Mohamad G. Fakih MD, MPH (is Chief Quality Officer, Ascension, Professor, Department of Internal Medicine, Wayne State University School of Medicine.), Florian Daragjati PharmD, BCPS (is Senior Director of Quality, Ascension.), Lisa K. Sturm MPH, CIC, FAPIC (is Senior Director, Infection Prevention, Ascension.), Collin Miller MS (is Manager, Data Analytics, Ascension Data Science Institute, Ascension.), Betsy McKenzie MBA (is Senior Director of Quality, Ascension.), Kelly Randall PhD, MSW (is Vice President of Patient Safety and Regulatory, Ascension.), Frederick A. Masoudi MD, MPSH, MACC, FAHA (is Chief Science Officer and Vice President of Research and Analytics, Ascension, and Professor, Department of Internal Medicine, Dell Medical School, University of Texas.), Jamie Moxham MSPH (is Director of Analytics, Ascension.), Subhangi Ghosh PhD, MS (is Senior Data Analyst, Ascension Data Science Institute, Ascension.), Jyothi Karthik Raja MS (is Senior Vice President, Chief Analytics and AI Officer, Ascension Data Science Institute, Ascension.), Allison Bollinger MD (is Vice President, Acute Clinical Care, Ascension.), Stacy Garrett-Ray MD, MPH, MBA (is Senior Vice President–Chief Community Officer, Ascension, and Adjunct Assistant Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine.), Maureen Chadwick PhD, RN, MSN, NE-BC3 (is Senior Vice President, Nursing, and Chief Nursing Officer, Ascension.), Thomas Aloia MD, MHCM, FACS, FACHE (is Senior Vice President, System Chief Medical Officer, Ascension.), Richard Fogel MD (is Executive Vice President, Chief Clinical Officer, Ascension. Please address correspondence to Mohamad Fakih)
{"title":"Optimizing and Sustaining Clinical Outcomes in 88 US Hospitals Post-Pandemic: A Quality Improvement Initiative","authors":"Mohamad G. Fakih MD, MPH (is Chief Quality Officer, Ascension, Professor, Department of Internal Medicine, Wayne State University School of Medicine.), Florian Daragjati PharmD, BCPS (is Senior Director of Quality, Ascension.), Lisa K. Sturm MPH, CIC, FAPIC (is Senior Director, Infection Prevention, Ascension.), Collin Miller MS (is Manager, Data Analytics, Ascension Data Science Institute, Ascension.), Betsy McKenzie MBA (is Senior Director of Quality, Ascension.), Kelly Randall PhD, MSW (is Vice President of Patient Safety and Regulatory, Ascension.), Frederick A. Masoudi MD, MPSH, MACC, FAHA (is Chief Science Officer and Vice President of Research and Analytics, Ascension, and Professor, Department of Internal Medicine, Dell Medical School, University of Texas.), Jamie Moxham MSPH (is Director of Analytics, Ascension.), Subhangi Ghosh PhD, MS (is Senior Data Analyst, Ascension Data Science Institute, Ascension.), Jyothi Karthik Raja MS (is Senior Vice President, Chief Analytics and AI Officer, Ascension Data Science Institute, Ascension.), Allison Bollinger MD (is Vice President, Acute Clinical Care, Ascension.), Stacy Garrett-Ray MD, MPH, MBA (is Senior Vice President–Chief Community Officer, Ascension, and Adjunct Assistant Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine.), Maureen Chadwick PhD, RN, MSN, NE-BC3 (is Senior Vice President, Nursing, and Chief Nursing Officer, Ascension.), Thomas Aloia MD, MHCM, FACS, FACHE (is Senior Vice President, System Chief Medical Officer, Ascension.), Richard Fogel MD (is Executive Vice President, Chief Clinical Officer, Ascension. Please address correspondence to Mohamad Fakih)","doi":"10.1016/j.jcjq.2024.11.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Optimizing outcomes of hospitalized patients anchors on standardizing processes in medical management, interventions to reduce the risk of decompensation, and prompt intervention when a patient decompensates.</div></div><div><h3>Methods</h3><div>A quality improvement initiative (optimized sepsis and respiratory compromise management, reducing health care–associated infection and medication risk, swift management of the deteriorating patient, feedback on performance, and accountability) was implemented in a multistate health system. The primary outcome was risk-adjusted in-hospital mortality. Secondary outcomes included health care–associated infections, patient-days with hypoglycemic and severe hyperglycemic episodes, and hospital onset (HO) acute kidney injury (AKI).</div></div><div><h3>Results</h3><div>A total of 2,015,408 patients were admitted to 88 hospitals over the 36-month study period. Overall mortality improved from the baseline observed/expected (O/E) of 0.97 in 2021 to 0.74 in 2023 (-23.4%; 4,186 fewer deaths, <em>p</em> < 0.001). Controlling for baseline (2021) mortality O/E ratios, the mean mortality O/E ratio for 2023 was 0.74 for system and 0.84 for peers, representing a difference of -0.10 (<em>p</em> < 0.001, 95% confidence interval [CI] 0.12 – -0.07], with 1,807 fewer deaths). The standardized infection ratio declined for central line–associated blood stream infections by 24.8% (0.58; 88 fewer events), catheter-associated urinary tract infections by 30.6% (0.44; 98 fewer events), HO methicillin-resistant <em>Staphylococcus aureus</em> bacteremia by 29.0% (0.72; 67 fewer events), and HO <em>Clostridioides difficile</em> infection by 35.1% (0.36; 311 fewer events) in 2023 compared to 2021. HO AKI episodes dropped by 6.2% (8.6%; 1,725 fewer events), and patient-days with hypoglycemia and severe hyperglycemia decreased by 5.8% (4.0%; 4,840 fewer events) and 22.8% (5.2%; 30,065 fewer events), respectively.</div></div><div><h3>Conclusion</h3><div>This systemwide initiative focusing on standardizing processes, feedback on performance, and accountability was associated with sustainable improvements in mortality and a reduction in infectious and safety events.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 86-94"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024003672","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Optimizing outcomes of hospitalized patients anchors on standardizing processes in medical management, interventions to reduce the risk of decompensation, and prompt intervention when a patient decompensates.
Methods
A quality improvement initiative (optimized sepsis and respiratory compromise management, reducing health care–associated infection and medication risk, swift management of the deteriorating patient, feedback on performance, and accountability) was implemented in a multistate health system. The primary outcome was risk-adjusted in-hospital mortality. Secondary outcomes included health care–associated infections, patient-days with hypoglycemic and severe hyperglycemic episodes, and hospital onset (HO) acute kidney injury (AKI).
Results
A total of 2,015,408 patients were admitted to 88 hospitals over the 36-month study period. Overall mortality improved from the baseline observed/expected (O/E) of 0.97 in 2021 to 0.74 in 2023 (-23.4%; 4,186 fewer deaths, p < 0.001). Controlling for baseline (2021) mortality O/E ratios, the mean mortality O/E ratio for 2023 was 0.74 for system and 0.84 for peers, representing a difference of -0.10 (p < 0.001, 95% confidence interval [CI] 0.12 – -0.07], with 1,807 fewer deaths). The standardized infection ratio declined for central line–associated blood stream infections by 24.8% (0.58; 88 fewer events), catheter-associated urinary tract infections by 30.6% (0.44; 98 fewer events), HO methicillin-resistant Staphylococcus aureus bacteremia by 29.0% (0.72; 67 fewer events), and HO Clostridioides difficile infection by 35.1% (0.36; 311 fewer events) in 2023 compared to 2021. HO AKI episodes dropped by 6.2% (8.6%; 1,725 fewer events), and patient-days with hypoglycemia and severe hyperglycemia decreased by 5.8% (4.0%; 4,840 fewer events) and 22.8% (5.2%; 30,065 fewer events), respectively.
Conclusion
This systemwide initiative focusing on standardizing processes, feedback on performance, and accountability was associated with sustainable improvements in mortality and a reduction in infectious and safety events.
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