The Centers for Medicare & Medicaid Services (CMS) established the National Patient Safety Initiative (NPSI) under its 9th Statement of Work (SOW) for quality improvement organizations (QIOs), which began August 2008. As part of this initiative, all 53 QIOs are working with hospitals across the nation to reduce rates of methicillin-resistant Staphylococcus aureus (MRSA) infection by using evidence-based tools and methods to help improve systems and processes. Since 2008, the NPSI has directly benefited more than 120,000 patients in hospitals and nursing homes that participate in the initiative.
Focused on health care safety improvements, QIO projects in the last SOW covered surgical care, heart failure, pressure ulcers and restraints in nursing homes. Now, the QIOs are building on these successes and existing relationships to tackle MRSA and other aspects of patient protection.
MRSA causes approximately 94,000 serious infections and 19,000 deaths in the United States each year. Of these, 86% are health care associated and 14% are community associated. The Centers for Disease Control and Prevention (CDC) reports that MRSA infection as a proportion of all staph infections has gone up dramatically in the last few decades. This increase is alarming, given the challenges of treating antibiotic-resistant infections.
Each QIO has designated National Quality Improvement Leaders who serve as patient safety champions, working on MRSA and other NPSI projects, and spearheading patient safety initiatives in each state. These leaders meet with one another throughout the year to stay current on evidence-based interventions and to share best practices.
The leaders and their teams provide hospitals with one-on-one technical assistance that enables them to establish an organization-wide culture of patient safety. They also help them design strategies to improve clinical processes, and provide data reports to help motivate provider action and benchmark success.
Each participating hospital must establish and implement a MRSA monitoring program, and must secure the support of the facility’s chief executive. The QIO works to reduce MRSA rates in one unit of the hospital, such as the intensive care unit.
QIO technical support is customized to match the improvement goals of each participating hospital. The QIO might, for example, lead a root cause analysis to identify where processes of care should be changed in order to improve performance. A combination of on-site consultation, phone support, teleconferences, webinars and in-person learning sessions help each facility reach its goals. In some cases, QIOs have collaborated with local hospital associations to design professional and public education tools, as well as to recruit participants.
Among the improvement tools available to hospitals in some states is a MRSA “bundle.” A bundle is a group of evidence-based best practices related to a specific disease process that, when implemented together, result in better outcomes than when implemented individually. The MRSA bundle includes eight required practices — such as the development of a laboratory-based alert system, use of CDC hand hygiene guidelines, equipment disinfection, and patient education following MRSA identification – as well as four supplemental practices.
Patients and hospital visitors play a key role in this project. QIOs have created tools, such as fact sheets and posters, that hospitals use to educate them about their role in infection control. QIOs have also developed positive reinforcement tools for hospital staff, as well as educational materials such as employee newsletter article templates and videos.
CMS has set specific objectives that QIOs must meet by the end of the MRSA project in July 2011, as well as interim goals. While the data are not yet in, it is expected that the evidence-based practices implemented as a result of QIO-led activities will have a significant impact on both quality of care and health care costs across the nation.
Harry M. Feder, MPA, the chief operating officer for IPRO, is responsible for the monitoring and assessment of health care provided to Medicare, Medicaid, and private patients across the continuum of care.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 9SOW-NY-THM6.2-10-92