Improving Mortality Through a Multihospital, Collaborative Quality Improvement Project.

Improving hospital mortality is a key focus of quality and safety efforts at both the local and national level. Structured interventions can assist organizations in determining whether interventional efforts have led to sustained improvement. The PARiHS framework (Promoting Action on Research Implementation in Health Services) can assist organizations in implementing research into practice. This study investigates the use of the PARiHS framework in implementing a multihospital quality improvement project aimed at improving observed-to-expected mortality as measured by Vizient's Clinical Data Base (CDB). Structured interventions during the study period included mortality reviews, clinical documentation improvement opportunities, educational webinars, training and support in the use of CDB to explore ongoing opportunities for mortality improvement and quarterly reports to each participating hospital's leadership team on their performance. Data were gathered from an improvement collaborative in the Upper Midwest, which comprised 34 hospitals, of which 17 participated in the intervention. Measurement occurred from Quarter 4 2016 through Quarter 3 2020 and consisted of a preintervention, intervention, and postintervention period. Although both participating and nonparticipating hospitals achieved a significant reduction in their mortality observed-to-expected ratio from the preintervention period through the postintervention period, the participating hospitals achieved a greater reduction in their observed-to-expected mortality ratio ( P < 0.0004). In addition, the participating hospitals achieved a relative 21% improvement in the mortality domain rank of the Vizient Quality & Accountability Study.

Reducing avoidable hospital readmissions effectively: a statewide campaign.

BACKGROUND: The Reducing Avoidable Readmissions Effectively (RARE) Campaign was designed to engage hospitals and care providers in Minnesota across the continuum of care to prevent avoidable hospital readmissions within 30 days of hospital discharge. METHODS: Support for hospitals was provided on a one-on-one basis by a RARE resource consultant, as well as through the campaign website and a monthly newsletter. Hospitals had the opportunity to participate in any of three learning collaboratives-Care Transitions Intervention, Project RED (ReEngineered Discharge), or SAFE Transitions of Care. The operating and supporting partners of the RARE Campaign offered monthly webinars for sharing of best practices, and hosted Action Learning Days and celebratory events. Potentially preventable readmissions (PPRs) were tracked over time, and a ratio of actual-to-expected PPRs (A/E PPRs) was calculated for each hospital and reported quarterly. RESULTS: As of December 31, 2013, 82 hospitals were participating, with 58 (71%) taking part in at least one learning collaborative. More than 7,000 readmissions have been prevented, and patients have spent more than 28,000 nights of sleep in their own beds rather than in a hospital. By the end of September 2013, the A/E PPR ratio was reduced by 12%-from .98 to .86. CONCLUSIONS: The peer-to-peer networking and collaboration between hospitals facing similar issues, coupled with statewide resources, collaborating Operating Partners, and support for system improvements, have led to improved discharge planning, better management of care transitions and medications, engaged patients and families, and lower readmission rates.