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New Jersey Hospital Improvements Save Lives and Dollars

ACA initiative in 63 Garden State facilities leads to better results for patients and significant savings overall

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Patient safety improvements at New Jersey hospitals averted tens of thousands of harmful incidents and saved more than $640 million in healthcare costs over the past five years, according to a trade group report released Wednesday.

And while the improvements were achieved under the federal Affordable Care Act — now on the chopping block in Washington, D.C. — officials with the New Jersey Hospital Association, which has overseen the project, said Garden State facilities are among 16 groups nationwide scheduled to continue this work for several more years with funding from Medicare, a program not currently being targeted for reform.

The NJHA’s “Partnership for Patients” progress report notes that between 2012 and 2016 hospitals here halved the number of patients who suffered from bad drug reactions or interactions, experienced blood clots, or chose to give birth before 39 weeks of pregnancy — a decision that can lead to developmental difficulties for an infant. The data also revealed that a 30 percent drop in hospital readmissions avoided nearly $582 million in additional healthcare costs, while a 38 percent drop in bedsores saved the system more than $34 million.

Tackling ‘different areas of harm’

The advances reflect a concerted effort among the 63 participating hospitals to drill down on the data related to a bakers’ dozen of “adverse events” and to share best practices to improve outcomes, NJHA leaders explained. “There are many different areas of harm that we’ve been working on and we have a lot of different strategies to tackle these,” said Shannon Davila, a nurse with the NJHA who specializes in infection prevention.

Davila and Aline Holmes, a nurse who serves as the NJHA’s senior vice president for clinical affairs, said hospital employees share knowledge through webinars, in-person lessons and various data-based tools that allow them to see what has worked for others in the field. The project “empowers healthcare providers to implement evidence-based best practices in care at the bedside and throughout organizations,” Holmes said.

The program, launched by the federal Centers for Medicare and Medicaid Services in 2011, builds on a growing understanding of how medical errors and low-quality care can have a lasting impact on patient outcomes as well as on healthcare costs. It was one of many initiatives included in the ACA to encourage providers to work together on more effective, efficient care concepts that have yet to be included in proposals under debate to replace the landmark law.

The NJHA was one of more than two dozen entities awarded federal contracts for this work and has been paid $10.3 million for its role so far. The new contract will provide the group $4 million over the next two years, the NJHA said.

Sepsis rates have fallen

Initial results from the first few years, released in September 2015, were encouraging, the NJHA said: surgical site infections related to knee replacements fell by 72 percent and colon surgeries were cut in half. Hospitals also brought down the rate of early elective deliveries by 70 percent, something that was particularly important to healthcare experts concerned about New Jersey’s traditionally high rate of these induced births and C-sections, a surgical procedure that can cause complications for both mother and baby.

“We saw some early success with that,” Davila noted, praising hospital leaders for their commitment to improving outcomes and staff members who have worked hard to reduce adverse events.

New Jersey facilities have also made good progress reducing the rate of sepsis, a potentially deadly systemic infection that tends to affect vulnerable patients when hospitalized. Sepsis rates have dropped more than a quarter over the five years, sparing more than 3,330 patients from inflammation, organ failure or worse, according to the new report.

In fact, sepsis has also been the focus of a separate but related NJHA campaign Surviving Sepsis, that involves similar cross-hospital collaboration and has helped New Jersey hospitals cut their sepsis mortality rate by 11 percent — halfway to their goal of a 20 percent decline. “We had a big push for that and we were able to reduce our sepsis mortality rate over time,” Davila said, calling the shift “one of our great successes.”

Hospital readmissions down

Garden State hospitals are also making progress to reduce the number of hospital readmissions, a quality indicator that the NJHA said has proved difficult for facilities here to improve. In 2015, the federal government penalized all but one New Jersey hospital for high rates of returning patients, making it the state with the highest share of hospitals that faced fines nationwide. (Bergen Regional Medical Center, a large facility that treats many patients with significant behavioral health issues, was not penalized.)

According to “Partnership for Patients,” readmission rates have dropped from 10.6 percent to 7.4 percent in five years — a 30 percent decline. As a result, more than 66,000 patients were able to avoid a return trip to the hospital, a shift that accounted for the vast majority of the overall cost savings.

Other gains noted in the report:

  • 45 percent decline in catheter-associated urinary tract infections, sparing 94 patients and saving $94,000

  • 43 percent drop in injuries related to falls or immobility, a benefit to 833 patients and saving $552,000

  • 34 percent decline in adverse events related to vaginal births, an improvement in care for 1,269 patients that generated more than $3.8 million in savings

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