THE 2017 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY IN WASHINGTON

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1 THE 2017 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY IN WASHINGTON Since 2002, Qualis Health has presented the annual Awards of Excellence in Healthcare Quality to outstanding organizations in Washington and Idaho. Winners have demonstrated leadership and innovation in improving healthcare practices, reflecting the very best in healthcare quality improvement. The awards, now in their 15th year, recognize those who demonstrate outcomes relevant to the three broad aims of the National Quality Strategy: Better healthcare (for individuals) Better health (for populations) Reduced costs through improvement Winners of the 2017 Washington Awards of Excellence in Healthcare Quality in Washington are selected by a panel of expert Washington stakeholders. Awards are presented at the annual Northwest Patient Safety Conference on May 11, AWARD OF EXCELLENCE: LARGE HOSPITAL Harborview Medical Center, Seattle, Washington Improving Diabetes Self-Management with Limited-English- Proficient Patients Using Bilingual/Bicultural Diabetes Navigators Submitted by: Jeanne Lowe, PhD, RN on behalf of Lea Ann Miyagawa, MN, RN and Martine Pierre-Louis Uncontrolled type 2 diabetes can result in serious medical complications with significant long-term costs in both dollars and quality of life. A disproportionate burden of diabetes and its complications often falls on underserved and vulnerable groups, such as immigrant and refugee populations with limited English proficiency. To address these disparities, staff at Harborview Medical Center designed a program to improve diabetes self-management and health outcomes for Spanish- and Somalispeaking patients with uncontrolled diabetes. Funded by a grant, Harborview hired two bilingual/ bicultural diabetes navigators to address the challenges experienced by its Spanish- and Somali-speaking patients. As part of the healthcare team, the navigators support patient care by providing direction, cultural mediation and advocacy, case management, education, coaching, and interpretation. To measure success, they tracked changes in the patients hemoglobin Ac (HbA1c) value, which is used to identify people with diabetes. Eighty-two percent of the patients in the program saw improvements in their blood sugar levels and overall health outcomes, including a 10% reduction in HbA1c.

2 AWARD OF EXCELLENCE: POST-ACUTE CARE Issaquah Nursing and Rehabilitation Center, Issaquah, Washington Reducing Antipsychotic Use in Dementia Patients Submitted by: Lisa B. Stubenrauch, Administrator When staff at Issaquah Nursing and Rehabilitation Center identified that 33.9 percent of their dementia patients were taking antipsychotic drugs that were not serving their prescribed purpose, they determined that such unnecessary drugs should be eliminated. Use of antipsychotics in the elderly can cause an increase in adverse events, including falls resulting in fractures, decreased overall health, hospitalizations, and death. They are also costly: in 2012, Medicare Part D plans paid approximately $363 million for antipsychotic drugs used by enrollees age 66 and older with dementia. In response to these factors, Issaquah staff initiated a project on January 1, 2015, to reduce the use of antipsychotic medications administered to dementia patients to less than 10 percent by December 31, Stakeholder education formed the core of this effort: staff distributed the American Health Care Association (AHCA) consumer fact sheet about antipsychotic use to families; facilitated staff training, including videos on nonpharmacologic interventions for behaviors; and initiated physician training, incorporating federal regulatory guidance, facility standards, and non-pharmacologic interventions. As a result of these efforts, antipsychotic use at the facility decreased from 33.9 to 3.5 percent. AWARD OF EXCELLENCE: PHARMACY Kelley-Ross Pharmacy Group, Seattle, Washington Heart 2 Heart, Improving Outcomes and Decreasing Readmissions for Heart Failure Patients through Integrated Pharmacist Home Visit Model Submitted by: Joshua Akers, PharmD, BCACP, Pharmacy Manager and Residency Program Director One in every four heart failure patients discharged from the hospital will readmit to the hospital within 30 days. Kelley-Ross Pharmacy Group noted that, despite the prevalence of proposed health system changes and interventions to improve the transition outcomes of discharged heart failure patients, reducing readmission rates continues to be a challenge. Identifying that medication issues and patient understanding of the discharge plan are the most commonly cited causes for readmissions, Kelley-Ross sought to provide an in-home medication coaching program for patients with heart failure discharged from the hospital, with the aim of reducing medication-related problems and, as a result, readmissions. Through the coaching program, each patient generally receives three in-home visits and three follow-up phone calls over three months. Staff worked with the Virginia Mason Medical Center (VMMC) cardiology department to identify patients at the time of discharge and documented all pharmacist-patient encounters within the VMMC electronic health record (EHR) to allow for improved communication. As a result of Kelley-Ross s 50-patient pilot, VMMC s 30 day all-cause readmission rate for heart failure patients fell from 22.1% to 8%.

3 AWARD OF EXCELLENCE: OUTPATIENT Mason General Hospital Olympic Physicians, Shelton, Washington Improving the Rate of Colon Cancer Screening in a Rural Underserved Population Patients Years Old Submitted by: Peggy Moore, Clinic Manager, and Tracy Skinner, QI Team Lead Colon cancer is a growing threat nationwide, with 95,520 new cases of colon cancer identified in the U.S. in As with most types of cancer, early detection is crucial. But in Mason County, screening rates for colon cancer have been historically low 22% in In an effort to improve rates of detection, Olympic Physicians, the health clinic affiliated with Mason General Hospital, implemented a quality improvement project founded on outreach and assistance for patients ages 50 to 75. As part of the process, medical assistants were trained to educate patients about the different types of colon cancer screening tests available and provide guidance on which method would be most appropriate for their needs. Using a combination of EMR modifications and tracking, medical assistants were able to reach out to patients in need of screening, place orders for screenings, and update the patient records when screenings had been completed. To further increase rates, they mailed the ifit home screening test kit to patients, following up by phone until it was returned. A colonoscopy referral tracking system, in partnership with specialty providers, assisted in better streamlining the flow of information between GI providers and primary care. Two years into Olympic Physicians effort, Mason County has a 62.7 % rate of colon cancer screening, and a declining rate of colon cancer overall. AWARD OF EXCELLENCE: OUTPATIENT Swedish Medical Group, Seattle, Washington Effectiveness of an Electronic Medical Reminder for Hepatitis C Screening Submitted by: Claire Allen, Program Supervisor Hepatitis C is the leading cause of hepatocellular carcinoma and cirrhosis, affecting approximately three million Americans. Despite significant health benefits to diagnosing hepatitis C early, the diagnosis is often delayed or missed, leading to higher likelihood of hospitalizations and death. The U.S. Preventive Services Task Force recommends hepatitis C screening for all adults born between 1945 and 1965; however, screening rates in primary care patient populations remain low. Seeking to increase hepatitis C screening rates across its patient population, Swedish Medical Group implemented an electronic medical record (EMR)-based reminder designed to prompt providers at the time of visit of the patient s hepatitis C screening status. Using the EMR reminder as the only intervention with a cohort of 75,014 patients, Swedish staff saw its hepatitis C screening rates increase from a baseline of 12% in May 2015 to 51.9% in December 2016.

4 AWARD OF EXCELLENCE: LARGE HOSPITAL Virginia Mason Medical Center, Seattle, Washington Journey to Never Land A Project to Eliminate Central Line- Associated Bloodstream Infections Submitted by: Jamie Moran, MSN, RN, CIC, Director of Quality, Safety and Infection Prevention Central line-associated bloodstream infections (CLABSIs) are among the most serious and costly preventable healthcare-associated infections, resulting in thousands of deaths and billions of dollars in added costs to the healthcare system in the U.S. each year. When Virginia Mason Medical Center identified that the hospital s 2014 and 2015 CLABSI rates were higher than median national rates, they used the information as a catalyst: eliminate CLABSIs acquired by patients in the hospital. Using the Virginia Mason Production System (a patient-focused, process improvement methodology), staff implemented several key changes: they (1) limited the operators allowed to access central lines for blood draws; (2) reduced the indications for central lines to those with an evidence base; (3) improved knowledge and awareness of CLABSIs and prevention practices among patients and team members; and (4) moved CLABSIs into never event status, requiring executive-level case review and accountability for corrective actions. As a result of the project, VMMC experienced a 66% relative improvement in the 12-month standardized infection ratio (SIR), with only four patients experiencing a CLABSI in 2014 compared to 17 patients in 2014 and 15 patients in The improvement resulted in a collateral 77% relative reduction in 12-month SIR for drug-resistant bacteremia, and potential savings of more than $369,000, with 186 fewer excess hospital days in AWARD OF EXCELLENCE: HEALTH SYSTEM Virginia Mason Medical Center, Seattle, Washington Early Recognition and Treatment of Sepsis Submitted by: Alice Ferguson, RN, Project Manager Sepsis is the leading cause of patient death at Virginia Mason Medical Center and nationally. Additionally, patients who survive sepsis typically have longer lengths of stay, have high rates of readmission, and can suffer from long-term related effects. Focused on research showing that speed is life in sepsis treatment, Virginia Mason began working to reducing in-hospital sepsis-related morbidity and mortality by improving the consistency and timeliness of sepsis care. Recently, the team designed and implemented an innovative sepsis program that not only includes physician tools and processes, but also empowers the bedside nurse in recognizing and initiating treatment. Through team-based processes in the emergency department (ED) and hospital, staff focus on identifying sepsis and completing initial treatment within one hour. Since the project began, VMMC has achieved a median time from sepsis identification to antibiotic administration (the most critical element) to 47 minutes in the ED and 67 minutes in the hospital, and began work in 2017 to expand sepsis care to ambulatory clinics. Additional successes resulting from the program included a decrease in hospital rapid response calls, from 120 per month to 35 with no increase in Code Blues, and a decline in sepsis mortality, from roughly 13% to 9%.

5 ABOUT QUALIS HEALTH Qualis Health is one of the nation s leading population health management organizations, and a leader in improving care delivery and patient outcomes, working with clients throughout the public and private sectors to advance the quality, efficiency and value of healthcare for millions of Americans every day. In Washington, Qualis Health serves as the Quality Innovation Network Quality Improvement Organization (QIN QIO) and the Quality Payment Program Small and Underserved/Rural Support (QPP-SURS) contractor for the Centers for Medicare & Medicaid Services (CMS), serves as the Healthier Washington Practice Transformation Support Hub under contract to the Washington Department of Health (DOH), co-leads Healthy Hearts Northwest funded by the Agency for Healthcare Research and Quality (AHRQ), serves as the External Quality Review Organization (EQRO) for Washington Medicaid, and provides utilization and case management services to the Washington Department of Labor and Industries. For more information, visit