hospital impact

by Christopher Cornue

I've written in this space before about a national collaborative, funded by the Robert Wood Johnson Foundation (RWJF), called Expecting Success: Excellence in Cardiac Care. This was a 29-month collaborative project, led by the George Washington University and comprised of 10 hospitals from varying communities in the United States. Detailed information is available at the website and further tools developed during this process will be available at a new website in June (I'll post an update when that becomes available). Briefly, though, I want to call out some significant successes from this project that "formally" concluded a few weeks ago and were shared at a national meeting in Washington, D.C on 8-9 May 2008.

* Each hospital implemented a consistent way of collecting Race, Ethnicity and Language, based upon OMB classifications - this is expected to become a Joint Commission requirement in 2009. These data allow hospitals to identify potential disparities, and then implement changes to address any that may exist;
* Through the project, 61 statistically significant changes in quality occurred (58 of which were improvements; while 3 were declines);
* Evidence-based "Measures of Ideal Care" for AMI improved significantly across the hospitals since the project began in Q4 CY2005 through Q4 CY 2007: mediancompliance increased from mid-70% to upper 80%; additionally, the spread of compliance across hospitals (which in the beginning was a large gap between approx. 17% to 93% to a much smaller gap of approx. 77% to 100%);
* The gap for "Measures of Ideal Care" for Heart Failure were even wider than AMI when the project began (approx. 5% to 88% compliance in Q4 CY 2005) and ended with a narrower gap of approx. 59% to 98%);
* Some hospitals demonstrated a significant reduction in the gap of care provided by race and ethnicity - with one example focusing on percentage of AMI patients receiving ACE/ARB for LVSD where in early 2006, whites received ACE/ARB 90% of the time while blacks received it approximately 76% of the time. By the end of the project, the gap had closed to such a significant degree that both received ACE/ARB 100% of the time.

There were many other noteworthy examples demonstrating the significant improvements. Suffice to say, quality has improved significantly at these 10 hospitals over the past 29 months, with the gap in race and ethnicity closing. While more specific info about next steps will be shared in June and July this year, RWJF plans to implement this project on a broader scale nationally, using lessons learned from these 10 collaborative hospitals. Their focus will be on dozens of communities across the country in an effort to spread the successes and ultimately improve the quality of care in cardiac care, while reducing disparities where they may exist. More detail to come ...