For years, Santa Clara Valley Medical Center in San Jose, Calif., faced a problem with sepsis in patients.
There was a concentrated effort to screen for sepsis when patients arrived in the emergency department. But once patients were admitted, there was no consistent screening or treatment approach. And there was no facility-wide training effort, said Kathy Madlem, a nurse who serves as sepsis quality improvement coordinator at the safety net hospital.
Hospital leaders wanted to improve their care for these patients, but the safety net hospital was hamstrung by lack of financial resources. Then in 2011, the hospital launched a campaign to improve the early detection and treatment of sepsis. That year, 14.6% of patients with sepsis died. By June of last year, the mortality rate had dropped to 6.5%.
The improvement program was made possible by California's Delivery System Reform Incentive Payment (DSRIP) program, a federally approved waiver program that allows federal Medicaid funding to be used to create financial incentives for providers to pursue delivery-system reforms. Those reforms involve infrastructure development, system redesign and clinical-outcome and population-focused improvements. Under these programs, the initial focus is on meeting process-type metrics in setting up the reforms; in the later years, the focus shifts to outcomes-based metrics such as population health improvements.
In 2010, California became the first state to win federal approval for and launch a DSRIP initiative as part of a broader Medicaid Section 1115 waiver. The waiver programs provide states with significant funding to support hospitals and other providers in reforming how they deliver care to Medicaid beneficiaries. “We needed support and incentives to get to the place we wanted to be,” said Dr. Susan Ehrlich, CEO at San Mateo (Calif.) Medical Center.