Improve the Health Care System

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Combatting Antibiotic Resistant Bacteria through Antibiotic Stewardship in Communities

The development of antibiotics revolutionized the field of medicine, but with broad use in clinical practice, has come antibiotic resistance. Central to a comprehensive program to combat antibiotic-resistant bacteria is antibiotic stewardship, also referred to as antimicrobial stewardship, within health care systems and throughout the health care community. Antibiotic stewardship is a program that allows health care facilities to monitor, reduce and prevent misuse and/or overuse of antibiotics within a healthcare system using a multidisciplinary team and strategic approach. Quality Innovation Network – Quality Improvement Organizations (QIN – QIOs) are spreading the principles of antibiotic stewardship in outpatient settings at the point of care where antibiotics are prescribed. QIN – QIOs provide outreach and education and technical assistance to practitioners, pharmacists, healthcare system leadership and most importantly, Medicare beneficiaries. QIN – QIOs are also helping to carry out the recommendations of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria by forming, lending and/or participating in critical partnerships with state and local agencies, private-sector organizations, patient advocacy groups and other entities engaged in this important work.

Reducing Healthcare-Acquired Conditions in Nursing Homes

Through the National Nursing Home Quality Care Collaborative, QIN-QIOs support system-wide improvement. The Collaborative aims to improve resident satisfaction through prevention of Healthcare-Acquired Conditions (HACs) like pressure ulcers and falls. Thousands of nursing homes across the U.S. participated in the first national Collaborative from 2012 to 2014 and many continue to take part in the latest Collaborative that began in April 2015. All nursing homes nationwide are encouraged to participate.

QIN-QIOs lead the Collaborative within their state or region. Its mission supports development of strategies for overall quality using QAPI as the framework, utilizes a data-driven and proactive approach to quality improvement, and allows flexibility for each nursing home to target their own priority areas.

QIN-QIOs provide training and tools based on the best clinical, management, and leadership practices of high-performing nursing homes. Additional resources are available for several focus areas, which include increasing mobility among long-stay residents, decreasing unnecessary antipsychotic use for residents with dementia, preventing avoidable hospitalizations, and decreasing HAIs and other HACs. QIN-QIOs supplement Collaborative activities with focused technical assistance to help facilities implement what they have learned.

Promoting Effective Care Coordination and Communication

The QIO Program has made great strides in helping providers and communities reduce avoidable admissions and readmissions by improving the quality of care transitions. Their efforts resulted in approximately $1 billion in costs savings between 2011 and 2014, indicating  an increase in the number days beneficiaries remain in their home. QIN-QIOs are uniquely positioned to spark and strengthen community-based care coordination initiatives due to their experience with convening acute and post-acute providers, practitioners, pharmacies, long-term care services and supports, patients and advocates, and other local stakeholders.

Medication safety in all healthcare settings is essential to care coordination and the health of Medicare beneficiaries. Adverse drug events (ADEs) are a leading cause of preventable patient harm.  Poorly coordinated care can be a significant contributor to ADEs, particularly when multiple providers prescribe medications that could conflict and complicate the patient’s condition. ADEs cause unnecessary stress on the patient and the healthcare system and may contribute to:

  • Unnecessary diagnostic tests
  • Avoidable hospital admissions/readmissions
  • Preventable doctor’s office or ER visits
  • Unneeded treatment
  • Lost patient productivity
  • Patient death

Between 2011 and 2014, QIO Program efforts to improve care transitions helped avoid approximately 44,640 potential ADEs.