A Crucial QUEST

April 10, 2013
The results coming out of three years of hospitals' participation in the Premier Health Alliance's QUEST program are in, and they are stunning. When it comes to performance improvement, both on the patient safety/care quality side, and on the cost-reduction side, the QUEST results show that there is no excuse for lack of performance improvement.

On Jan. 18, I participated by phone in a press conference in which executives and leaders of the Charlotte-based Premier Health Alliance announced three years of results from that organization’s ongoing QUEST High-Performing Hospitals Collaborative program. Present were both Premier staff members, including the alliance’s CEO and its senior vice president of public affairs, and several senior executives of QUEST program member hospitals.

As I noted in that report, in order for QUEST program member hospitals to reach expected standards for quality and cost-effectiveness work, those organizations had to reduce mortality by at least 18 percent, reduce the average cost of care to less than $5,270 per discharge, use evidence-based care measures in three specific areas at least 84 percent of the time; eliminate preventable harm events; and improve patients’ experiences enough so that they would recommend those hospitals in surveys.

What’s more, many of the hospitals participating in the program bested those requirements by wide margins, proving unquestionably that fundamental change is possible. Indeed, the average reduction in observed-to-expected mortality from January 2010 through December 10 among participating hospitals was 29 percent, a stunning figure that doesn’t even account for the most exceptional gains in that area.

And, again, just looking at mortality, in three years, the participating hospitals averted 6,092 sepsis deaths, 7,296 deaths from respiratory conditions, 3,838 cardiac- and shock-related deaths, and 1,637 deaths connected with end-of-life care.

Similar gains have been made in the adoption of evidence-based care guidelines and in the cost-control area. Consider this: the average decrease in cost per case among participating QUEST hospitals was $1,025 per case after three years.

And, though it’s more complicated to explain briefly, the QUEST hospitals have also dramatically reduced variation in composite harm scores—an indicator of clinical care excellence, as unjustified variations in care are among the major challenges facing care quality improvement efforts.

As was pointed out at the press conference, had all U.S. hospitals achieved this level of gains during the past three years, the healthcare system would have saved 87,250 lives and $34 billion in costs. Those are significant numbers.

Folks, these results are stunning. But what’s important here is not only the achievement of improvements across quality and cost areas—and, of course, my congratulations go out to all of the QUEST hospitals—but also the fact that the QUEST program results underscore the fact that significant change is possible, despite the ongoing complaints on the part of some in the industry that all the healthcare reform-related and meaningful use-related performance mandates are adding unreasonable demands to providers’ to-do lists.

The bottom line? It’s impossible to look at these results from QUEST and deny the possibility of positive change in the healthcare system. What’s more, and this should be no surprise to providers—policy-makers on Capitol Hill and in the state legislatures, and senior executives at health plans and in business health alliances, are all looking at these numbers; and they make sense, as they should. And they apply to all three of the major healthcare reform-mandated performance improvement programs under Medicare: the readmissions reduction program, the healthcare-acquired conditions program, and of course, the value-based purchasing program, all of which will very soon be influencing hospital payment.

In other words, we’re rapidly moving into the “no excuses” territory on performance improvement in healthcare. And it will be fascinating to see future results coming out of the QUEST program, as it evolves forward. I know it’s difficult not be overwhelmed by all the reports, studies, white papers, surveys, and so on, that we all receive via e-mail every day. But this is one to keep watching.

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