Premier Shows Dramatic Quality and Cost Improvement Results with QUEST Initiative

The marquee headline is enough to grab the attention of readers in and of itself: “157 hospitals in national collaborative save 22,164 lives, $2.13 billion over two years.” Then there’s the deck: “If all of the nation’s hospital’s could replicate these results, an additional 64,000 lives and $23 billion could be saved annually.”

But those are indeed the results being documented by the national collaborative called “QUEST: High Performing Hospitals,” an initiative being sponsored by the Charlotte-based Premier Healthcare Alliance. And in a telephonic press conference held Nov. 22, Premier leaders announced those results and more, to highlight the progress being made by hospitals nationwide involved in an initiative that they believe could be a model for healthcare reform as played out on the local-hospital level.

(For more information, see Premier’s press release on the subject.)

What’s more, QUEST hospitals’ observed mortality that has for the past two years been running at 5 percent lower than non-participant hospitals, when bench-marked against expected levels, while their cost trajectory is running at 2 percent inflation, compared to 14 percent industry-wide.

All these results led Premier leaders to hold their press conference last week to discuss their initiative’s results, and the implications for the industry as a whole.

Susan DeVore, Premier’s president and CEO, began by saying that she believes the results of the QUEST Initiative reflect “this approach to get at systemic, systematic performance improvement. The attempt is really to say, can we help hospitals, and can hospitals help themselves, to improve across all five dimensions at the same time? And if you could do that, wouldn’t that be a high-value, or a high-performing, healthcare system? So we really set out to define how you would measure those variables, and then define the metrics, and make improvements,” DeVore said.

“If you look first at mortality, we’ve seen a 23 percent reduction in observed mortality compared to what was expected,” DeVore continued. “You also see a declining mortality level [overall], and a decrease in variation in performance. So we feel very good about that. And if you compare the results of the QUEST hospitals to Premier hospitals not in QUEST, and to non-Premier hospitals, by the first quarter of 2008, you start to see a significant improvement in mortality levels, compared to the other groups.”

What’s more, as Premier officials noted, if one were to take the $603 per discharge saved by the participating QUEST hospitals, compared to non-QUEST hospitals, and multiply that figure by the number 37,526,480, which is the number of annual hospital discharges among all non-QUEST hospitals in the U.S., the total would come to $22.6 billion saved annually.

Referring to the presentation shared with the media at the press conference, DeVore said, “These to me are among the most compelling slides, because while we’re all working on quality, bending the cost of care remains a huge challenge. But the inpatient cost per discharge has gone from almost $5,900 per case to just over $5,200 per case, inflation-adjusted,” among QUEST hospitals, and, she said, “This is bending the cost curve,” particularly in the context of a nearly-14-percent increase in healthcare costs nationwide during the same two years. Clearly, she said, achieving a level of only 2 percent cost increases among QUEST hospitals during that time period is significant and noteworthy. And the cost savings, if achieved across the U.S. healthcare system, could among other things be applied to alleviating increasing shortages of physicians and nurses in patient care organizations nationwide.

Among the critical success factors that DeVore and her Premier colleagues cited with regard to the advances being made among QUEST hospitals included the following: executive leadership; staff engagement; the existence of an improvement framework, guided by multidisciplinary teams of leaders; the systemic use of data; the active use of some kind of learning system or community; and a workable framework for execution. As DeVore put it, “None of it matters if there isn’t a really strong execution framework to drive the change.

Maureen Bisognano, president and CEO of the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), an organization that has been in the forefront of advocating for improved patient safety and care quality in the past several years in U.S. healthcare, congratulated DeVore and her colleagues at Premier on the success of the QUEST initiative to date and emphasized the national implications of what’s been learned to date by the hospitals participating in QUEST. “This is a real demonstration that local change can happen that has national implications,” Bisognano said. “We’ve seen the debate over whether change can happen at the top and filter down, or whether it has to occur at the local level and bubble up.” It is actually important for change to be pushed from both directions, she emphasized.

In addition, Bisognano said, she sees three core success factors among hospital organizations that have made significant advances in patient safety, care quality, and efficiency in recent years. Those three elements, she said, are building the will to change across an organization; building new models for delivering care, and achieving “an exquisite execution focus.”

Significantly, Bisognano added, “I’m often asked by senior leadership teams, how am I doing? And most hospitals don’t have the level of benchmarking that QUEST has.” That element, she stressed, sets QUEST apart from many homegrown improvement efforts.

Asked about the importance of creating information technology and data reporting infrastructures to support all the data collection, data publishing, and data analysis elements in an initiative like QUEST, DeVore said, “We have small and large, and urban and rural hospitals, all participating. A lot of the measurements today come from the administrative data, and it’s a question of how you bring that into business intelligence; so most have the raw data to do this; the question is whether they can bring that raw data into business intelligence programs to make this work. A particular challenge is in the [patient] harm data [now being collected and reported by participating QUEST hospitals]. We have to make sure that what shows up in the administrative data is truly indicative of harm. There’s a similar issue on infections and automation.”

DeVore went on to say that “I think the part of the healthcare reform legislation and the HIT stimulus and meaningful use that is relevant here” is that federal policymakers, in drafting the comprehensive healthcare reform legislation passed in March, and the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, “are really moving hospitals towards accountability [for outcomes], which really encourages the integration of all this data.”

Not surprisingly, she added, the work being pursued within the QUEST initiative is “absolutely” complementary to the aims of healthcare reform and of the HITECH Act. “We also think this [work] allows you to focus in on the real drivers of harm, the real drivers of mortality. The challenge in terms of all the investment being made in IT now is, do you end up with a lot of unusable data, or can you turn the data into usable [performance improvement]?” To DeVore and her colleagues at Premier, the work being pursued under the QUEST banner answers that question perfectly.