Hospitals in Maryland are seeing impressive gains in reducing readmission rates and preventing patient harms from hospital-acquired infections, medication errors and other safety events, according to a report released Wednesday by the state's hospital association.
The report comes after Maryland recently passed the one-year mark on a unique all-payer model agreement. The five-year experiment sets predetermined Medicare reimbursements for hospitals and target goals for reducing unnecessary hospitalizations and preventable conditions.
“It really shows the emphasis that we have here in the state,” says Nicole Stallings, vice president for policy and data analytics for the Maryland Hospital Association. “Effort and resources are really being put into continuing to improve quality in our hospitals.”
The MHA's 2014 report (PDF) on quality looked at how a total of 67 acute-care hospitals, specialty hospitals and health systems in the state performed on various quality metrics, based on their voluntary participation in collaborative efforts led by the association.
Some of the initiatives were unit-based. Hospitals could choose which unit, such as the intensive-care unit or neonatal ICU, would be enrolled into a specific collaboration, such as to address central-line-associated bloodstream infections, sepsis or ventilator-associated pneumonia.
Of 150 hospital units participating in a program to eliminate serious bloodstream infections, 90% reported having zero central-line-associated bloodstream infections per month in 2014. Of 130 units participating in a program to address the unnecessary use of catheters and their associated infections, 83% reported zero infections each month, the report found.
Participation in the readmission-rate-reduction and hand-hygiene collaborations were not unit specific, and were reported across an entire facility, Stallings said.
The report found that between 2010 and 2014, compliance with hand-hygiene protocols jumped from 71% to 90% for those participating in that statewide collaborative. Among 36 acute-care hospitals and one specialty hospital to participate in a care-transition program to reduce rates of avoidable 30-day readmissions, rates dropped by more than 4% between 2013 and 2014.
In January 2014, the state of Maryland received federal approval for an all-payer model agreement, which enforced a cap for inpatient and outpatient hospital revenue in order to achieve a targeted $330 million in Medicare savings over the five-year trial period.
It also set several quality and safety targets, such as requiring that the state's aggregate rate of hospital 30-day readmissions not exceed the national average and that the incidence of 65 preventable conditions drop by 30% during the trial, Modern Healthcare reported last year.
Though Stallings said the combination of these statewide, national and even individual hospital initiatives are the momentum behind the improvements, she added: “This does not mean we're going to be able to take our eye off the ball. Just to sustain improvement also takes tremendous effort.”