(Skokie, Ill.) April 2, 2018 – AAAHC recently honored a primary care center in Arizona and a surgical center in Connecticut for their exemplary work in quality improvement studies. The prestigious Bernard A. Kershner Innovations in Quality Improvement Award recognizes AAAHC-accredited organizations that successfully implemented meaningful changes in their operations to boost quality of care, patient safety and overall efficiency.
Representatives from the winning organizations received the award – named for Bernard A. Kershner, a leader in ambulatory health care and distinguished past Chair of the AAAHC Institute Board of Trustees – at the 2018 Achieving Accreditation conference on March 17 in Tampa, Fla.
AAAHC-accredited primary care and surgical/procedural organizations submitted detailed descriptions of completed quality improvement studies, and an expert panel identified three finalists in each category from the submissions.
In the primary care category, the winner, Winslow Indian Health Care Center, implemented a comprehensive study to improve medication reconciliation during the transition of care process from hospital to ambulatory care and reduce readmission rates. The surgical/procedural care winner, Danbury Surgical Center, conducted an efficiency study to reduce pharmaceutical costs while maintaining quality of care.
“The Kershner Awards recognize the top quality improvement studies that demonstrate the importance of finding new ways to continually advance patient safety and clinical care,” said Naomi Kuznets, Ph.D., vice president and senior director for AAAHC Institute. “The AAAHC Institute is excited to showcase this year’s QI winners and their proven strategies to lower costs and readmissions.”
2017-18 Bernard A. Kershner Primary Care Winner
“Transition of Care Service: Post-Discharge Medication Reconciliation”
Winslow Indian Health Care Center
The Challenge: Implementing a routine medication reconciliation after hospital discharge is vital to preventing medication errors and ensuring safe patient use of the medications. When properly enacted, these routines resolve discrepancies, reduce the risk of adverse drug interactions, and help eliminate duplication and complexity of a medication regimen. Medication reconciliation also increases patient adherence to regimens and reduces hospital readmission rates. Medicare reports spending $17.8 billion a year on patients whose return trips to the hospital could have been avoided through adequate processes including medication reconciliation. The Winslow Indian Health Care Center spent $1.9 million on inpatient services in FY 2015, negatively impacting the center’s funding for indirect services. The goal of the study was to implement a medication reconciliation and transition of care program that would reduce readmission rates at the facility to the national average of less than 20 percent of hospital admissions.
The Solution: The Winslow Indian Health Care Center conducted an extensive chart review for hospital readmissions, for FY 2014, to identify sources of the high rates. The review found hospital readmissions were attributed to low rates of medication compliance, omission of chronic disease treatment, duplicate prescriptions and limited communication between inpatient and outpatient medical providers. The pharmacy developed a medication reconciliation program for discharge medications with a focus on patients with the top four conditions for readmissions based on the rate data. The transition of care plan included written policies and procedures which defined roles for the pharmacists, physicians, patient care coordinators and public health nurses, and steps for working together in a collaborative process.
The Result: After implementing the transition of care and medication reconciliation program, readmission rates decreased from 33 percent in FY 2014 to 10 percent in FY 2016. The drop in readmission rates lowered the costs associated with inpatient services and improved the overall health of the patients by monitoring adherence to medication therapy.
2017-18 Bernard A. Kershner Surgical/Procedural Care Winner
“Cutting the Cost on Miochol™-E”
Danbury Surgical Center
The Challenge: During routine cataract removal, iridectomy and penetrating keratoplasty surgery, the surgeon uses Miochol™-E to obtain intra-operative miosis. The alternative option, Miostat®, is available at a fraction of the cost. Before switching to the lower cost option, the ophthalmologists at the center requested clinical evidence that Miostat® is not associated with post-op nausea and vomiting. The goal of the study was to reduce pharmaceutical costs by switching from Miochol™-E to Miostat® during routine ophthalmologic surgery, while ensuring post-op comfort.
The Solution: The quantity and cost of Miochol™-E was tabulated from October 2015 through September 2016. The annual estimated quantity and cost of Miostat® was calculated and compared to that of Miochol™-E; it represented $24,415 in potential savings per year. For a two-month period, the ophthalmologists at the center agreed to substitute Miostat® for Miochol™-E and monitor for adverse reactions. Registered nurses conducted brief post-op interviews with patients who received Miostat®, to determine if there was any correlation between the medication and post-op nausea and vomiting.
The Result: At the end of the test period, no significant correlation was found between the use of Miostat® and post-op nausea and vomiting. Ophthalmologists agreed to switch exclusively to Miostat®, which generated $27,175 in savings – surpassing the estimated cost reduction.
The winners were selected from a diverse pool of highly-competitive quality improvement study submissions. The expert panel also noted four programs deemed finalists for the Kershner Award:
2017-18 Primary Care
· “Travel to Obtain Healthcare and USCG C-130 Hercules Aircraft Utilization”
HSWL Kodiak, Rockmore-King Clinic
· “Narcotic Prescribing in Primary Care: System Level Changes to Help Manage the Opioid Crisis”
West Allis, Wisc.
2017-18 Surgical /Procedural Care
· “Using CO2 for Insufflation to Reduce Patient Discomfort”
Fort Worth Endoscopy Center
Fort Worth, TX
· “Reducing Immediate Use Steam Sterilization”
Ophthalmology Surgery Center of Dallas
People’s Choice Winners
In addition to the expert panel choices for winners, attendees at a recent AAAHC Achieving Accreditation meeting reviewed all six finalists’ posters and voted on their own choices for top submissions.
2017-18 Peoplel’s Choice Primary Care Winner
“Travel to Obtain Healthcare and USCG C-130 Hercules Aircraft Utilization”
HSWL Kodiak, Rockmore-King Clinic
The Challenge: Most specialty care for patients on Kodiak Island are available offsite and require costly air travel to transport patients to and from facilities. The U.S. Coast Guard has an agreement with the Kodiak base medical center to provide patients in need of specialty care two flights per month off the island to Anchorage. The cost difference of traveling via military air travel vs. commercial air travel is significant and could generate $300,000 annually in medical travel savings. The goal of the study was to evaluate the opportunities to optimize access to military air travel and further increase savings.
The Solution: A task force convened to evaluate barriers to military air travel utilization and discuss innovative solutions to improve the use of these resources and reduce medical travel costs. Every flight taking patients off the island for special care using military aircrafts saves $300 in travel expenses. The task force was able to identify specific obstacles in the way of increased use of USCG C-130 aircraft flights, developed strategies to overcome these obstacles, and improved cost-efficiency.
The Result: By instituting new measures with proactive management of patient appointments, the medical center increased military air travel use by more than 15 percent within a six-month period. This has been sustained and improved upon over the course of FY17 and into FY18.
2017-18 People’s Choice Surgical/Procedural Care Winner
“Using CO2 for Insufflation to Reduce Patient Discomfort”
Fort Worth Endoscopy Center
Fort Worth, TX
The Challenge: The surgery center reported a significant increase in pain-related transfers and late complications from colonoscopy procedures in 2012 and 2013. The goal of the study was to determine if an agent could be used for bowel insufflation, while causing minimal discomfort. Reducing patient discomfort is very important in surgery centers, as it can greatly influence the patient’s willingness to return for the recommended follow-up.
The Solution: To reduce patient discomfort after a procedure, the surgery center changed from air to the use of carbon dioxide for insufflation. Because carbon dioxide is absorbed in the intestines 160 times more rapidly than nitrogen and 13 times more rapidly than oxygen (the principle components of air), patient discomfort should be alleviated.
The Result: After implementation of carbon dioxide for insufflation in 2014, the pain-related complications dropped 57 percent from 2013 to 2016. Adverse events reported at the surgery center also declined by 57 percent, while transfer rates decreased 26 percent during the time period.
For more information on the winning programs, or how to nominate a program next year, please visit https://www.aaahc.org/institute/QI-awards/
AAAHC (Accreditation Association for Ambulatory Health Care), founded in 1979, is the leader in ambulatory health care accreditation with more than 6,000 organizations accredited. We accredit a wide range of outpatient settings including ambulatory surgery centers, office-based surgery facilities, endoscopy centers, student health centers, medical and dental group practices, community health centers, employer-based health clinics, retail clinics, and Indian health centers, military and bureau of prisons health treatment facilities among others.
AAAHC advocates for the provision of high quality health care through the development and adoption of nationally-recognized Standards. We provide a valuable survey experience founded on a collaborative, consultative, educational approach to peer-based, on-site review. The AAAHC Certificate of Accreditation demonstrates an organization’s commitment to provide safe, high quality services to its patients. It is recognized by third party payers, medical professional associations, liability insurance companies, state and federal agencies, and the public.