in order to achieve improvements in many other areas. Though the rate of uninsurance among adults 18-64 substantially decreased, racial differences in rates persist.
Federal efforts that provide local support for health care quality and patient safety improvement seem to be yielding some of the most impactful results. An initiative to improve dementia care and reduce antipsychotic medication use in nursing homes has reduced antipsychotic use for long-stay nursing home residents by 15.1 percent from the fourth quarter of 2011 to the end of 2013. Quality improvement efforts have resulted in some sites reporting statistically significant reductions in avoidable hospital readmissions and hospital-acquired conditions. Quality Innovation Network-Quality Improvement Organizations worked with hospitals across the country that reported high rates of central-line blood stream infections and catheter-associated urinary tract infections, results showed a 53 percent relative improvement rate.
Patient safety and quality improvement efforts ranging from the local to the national level require valid, standard measures and efficient systems for collecting information about patient safety and quality. For example, CDC is developing guidelines for opioid prescribing for chronic pain outside the setting of end-of-life care; and ONC is exploring ways to convert these guidelines into health IT-enabled clinical decision support interventions.
While progressing, the fact that in 2013 patients are still impacted at a rate of 121 hospital-acquired conditions per 1,000 discharges highlights the need for continued diligence in making health care safer. The shifting landscape in clinical quality measurement, including the drive to develop composite measures, measure relationship between value and cost, and capture the patient experience, continues to be a challenge. In addition, automating quality measurement to improve efficiency and drive improvement was identified as a challenge. Further, clinical quality measurement can be more challenging in rural communities because data collection is based on a small volume of patients.
Highlighting the importance or patient safety, the Department is in the process of implementing a priority goal related to combating opioid abuse as well as antibiotic stewardship in multiple health care settings.
1 CLABSI baseline will not be re–established in the HHS HAI Action Plan. However, future targets will be adjusted accordingly to align with the Plan.
2 The Standardized Infection Ratio (SIR) is calculated by dividing the actual (observed) infections by the expected infections using data gathered through the CDC National Healthcare Safety Network (NHSN).
3 Targets and results in this table reflect a reduction from a baseline with positive numbers. Consequently, a negative number indicates an increase from the baseline (the opposite of the desired result).
4,11 The Standardized Infection Ratio (SIR) for FY 2010 is 0.94. SIR is calculated by dividing the actual (observed) infections by the expected infections using data gathered through the CDC National Healthcare Safety Network (NHSN). Projected FY 2012 SIR calculation (0.94 x 0.9). Projected FY 2013 calculation (0.94 x 0.8).
6 The final FY 2014–15 CAUTI target will be 10% reduction in the national CAUTI SIR from baseline of 1.03 to target SIR of 0.93. The end period for this goal is September 2015 and the final goal data will be reported in March of 2016.
7 CDC is resetting the national CAUTI SIR baseline back to 1.0 at the end of FY 2015. The FY 2016 CAUTI SIR midpoint target calls for a 5% reduction in the national CAUTI SIR which equates to a SIR of 0.95 (from 1.0 to 0.95).
8 CDC is resetting the national CAUTI SIR baseline back to 1.0 at the end of FY 2015. The FY 2017 target goal is a 10% reduction equating to a national CAUTI SIR of 0.90 (from 1.0 to 0.90).
9 NHSN CAUTI data through March 2013 (FY 2013 midpoint) was calculated at 1.02 SIR or a 9 percent increase (opposite of desired outcome) in the SIR over the baseline of 0.94 SIR, and is behind the midway goal of 0.85 SIR or a 10 percent reduction.
10 The national CAUTI SIR data, which was reported in March of 2015, reflects a SIR of 0.98, a 4.9% reduction just shy of target goal.
11 FY 2014 Target was originally 6.9% in the CMS CJ. The target was reduced to 6.7% when 2012 results were received.; For internal purposes, the FY 2014 target was reduced to 5.9% in 2014, but the target could not be reduced for external reporting purposes.
12 FY 2015 Target was reduced from 6.6% to 5.7% in FY 2016 CJ.
13 This activity became high profile and changes were made to reflect modifications to the methodology and to be consistent with other public–facing reporting on this initiative. The original CY 2014 target was reduced from 20.3 percent to 19.1 percent.
14 Due to the significant progress made toward achieving this measure, the CY 2015 target, as originally reported in the FY 2015 Congressional Justification, was reduced from 19 percent to 17.9 percent.
15 “States” included in the denominator of this measure are the 50 States plus the District of Columbia. The FY 2013 result was 45/51 or 88%.
16 “States” included in the denominator of this measure are the 50 States plus the District of Columbia. The FY 2013 result was 30/51 States or 58.8% – rounded to 59%.
17 http://www.health.gov/hai/prevent_hai.asp#hai_plan
