At a time of tremendous challenges in U.S. healthcare, progress is being made on a number of fronts. One area in which progress appears to be rapidly advancing is around healthcare-acquired conditions, specifically hospital-acquired conditions, and most specifically, hospital-acquired infections—with the acronyms “HACs” and “HAIs” describing these various phenomena.
Indeed, a report released in December of last year by the Department of Health and Human Services, and publicized via press release on Dec. 12 by the Agency for Healthcare Research and Quality, or AHRQ, offers real encouragement in this area.
The Dec. 12 press release from AHRQ begins, “A report released by the U.S. Department of Health and Human Services (HHS) today shows that nationwide efforts to make health care safer are paying off. Thanks in part to provisions of the Affordable Care Act, approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved from 2010 through 2015. In total, hospital patients experienced more than 3 million fewer hospital-acquired conditions from 2010 through 2015, the result of a 21 percent decline in the rate of these adverse events over that period. Hospital-acquired conditions are conditions that a patient develops while in the hospital being treated for something else. The decline in their incidence aligns with a major goal of the Affordable Care Act to improve the quality of health care,” the press release notes.
It goes on to say that “The National Scorecard on Rates of Hospital-Acquired Conditions represents demonstrable progress over a five-year period to improve patient safety in hospitals. These data, compiled and analyzed by the Agency for Healthcare Research and Quality (AHRQ), build on results previously achieved and reported in December 2015. Last year's data showed that 87,000 fewer patients died due to hospital-acquired conditions and $20 billion in health care costs were saved from 2010 to 2014.”
And it quotes HHS Secretary Sylvia Mathews Burwell as saying that "The Affordable Care Act gave us tools to build a better health care system that protects patients, improves quality, and makes the most of our health care dollars and those tools are generating results," Secretary Burwell added. "Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital acquired conditions, resulting in thousands of lives saved and billions of dollars saved."
Let’s be very clear here: 125,000 lives saved, 3 million fewer cases, and a 21-percent decline overall in hospital-acquired conditions in five years, at a savings of $28 billion? That is quite huge—and quite significant. First of all, it is huge on its face. That is a whole lot of lives saved and made better; and a whole lot of savings. And that in itself is something to rejoice over, at a time when the going seems very tough on so many fronts in U.S. healthcare. It shows that clinician leaders, administrative leaders, and front-line clinicians and non-clinical staff members are doing something right—or, more likely, a bunch of things right.
As the HHS press release noted, “Many federal efforts supported this progress toward a safer health care system, including the Partnership for Patients initiative, a public-private partnership working to improve the quality, safety and affordability of health care. HHS launched the Partnership for Patients in 2011 though the Center for Medicare & Medicaid Innovation to target a specific set of hospital-acquired conditions for reductions through systematic quality improvement. In addition, the Centers for Medicare & Medicaid Services (CMS), through a program created by the Affordable Care Act, worked with hospital networks and aligned payment incentives to bring about a shared and sustained focus on making care safer.”
And it was not out of place for Patrick Conway, M.D., deputy administrator for innovation and quality, and the CMO at the Centers for Medicare & Medicaid Services, to boast a bit about what this all meant. Dr. Conway was quoted in the press release as saying, “These achievements demonstrate the commitment across many public and private organizations and frontline clinicians to improve the quality of care received by patients across the county. It is important to remember that numbers like 125,000 lives saved or over 3 million infections and adverse events avoided represent real value for people across the nation who received high quality care and were protected from suffering a terrible outcome,” he added. “It is a testament to what can be accomplished when people commit to working towards a common goal. We will continue our efforts to improve patient safety across the nation on behalf of the patients, families, and caregivers we serve."
And Jay Bhatt, D.O., the CMO at the American Hospital Association and the president of the AHA’s Health Research & Educational Trust, added the statement that "Not only have they saved lives, but they’ve also developed tremendous capacity to tackle safety challenges—a foundation that will help them get to zero incidents."
What’s more, much of the evidence on how to prevent HACs was developed at tested by AHRQ. And that, too, is significant. Here’s the thing: this dramatic reduction in hospital-acquired conditions is a U.S. healthcare system-wide improvement; and its achievement represents systemic and systematic work, from the clinical unit level within individual hospitals, to the hospital facility level, to the integrated health system level, to the U.S. healthcare system level. And it represents the best possible functioning of our healthcare system, when clinicians and their colleagues learn about and absorb learnings from the clinical literature, industry reports and trade press reportage, and directly from their colleagues via conferences and direct contact; when they then develop and execute plans to improve their clinical outcomes; when they build awareness and understanding, as well as participation, among their clinician colleagues; and when they then go back to analyze the outcomes in their organizations, and engage in that “blessed cycle” of learning, a cycle that involves continuous data and information input, feedback, improvement work, and analysis. And none of this would be possible without strong data analysis.
But it requires good, strong, evidence-based policy-level guidance as well, and AHRQ and other organizations should be applauded for their work in this area. As AHRQ director Andy Bindman, M.D. noted in a statement in the press release, "AHRQ has been building a foundation of patient safety research for the last decade and a half at the request of Congress. Now we’re seeing these investments continue to pay off in terms of lives saved, harm avoided, and safer care delivery overall,” Dr. Bindman added. “We’re gratified by the progress, and we look forward to building on this work to help make patient care even safer as the work continues."
So this is a classic example of “glass half-full” versus “glass half-empty” thinking in U.S. healthcare. Yes, there are nearly countless challenges facing healthcare leaders right now in the U.S. healthcare system. And yet one can accept the truth of that, and at the same time, applaud progress where it genuinely is being made, particularly when progress in a particular area requires systemic approaches to improvement. And reducing HACs in hospitals, as well as in other patient care settings, is something that all of the professionals working in patient care organizations in the U.S. can take genuine pride in.
