Ohio quality project shows success with cardiac health

Hospitals and business leaders put their heads together and lower the number of deaths caused by heart attacks.

By Andis Robeznieks, amednews staff. Dec. 16, 2002.

Business leaders in the Dayton, Ohio, area retreated from their plan to publish hospital outcome data, and their efforts to launch a health plan with quality performance bonuses is moving forward at glacial speed. Yet despite these setbacks, they're getting credit for helping save 150 lives.

Working together, the Tri-River Employers Healthcare Coalition and five hospitals in the Greater Dayton Area Hospital Assn. helped reduce heart attack deaths by 36% in their community over three years.

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"It's been a communitywide effort that I think is reproducible in other communities," said Stephen House, MD, director of clinical management at Kettering Medical Center. "We started looking at processes all along the line -- not just the ER and cardiology. Everyone looked at the whole process and said: 'Guys, we can do better than this.' "

Dr. House, who is the vice chair of the AMA's Organized Medical Staff Section, said there were opportunities for built-in excuses, such as serving a large population of Medicare patients with do-not-resuscitate orders. But he said pressure from the business community -- including talk of publishing hospital outcome data -- ignited the competitive nature of the physicians and led to positive results.

Heart attack deaths were reduced 36% over 3 years.

Business leaders "may have driven the process," Dr. House said. "If they weren't at the table, we may have looked at the data and said: 'Big deal, we have sicker patients.'

"But the whole threat of publishing hospital-specific data raised the bar and increased competition," he added. "All the hospitals got aggressively competitive, and the docs became competitive. Most of the doctors work at a specific hospital and thought: 'It's my hospital; I don't want it to look bad.' "

Instead, they made their hospitals look good. So good, in fact, that the Joint Commission on Accreditation of Healthcare Organizations recognized the hospital association with its Ernest A. Codman Award, which honors excellence in the use of outcomes measurement to make quality and safety improvements in health care.

Technology played a role

Dr. House credited a new computer network that collected and distributed information in three-month intervals with helping make the effort work.

"I think the rapid turnaround of data is very important, because you can't get data a year and a half later and expect to do much with it," he said. "If you get data in a rapid fashion, you can look at care issues instead of just outcomes."

Using the data, efforts were made to improve "door-to-ECG times," compare percutaneous coronary and thrombolytic interventions, and implement basic strategies such as giving patients aspirin while they're in the ambulance. Now that the system is in place, Dr. House said efforts would continue to improve acute myocardial infarction care, and improvements for treatment of congestive heart failure and community-acquired pneumonia are in the works.

In the meantime, the Tri-River Employers Healthcare Coalition -- which includes 15 companies providing benefits to some 35,000 area residents -- will continue its effort to build membership in its health plan, which is based heavily on adhering to certain performance measures and awarding financial incentives to those who do.

Incentive money comes from a pool into which each purchaser pays $2 per member each month. But since there are only about 1,500 members (covering about 2,800 people), the pool is not very deep. There is about $18,000 to $20,000 in the pool now, but officials are optimistic this will grow. "We're sure hoping it does," said coalition Executive Director Tom Hickey. "We've put in some very defined quality objectives, and we're using that as a motivator to drive quality care."

Hickey said business leaders believe improving quality eventually will provide "some relief" to high health care costs. Dr. House agreed but said physicians have to take it upon themselves to drive the process.

"Change ought to be driven by the medical community instead of the business community because, obviously, they have better understanding of the issues in patient care," Dr. House said.

"Quality is a physician-driven process. It has to be driven by physicians who take the evidence and apply it so patients get optimal care."

ADDITIONAL INFORMATION:

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Profile of the Tri-River Employers Healthcare Coalition, from the National Health Care Purchasing Institute (http://www.nhcpi.net/tririver.cfm)

Profiles of Codman Award winners, in pdf, from the Joint Commission (http://www.jcaho.org/accredited+organizations/codman+award/02_codman+award+winners.pdf)