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Quality at CRH
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Quality is a top priority at Calais Regional Hospital. We recognize and value the important role it plays in providing cost-effective services and improving patient safety.
Demonstrated commitment to quality
Calais Regional Hospital is committed to quality patient care, as evidenced by our years of participation in national, state and internal quality improvement projects. We participate with such key organizations as the Northeast Quality Health Care Improvement Organization and the Quality Improvement Organization for Maine, New Hampshire and Vermont (formerly referred to as the Peer Review Organization or PRO).
CRH actively takes part in the following national quality initiatives: 100,000 Lives program, Core Measures by the Centers for Medicare and Medicaid (CMS), National Patient Safety Goals by the Joint Commission on Accreditation of Healthcare Organizations, Get With the Guidelines by the American Heart Association and the Leapfrog Group. In addition, we have implemented many more initiatives because they were the right thing to do.
What have we been doing at Calais Regional Hospital?
At CRH, we measure quality through the assessment of outcomes and processes. In 2006, we took a hard look at our performance, identified our opportunities for improvement and made process changes as a result. During the past year, the Performance Improvement Committee, with the endorsement of Board, Administration, and through the support and guidance of the Medical Staff, implemented standing orders. That is a list of tests and procedures demonstrated to improve the outcome, for our patients with a diagnosis of heart attack, heart failure or pneumonia (community acquired). In 2007 we added the measures and indicators associated with Surgical Infection Prevention (SIP), now known as the Surgical Care Improvement Project (SCIP). The scope of the improvement effort is coordinated by the Performance Improvement Committee, however all hospital committees and staff members of the hospital contribute to make this effort successful.
For many years, we have had an independent third party administer patient satisfaction surveys. These questionnaires are mailed to individuals who have used our inpatient, outpatient, emergency department, or ambulatory surgery services, and the data is reported to us via the internet. The data allow us to review and evaluate our performance internally, as well as in comparison to other hospitals in the state and across the nation. These surveys ask questions on virtually every aspect of a patient's experience. We request to be rated on cleanliness, courtesy, comfort, and food; how family and friends were treated; the helpfulness of personnel; the waiting time for a test or procedure; pain management, staff response to questions, the skill of the nurses, physicians and other clinicians.
At Calais Regional Hospital, we carefully review all responses to patient surveys as well as patient letters and develop solutions to patient concerns. This effort is handled through our Quality Management and Nursing Department with input from the department where the service was rendered.
Core measures
The Centers for Medicare and Medicaid Services (CMS) have identified specific areas of hospital care to be measured and reported. Having undergone extensive validity and reliability testing, these standards are all endorsed by the National Quality Forum, a voluntary standard-setting, consensus-building organization representing providers, consumers, purchasers and researchers.
The standards, referred to as "core measures," for the treatment of heart attack, heart failure and pneumonia (community acquired) are the basis for reporting and measuring the quality of hospital care. These diagnoses have been selected because they are the most common causes for admission to a hospital, and unlike many other conditions, there is universal agreement on what is the best practice for treating each. In 2006 a core measure in evaluating quality care standards related to surgical infection prevention for selected surgeries were added.
CMS established the Core Measures in 2000 and began publicly reporting the data in 2003. Calais Regional Hospital has taken part by tracking and reporting data on treatment for heart attacks, heart failure and pneumonia on an ongoing basis. In 2005 we added the surgical infection prevention core measures to our tracking efforts.
How Do Core Measures Help?
“Core Measures were developed from evidence-based medicine," says Stacey Doten, CPHQ, Quality Managment Director. “They were developed and implemented because it has been demonstrated and scientifically proven they will improve outcomes.” As such, the core measures have been very helpful in Calais Regional Hospital’s work to improve patient care. They have provided a focus for the development of a consistent approach to providing optimal care to our patients.
Are the Core Measures A Report Card On Quality?
Unfortunately, the scores on the core measures can create misleading impressions when used as a hospital rating tool instead of an improvement tool, particularly for small hospitals. For example, if a small hospital received an 83% on the Heart Failure indicator does that mean that 17% of patients got substandard care or did patients at a hospital which scored 90% get better care? The first score could indicate low quality care, but not necessarily. For example, a small hospital may have only 6 patients in a quarter who qualify for the measurement. Say for one of those six, the physician or the nurse provides an aspect of care but fails to document properly. In the data collection process, that counts as a “miss.” So, only 5 of the 6 patients are counted as appropriate and the hospital gets a score of 83%. Data findings are shared with staff and can be utilized as an improvement tool by determining an area within the medical record to provide a prompt for the appropriate documentation to establish that the aspect of care was, in fact, provided. A larger hospital might have 50 patients who qualify for the indicator and have provided non-standard care (or not documented care correctly) on 5 of those. That earns a 90% rating. Which is better? You can’t tell without investigation — because the data is designed to assist improvement, not to appear as a grade on a report card.
Does All This Have A Cost To It?
With the current system, the tracking and reporting of Core Measure performance is a huge amount of work which occupies the time of multiple clinical staff members. “This is another unfunded mandate,” says Doten. “It is well intentioned, but there is no funding for the mandate, so the cost of tracking and reporting the data is ultimately passed on to our community. As the number of core measures expand (and they are expected to expand dramatically), the workload and cost will increase”.
At this point in time, data collection and entry is time consuming so efforts are underway to identify ways to streamline this process. Results must be submitted on a quarterly basis to CMS, which publicly reports the data to aid in hospital improvement efforts and to offer transparency to the public. In Maine, our data is submitted to the Maine Quality Forum (MQF), an independent division of Dirigo Health.
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