To reach those aims, HHS also outlined six initial priorities, chosen because of evidence of past success as well as feedback from stakeholders. Those aims include reducing harm and improving safety, promoting care coordination, engaging patients and families, and addressing the leading causes of mortality (See box, left).
Finally, HHS identified 10 principles to use when designing quality-improvement projects. Payment models should offer incentives to better health, providers should be held accountable for the care they provide, consumer incentives should promote better health habits, and clinicians should receive timely and accurate feedback, HHS said. The department also emphasized the importance of health information technology, training and workforce development, and innovation.
The strategy is broad—intentionally so, HHS says—and it doesn't feature definitive timelines, new measurement guidelines or set parameters. “The Affordable Care Act calls on the National Quality Strategy to include HHS agency-specific plans, goals, benchmarks and standardized quality metrics where available,” HHS said in the strategy. “By design, this first-year strategy does not include these elements, in order to allow them to be developed with additional collaboration and engagement of the participating agency along with private sector consultation.”
Future versions of the National Quality Strategy will include more specific metrics, as well as best practices and new research, HHS said.
What the strategy does include, however, are instances of successful initiatives that HHS said it will continue to build on in the future. For example, for the department's first priority—reducing harm and improving safety—HHS cited the success of the Michigan Keystone project, funded by HHS' Agency for Healthcare Research and Quality.
During that project, researchers from Johns Hopkins University, Baltimore, partnered with the Michigan Health & Hospital Association to reduce incidences of central line-associated bloodstream infections. After implementing a set of simplified best practices, central-line infections in Michigan intensive-care units dropped two-thirds in the first three months, and the project is now being rolled out across the country.
Aurora's Turkal highlighted the system's participation in the Hospital Quality Incentive Demonstration, a collaborative project led by the CMS and Premier, a Charlotte, N.C.-based quality-improvement and group purchasing organization. HQID is the foundation for the CMS' recently proposed value-based purchasing project.
“That was transformative for us,” Turkal said. “We saw that if you focus on quality and safety, you get better and you reduce costs.”
HHS said its initial opportunities for success in reducing harm will be in lowering the number of serious adverse medication events and in eliminating hospital-acquired infections. Healthcare-acquired infections cost as much as $5 billion annually and account for 99,000 deaths a year, and the strategy's focus on prevention and elimination was lauded by infection-prevention groups.
Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology, and an epidemiologist at St. Joseph Mercy Health System, Ann Arbor, Mich., argued that the emphasis on reducing infections would not only increase safety but would also address HHS' other priorities, such as affordability, care coordination and, in particular, community wellness. “Our members really appreciate that focus on the community,” Olmsted said. “It gives us more of an opportunity to partner with patients and their families, and it takes infection prevention beyond the hospital.”
Cardiovascular health also is an area of focus in the strategy. For its fourth priority—prevention and treatment of leading causes of mortality—HHS said it plans to start with cardiovascular disease, which accounts for one in three deaths in the U.S. and more than $503 billion in healthcare costs.
“While mortality from cardiovascular disease has declined dramatically over the past 40 years, current quality initiatives can help us do even better,” said HHS, pointing to successful projects such as the Centers for Disease Control and Prevention's Community Transformation grants.
HHS said it plans to use existing and future initiatives to promote evidence-based cardiovascular interventions, including exercise, smoking cessation and weight control. The department will then use those experiences and data as a model to inform other mortality-reduction efforts, focusing on diseases such as cancer, diabetes and HIV/AIDS.
“This has outstanding potential to improve patient care and clinical outcomes for what still remains the leading cause of death for both men and women in the U.S.,” said Dr. Gregg Fonarow, professor of medicine and associate chief of the division of cardiology at the University of California at Los Angeles. “There are a number of important disease states, but with 80 million people suffering from it, this is the most costly and the most preventable. When you look at the greatest potential gain for improved efficiency and quality, this really is a win-win.”
Fonarow, who also serves as a spokesman for the American Heart Association, said HHS actively sought out input and integrated many of the association's suggestions into the strategy.
In a statement, Dr. Ralph Sacco, the American Heart Association's president, said the National Quality Strategy aligns well with the heart association's own goals of improving cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular disease and stroke by 20% by the year 2020.
Engaging patients and families in shared decision-making and gathering patient feedback also are listed among the strategy's top priorities. Good examples of tools and programs that foster patient-centered care, according to HHS, are the Hospital Consumer Assessment of Healthcare Providers and Systems, known as HCAHPS, which the CMS has proposed using in its upcoming value-based purchasing program.
Another example cited by HHS is the newly formed Patient-Centered Outcomes Research Institute, which is charged with performing comparative effectiveness research. HHS' report came the same week that the Institute of Medicine released 21 recommended standards for systematic review of the comparative effectiveness of medical or surgical interventions and eight recommended standards to develop trustworthy clinical practice guidelines (See Related Content above).
The Campaign for Better Care, a group representing several advocacy organizations, said the strategy was a step forward in protecting vulnerable populations. But the group also cautioned that this first version lacked specific requirements for providers. “The hard work now begins to translate this strategy into concrete action, and that while the strategy provides a road map, there will need to be strong benchmarks to hold all stakeholders accountable to achieve its aims,” the campaign said in a news release.