NJ Hospitals Improve Care for Thousands of Patients Through ACA-Funded Effort

Andrew Kitchenman | September 28, 2015 | Health Care
Partnership for Patients drives decline in hospital-acquired conditions, readmissions

Aline Holmes, senior vice president of clinical affairs for the New Jersey Hospital Association
Patients staying in a New Jersey hospital are less likely to get an infection or bedsores than they were several years ago, according to a broad range of measures.

That improvement is being driven by Partnership for Patients, a program funded through the Affordable Care Act that teaches hospital personnel how to better protect patients from a range of hospital-related conditions. The program comprises 17 national, regional, and state organizations and in New Jersey is overseen by the New Jersey Hospital Association, serving 62 hospitals.

The state saw improvements across 14 measurements in the last three months of 2014, compared with data from 2010 and 2011. Perhaps most important was a 7.7 percent drop in readmission, which is estimated to have avoided 8,811 cases in which patients had to return to the facility that discharged them and saved $84 million. The federal government is looking to continue this success — which was matched nationally — by awarding $110 million to the 17 participating organizations for the next year. (How much of that funding will go to New Jersey is not yet known.)

Advocates for improving healthcare quality have long pointed to hospital-acquired conditions such as infections as areas where the healthcare system could do a better job. For example, the program can spread best practices that have been shown to be successful in some hospitals.

This appears to be supported by the experience in New Jersey, which saw some dramatic results. The surgical-site rate of infections for total knee replacements fell by 72 percent, while the rate for colon surgeries fell 54 percent. The state also reduced the number of early, induced-labor deliveries by 70 percent.

The association has held face-to-face learning sessions in which doctors and nurses shared their experiences in reducing the spread of infections and other preventable problems.

NJHA Senior Vice President Aline Holmes said she was encouraged by the results.

“It means better care, shorter hospital stays, and better patient outcomes,” said Holmes, who oversees clinical care for the association. “I’m especially proud of the areas like surgical-site infection rates and birth issues like early elective deliveries, where New Jersey hospitals not only have improved their results over time but have also performed much better than the national average.”

[related]Federal Centers for Medicare & Medicaid Services (CMS) officials said that in the second round of funding, announced on Friday, the organizations would be required to conduct intensive training to teach and support hospitals in making patient care safer; give technical assistance to help hospitals achieve quality measurement goals; and establish, implement, and improve the system to track and monitor hospitals’ progress in quality improvement.

Other areas that saw improvements include: the percent of patients that had a level of warfarin (known by the brand name Coumadin) outside of the therapeutic range, which fell from 10.4 percent to 6.5 percent; the rate of catheter-associated urinary tract infections, which fell from 2.27 per 1,000 days that patients had catheters to 1.72; and the rate of central-line associated blood-stream infections, which fell from 1.4 per 1,000 days to 1.07.

The number of patient falls per 1,000 days dropped from 3.1 to 2.76; the number of birth traumas per 100 live births fell from 0.23 to 0.19; and the number of bedsores fell from 1.79 per 1,000 patients discharged to 1.39. The state also saw improvements in obstetric trauma rates, surgical-site infection rates for hysterectomies, and post-operative deep-vein thrombolism or pulmonary embolism rates.

Holmes noted that New Jersey has had a high rate of readmissions, which she attributed to socioeconomic factors in the state’s cities.

“There are numerous personal economic factors that affect whether a patient may return to the hospital after an initial stay, such as whether a patient can afford prescriptions or whether transportation is available for follow-up appointments,” she said. “But the good news is that New Jersey hospitals are making progress,” resulting in reduced healthcare costs.

New Jersey was last in the country this year in the share of hospitals that were penalized by CMS for having too many patient readmissions. New Jersey’s average penalty of 0.72 percent of Medicare reimbursements was sixth-highest in the country.