Past Special Studies

PBS Remaking American Medicine—Hispanic/Latino Focus

HSAG was awarded special funding from the Centers for Medicare & Medicaid Services (CMS) to assist in promoting a four-part public television series entitled Remaking American Medicine (RAM), which aired in 2006–2007. HSAG partnered with the quality improvement organization (QIO) in California during that period, to build local coalitions in support of the broadcast and to showcase innovative work that QIOs were doing in reaching out to underserved populations in their communities. HSAG highlighted diabetic care quality improvement efforts among Arizona's Hispanic population.

Locally, HSAG worked in partnership with the Arizona Medical Association, the Arizona Partnership for Implementing Patient Safety, the Arizona Hospital and Healthcare Association, and others to support the series and highlight successful patient safety initiatives and the stories behind those efforts. For more information, visit  http://www.ramcampaign.org/default.htm

Identification and Synthesis of Components Essential to Achieving “High Performer” Status
in Various Provider Types

The High Performers Special Study was conducted by HSAG under contract with the Centers for Medicare & Medicaid Services (CMS). The overall goal of the study was to develop and implement a scientifically sound methodology to define and identify high-performing hospitals and those quality improvement practices, characteristics, and attributes that distinguish high performers from non-high performers.

Best Practice Methods

HSAG subcontracted with Qualis Health on a fourth study for "Best Practice Methods" to assist the Centers for Medicare & Medicaid Services (CMS) and the quality improvement organization (QIO) community in answering questions regarding best practice interventions used by external change agents to influence health care providers.

One-Day Admissions for Chest Pain (DRG 143) Project

In the United States, more than 4.4 million patients present to emergency departments with chest pain (DRG 143) each year. Many of these admissions do not have documented justification to support acute inpatient admission. Initiatives from the Centers for Medicare & Medicaid Services (CMS) are examining and correcting hospital underpayments and overpayments, including the DRG for chest pain.

HSAG and FMQAI (the Florida Medicare quality improvement organization), under contract with CMS, designed and implemented special projects in Arizona and Florida to reduce unnecessary hospital admissions for Medicare patients with chest pain. One commonality to both projects was the Case Management Protocol (CMP), successfully used in a 2004 CMS project conducted in Florida and later included in HSAG’s current special study, the Case Management Assessment Protocol Special Study.

For the 11 Arizona hospitals that worked with HSAG on this project, the rate for inappropriate one-day admissions for DRG 143 was reduced 42 percent from baseline to remeasurement and the absolute number for DRG 143 one-day admissions was reduced by 90 percent.

Translating VTE Guidelines into Practice Project

Venous thromboembolism (VTE) has been identified as one of the most preventable causes of hospital patient deaths. While evidence-based consensus guidelines for identifying hospital patients at risk for VTE have been available for over a decade, hospital medical patients are still not routinely screened for VTE risk or provided with appropriate prophylaxis to prevent VTE.
The goal of HSAG's "Translating VTE Guidelines into Practice" project, was to develop and pilot-test quality improvement tools and strategies that will improve providers' adherence to guidelines and decrease unnecessary morbidity and mortality in hospital medical patients at risk for VTE.

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Engaging Hospital Executives and Physician Leadership in VTE Prophylaxis Initiatives

During the course of this one-year project, HSAG addressed strategies to engage hospital executives and physician leadership in quality improvement initiatives for implementing appropriate venous thromboembolism (VTE) prophylaxis for hospitalized medical patients.

Up to 2 million Americans a year suffer from VTE, which includes deep-vein thrombosis (DVT) and pulmonary embolism (PE). DVT-related PE is the most common cause of preventable death in hospitalized patients, killing more Americans than AIDS and breast cancer combined. It is estimated that less than 30 percent of hospitalized patients receive prophylaxis within 30 days prior to a diagnosis of DVT.

Although technology, performance improvement methodology, and teams are all part of overall quality strategy, without strong leadership support even the most feasible changes are difficult to accomplish and sustain. In this project tools and strategies will be designed and tested to recruit and develop physician and hospital C-suite (chief executive officer, chief medical officer, chief financial officer, chief operating officer, chief quality officer, chief nursing officer, and chief information officer) champions for VTE prophylaxis.

Project objectives include:

1. Developing (and/or packaging) and testing a set of evidence-based materials for creating a sense of urgency related to the business case for VTE prophylaxis and engaging potential hospital C-suite champions.
2. Developing (and/or packaging) and testing a set of evidence-based materials for creating a sense of urgency related to the clinical case of VTE prophylaxis and engaging potential physician champions.
3. Identifying/developing and testing tools used to assess physician and C-suite leadership attributes associated with effective champions for change.
4. Establishing an effective approach/strategy used to recruit potential physician and C-suite champions for a VTE prophylaxis initiative.
5. Designing and producing physician and C-suite recruitment materials to complement and enhance the Translating VTE Guidelines Into Practice Resource Kit developed by HSAG under a previous study.

Case Management Assignment Protocol Special Study

HSAG participated in a six-state study that involved using a case management protocol for assigning bed status when a patient arrives at a hospital. Selected hospitals in each state learned how to modify their procedures for assigning and documenting the proper setting of care needed (inpatient or observation) when admitting a patient. Funded by the Centers for Medicare & Medicaid Services (CMS), the Case Management Assessment Protocol (CMAP) project was designed to reduce unnecessary short-stay hospital admissions and Medicare payment errors while assuring that patients received appropriate care. In addition to HSAG, quality improvement organizations (QIOs) in Florida, Nevada, New Mexico, Oregon, Utah, and Washington participated in this CMAP study. The project lead was the New Mexico Medical Review Association.

This special study expanded on the work that HSAG did in Arizona as part of the CMS Hospital Payment Monitoring Program that aimed to reduce the number of errors related to Medicare payments made to hospitals.

The Insulin Initiation and Adherence Study

HSAG worked in partnership with the El Rio Community Health Center in Tucson, Arizona to determine the effectiveness of transition coaching on adherence to insulin titration and maintenance in patients with type 2 diabetes mellitus.

Patients newly started on basal insulin are being recruited and provided coaching on use of medications, problem resolution, and interaction with their health care providers. Outcomes being examined include continued appropriate use of insulin, 30-day hospitalization, and level of knowledge about insulin use.

It is estimated that 280,000 Arizonans have diabetes. The prevalence of diabetes increases dramatically with age, with over 14 percent of Arizonans 65 years and older having diabetes compared to only 3.2 percent of Arizonans under 45 years of age.

The 2009 American Diabetes Association (ADA) practice standards recommend starting early insulin regimens in patients who have failed lifestyle interventions, yet insulin is a significant departure from usual oral-based care and poses the risk of nonadherence (it is estimated than only 63 percent of diabetics adhere to insulin regimens). A recent study conducted by Abt Associates suggests that increasing adherence by 10 percent can decrease health care costs by up to 28 percent, primarily due to decreased hospitalizations (up to 31 percent reduction).

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