Leveraging the Partnership for Patients' Initiative to Improve Patient Safety and Quality Within the Military Health System.

INTRODUCTION

Partnership for Patients (PfP) was a national initiative sponsored by the Department of Health and Human Services, Centers for Medicare and Medicaid Services, to reduce preventable hospital acquired conditions (HACs) by 40% and readmissions (within 30 days) by 20%, by the end of 2013 (as compared to the baseline of CY2010). Along with partners across the nation, the Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, pledged to support PfP in June 2011. Participation of the Military Health System (MHS) in PfP marked the implementation of the first enterprise-wide patient safety initiative.

MATERIALS AND METHODS

Three phases of the MHS initiative were developed to meet the aims of the national PfP initiative: (1) Planning and Design, (2) Implementation, and (3) Monitoring and Sustainment. The Planning and Design phase focused on the identification of evidence-based practices (Table III); the development of implementation guides; the implementation of various communication, education, and improvement strategies; and the development of methods by which to track progress and share successes. The implementation phase focused on identifying roles and responsibilities across all levels of care; creating, disseminating, and implementing evidence-based practices at participating military treatment facilities; and establishing a structured learning action network. Finally, during the monitoring and sustainment phase, per the guidance of the Agency for Healthcare Research and Quality, an overall HAC rate was developed for quarterly analysis. The HAC rate per 1,000 dispositions (i.e., discharges) was an aggregate of all PfP HACs. Using the HAC rate, the improvement rate was calculated by comparing the current quarter's HAC rate to the baseline (CY2010). This allowed the MHS to track the overall progress across the enterprise.

RESULTS

The MHS achieved a number of accomplishments, including a 15.8% cumulative reduction in HACs by the end of 2013, an 11.1% reduction in readmissions, avoided nearly 500 harm events since PfP implementation, and approximately $13.5 million in cost avoidance (on the basis of national cost estimate data available at the beginning of the PfP initiative).

CONCLUSION

The two most critical lessons learned for the MHS during the PfP initiative are (1) continuous leadership engagement and inspection is vital to ensure field workers are engaged with safety and quality expectations and (2) applying a "one-size-fits-all" approach to improve a large delivery system is not effective. In addition, it is most impactful when local military treatment facility-level teams are involved in determining strategies to implement evidence-based standard processes and protocols that reduce variation when integrating practice change into daily operations. The MHS will continue to integrate PfP efforts into improvement activities by leveraging lessons learned from this initiative and determining how they can be applied to other areas of care and/or patient safety and quality initiatives. The Patient Safety Improvement Collaborative has committed to oversee and support the establishment and implementation of ongoing, focused patient safety and quality initiatives across the MHS using a collaborative vision to engage all levels of leadership and staff, and to ensure sustained improvements.