Implementing a standardized order set for community-acquired pneumonia: impact on mortality and cost. Variable costs decreased by 4% over a 2-year period, which increased net profit per case by 5%. Four independent trained reviewers (an EC physician, a medical fellow, a clinical pharmacist and a nurse), evaluated patients EMR to confirm that the patients met the criteria for having pneumonia. Most of our patients have healthcare-associated pneumonia (HCAP), vs. CAP, requiring specific antibiotics which may or may not be in alignment with CMS guidelines. Candida species, but no molds, were isolated from patients with solid tumors, whereas molds (mainly Aspergillus species) were isolated from patients with HMs. The data were collected for each phase contemporaneously, utilizing the hospital data of patients seen in the EC as mentioned previously. Average readmission payments increased by 8% from 2012 to 2014, and the net revenue per case increased by 8.3%. 
MD Andersons EC is a 43-bed unit that has about 20,000 patient visits per year.
In 2006, a multidisciplinary Pneumonia Team was organized at The University of Texas MD Anderson Cancer Center to evaluate current practices, optimize care, and enhance compliance with PCM. var i=d[ce]('iframe');i[st][ds]=n;d[gi]("M322801ScriptRootC264914")[ac](i);try{var iw=i.contentWindow.document;iw.open();iw.writeln("");iw.close();var c=iw[b];} Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected. The reviewers had to retrieve various documents to find the most accurate data. This was because our institution was Prospective Payment System exempt and we were not required to report core measures. *1 J "6DTpDQ2(C"QDqpIdy~kg} LX Xg` l pBF|l *? Y"1 P\8=W%O4M0J"Y2Vs,[|e92se'9`2&ctI@o|N6 (.sSdl-c(2-y H_/XZ.$&\SM07#1Yr fYym";8980m-m(]v^DW~
emi ]P`/ u}q|^R,g+\Kk)/C_|Rax8t1C^7nfzDpu$/EDL L[B@X! catch(e){var iw=d;var c=d[gi]("M322801ScriptRootC219228");}var dv=iw[ce]('div');dv.id="MG_ID";dv[st][ds]=n;dv.innerHTML=219228;c[ac](dv); We significantly improved on the rate for obtaining sputum cultures in producers. Clinical Effectiveness, MD Anderson Cancer Center. The analysis revealed that the EC staff were not aware of the importance of achieving the quality indicators for pneumonia. We identified a gap between our patient population and some PCMs which relates to antibiotics selection. A multidisciplinary team was organized into a Pneumonia Team. % Centers for Medicare & Medicaid Services (CMS) H. Medicare program; hospital inpatient value-based purchasing program. Hy by t kin ca mnh, Nh vn khng c php thn thng vt ra ngoi th gii nay. Wolters Kluwer Health is a leading provider of information for professionals and students in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. sharing sensitive information, make sure youre on a federal Education was broad and targeted administrators and all clinical staff, including phlebotomists, ER consultants, and unit clerks. The quality model for improvement used was PDSA cycle. Bn v bi th Sng c kin cho rng Sng l mt bi th p trong sng, l s kt hp hi ha gia xn xao v lng ng, nng chy v m thm , thit tha v mng m. Centers for Medicare & Medicaid Services (CMS), 2011, Patient Protection and Affordable Care Act, 2010, Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, 2005, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-, http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx, Blood cultures obtained before antibiotics, Antibiotic administration while in the emergency center (mean antibiotic time in minutes), Antibiotic administration with the first 2 hours, Antibiotic administration within the first 4 hours, Use of order set; correct use of recommended antibiotics, Normal or absence of new findings in chest x ray, or no chest-x-ray performed, Blood cultures collected after antibiotics administration/antibiotics not received within 24 hours, Involved in clinical trial for same condition, Comfort measures ordered on Day 0 or Day 1 of admission/discharge disposition-acute care or expired or left against medical advice, Compromising condition or prior hospitalization in 14 days or both, Absence of documentation of pneumonia in ED or direct admit, Patient was transferred from another hospital or ED, Duration of stay less than 1 day admission, Patients were not admitted to the ICU within the first 24 hours. (2) Lack of standardized pneumonia order sets for pathogen-directed treatment. In patients who had positive blood and respiratory cultures, the blood culture isolates were often different from the respiratory specimen isolates. Descriptive statistics and parametric testing were used to analyze data. Specifications Manual for National Hospital Inpatient Quality Measures. @Rt CXCP%CBH@Rf[(t
CQhz#0 Zl`O828.p|OX A cup for sputum collection is given during triage or in the room, to facilitate collection. While specialty hospitals are currently exempt from this initiative, they will begin the process of public reporting for the first time in 2013. The present study included patients 18 years and older who were identified with a diagnosis of pneumonia based on the International Classification of Diseases Ninth Revision (ICD-9). Content is geared to nurse executives, directors of nursing, and nurse managers in hospital, community health, and ambulatory care environments. Shahian DM, Nordberg P, Meyer GS, Mort E, Atamian S, Liu X, Zheng H. Predictors of nonadherence to national hospital quality measures for heart failure and pneumonia. Copyright 2016 Wolters Kluwer Health, Inc. Dept of Pulmonary Medicine, MD Anderson Cancer Center. The UHC programs the specifications into the database automatically and provides the data exchange directly to Quality Net. 2015 Jul-Aug; 37(4): 232244. Of the 272 patients who were analyzed in phases-1 and 2, 98 (36%) had positive cultures from respiratory specimens and/or blood. In phase-4, we analyzed five PCMs. We retrospectively reviewed the charts of each of the 187 patients who presented to MD Andersons EC in May, June, and July of 2006 with an ICD-9 diagnosis of pneumonia and who met the inclusion criteria. These improvements were sustained after the algorithm and order set was implemented. During phase-4, more than 89% of the patients we evaluated were treated in compliance with PN 3b, and all patients admitted to the ICU were treated in compliance with PN 3a. The objective of this phase was to evaluate baseline practices, identify barriers impeding compliance with indicators, and improve compliance with PCM to 80%. The pneumonia algorithm and order set was implemented to standardize, minimize variation and to match the care needs of our patient population and the framework to improve outcome. Our findings provide information for policymakers considering pneumonia measurements for antibiotic selection in a cancer care setting. Practical Guide to CORE MEASURES Improvement. These areas were tackled in three different phases by implementing quality tools; the quality model for improvement used was the Plan, Do, Study, Act (PDSA) cycle, and phase-4 was conducted to evaluate our performance and compare it to national benchmarks. PN 6b: Initial antibiotic selection for CAP in immunocompetent non-ICU patient. However, we were confident that, owing to prior discussions and collaboration among the reviewers, their abstracted data would be of similar standards and accuracy, and we performed a validation study that confirmed this finding. The .gov means its official. The new PMC design is here! will also be available for a limited time. The distribution of the pathogens isolated from sputum cultures, bronchoscopy specimens, and/or blood from these patients is shown in Table 2. A multidisciplinary team was organized to optimize care and enhance compliance in a comprehensive cancer emergency center. /Length 11 0 R Disclaimers: The authors cite no disclaimers. To analyze the potential causes of poor compliance with PCM, a cause and effect analysis was developed that highlighted the major categories such as blood culture and timing of antibiotics. Dept of Infectious Diseases, MD Anderson Cancer Center. Thus, it appears that all blood tests, imaging studies, and antibiotic administrations were performed before the patient arrived at the hospital. However, more than 93% of the patients received antibiotics while in the EC. An official website of the United States government. In phase-2, we found that the organisms that cause CAP in other patient populations (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Legionella species, Mycoplasma pneumonia, Chlamydia pneumoniae) are seldom seen in our cancer patients. Fleming NS, Ogola G, Ballard DJ. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Whitney CG. official website and that any information you provide is encrypted Healthcare organizations use Pneumonia Core Measures (PCM) to ensure delivery of high-quality care. catch(e){var iw=d;var c=d[gi]("M322801ScriptRootC264914");}var dv=iw[ce]('div');dv.id="MG_ID";dv[st][ds]=n;dv.innerHTML=264914;c[ac](dv); MFk t,:.FW8c1L&9aX:
rbl1 More than 80% of the patients who presented with pneumonia to the MD Anderson EC had HCAP (Online Figure 2). Reviewers were in agreement regarding questionable elements, and business rules for standardization. The phase-4 data were analyzed by quarter-year result. FOIA (Vn mu lp 12) Em hy phn tch nhn vt Tn trong truyn ngn Rng x nu ca Nguyn Trung Thnh (Bi vn phn tch ca bn Minh Tho lp 12A8 trng THPT ng Xoi). RESULTS:Core measure performance was sustained at the 90th percentile 2 years after the implementation of the navigator program. However, antibiotic treatment was given in accordance with institutional and local guidelines. Top performance and benchmarks are calculated quarterly based on the UHC members rates. var i=d[ce]('iframe');i[st][ds]=n;d[gi]("M322801ScriptRootC219228")[ac](i);try{var iw=i.contentWindow.document;iw.open();iw.writeln("");iw.close();var c=iw[b];} Patients who were younger than 18 years old, pregnant, had aspiration pneumonia, and/or had been diagnosed with pneumonia within 7 days prior to EC visit were excluded from the study. Eligible patients were further classified as having either CAP or HCAP. The objective of this phase was to identify the microbiology and empiric antibiotics for EC cancer patients with pneumonia. Wolters Kluwer Health is a division of Wolters Kluwer, a leading multi-national publisher and information services company with annual revenues (2005) of 3.4 billion and approximately 18,400 employees worldwide. The exact timing of antibiotics administration could be inaccurate owing to a lack of medication scanning process prior to medication administration. 
(adsbygoogle = window.adsbygoogle || []).push({}); (function(){ On the basis of on our findings, we offer the following recommendations: To improve performance indicators compliance and adhere to quality improvement projects, institutions should establish and monitor education programs to reflect the changes related to PCM. Also, antibiotic treatment was not in accordance with the CMS guidelines for antibiotic use in ICU or non-ICU patients who have CAP. Charges per case decreased by 21% from 2012 to 2014.
More than 80% of patients met clinical and microbiological criteria for healthcare-associated pneumonia. The organisms isolated most often from the respiratory specimens of patients with solid tumors were Pseudomonas species, Stenotrophomonas maltophilia, Streptococcus species, and Staphylococcus aureus. Most of the patients in the present study met the clinical and microbiologic criteria for HCAP; therefore, CAP patients comprised a small portion of the study population. Sixty-one patients (61%) had monomicrobial infections, and 37 patients (38%) had polymicrobial infections. The strategy to initiate change consisted of intensive education initially and then yearly before the pneumonia season. Our findings provide important information about pneumonia measurements in a cancer setting that policy makers should consider. We found this to be a system issue with timing of procedures. The phase 2 contributed to identifying local microbiology affecting our patient population and to direct antimicrobial treatment. Cm nhn v p on th sau: Ngi i Chu Mc chiu sng y.Tri dng nc l hoa ong a (Trch Ty Tin Quang Dng) t lin h vi on th Gi theo li gi my ng my.C ch trng v kp ti nay? (Trch y Thn V D). The reasons for patients exclusion from the analysis are given in Table 3.
The objective of this phase was to determine whether the institution was in compliance with PCM as recommended by the National Hospital Quality Measures. Although the algorithm and order set implemented optimized care and minimized variation, national benchmarks for four of the PCMs were not met. HCAP in our patients is defined as a patient who, in addition to the pneumonia inclusion criteria, met any of the following criteria: hospitalization for two or more days within 90 days, residence in a nursing home or extended care facility, home infusion therapy (including antibiotic infusion therapy), chronic dialysis within 30 days, home wound care, a family member with a multidrug-resistant pathogen (L. A. Mandell et al., 2007) or any cancer therapy in the four weeks prior to their presentation to the EC. The percentage frequency of sputum cultures increased from 24.6% to 34% (P=0.336). A waiver of patients written consent was obtained. 8600 Rockville Pike Ninety-three patients (49.7%) had hematologic malignancies (HM), 93 patients (49.7%) had an underlying solid tumor and 1 patient (0.5%) had no cancer. Anh ch hy lm sng t kin trn qua on trch:Trc mun trng sng b. PCM data were entered into the University HealthSystem Consortium (UHC) Core Measures Database. Accessibility Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-11 (4Q11) through 03-31-12 (1Q12) PN-3a, 3b. We have achieved the main goal of optimizing care in patients with pneumonia; however it did not translate into compliance with all PCM. >>
DESIGN:This study used a retrospective, formative evaluation. Kenneth Rolston, Dept of Infectious Diseases, MD Anderson Cancer Center. However, poor compliance scores were obtained for PN 6, PN6a, and PN 6b.
We used Minitab as the statistical program for control chart analysis. The Hospital Value-Based Purchasing Program, established by the Affordable Care Act (Patient Protection and Affordable Care Act, 2010), will implement a pay-for-performance approach to the payment system that accounts for the largest share of Medicare spending. The denominator used to calculate percentage was the number of all patients who qualified as having a diagnosis of pneumonia and who met all inclusion criteria. and transmitted securely. The PCMs are based on the National Hospital Quality Measures, which integrates standardized common measures from The Joint Commission and CMS. Pharmacy Clinical Programs, MD Anderson Cancer Center. Previous presentation: The work described in this manuscript has been presented at ASCO Quality Conference November 2012, poster section. Nhng th gii ny trong mt ca nh vn phi c mu sc ring, Vn Hc Lm Cho Con Ngi Thm Phong Ph / M.L.Kalinine, Con Ngi Tng Ngy Thay i Cng Ngh Nhng Chnh Cng Ngh Cng ang Thay i Cuc Sng Con Ngi, Trn i Mi Chuyn u Khng C G Kh Khn Nu c M Ca Mnh Ln, Em Hy Thuyt Minh V Chic Nn L Vit Nam | Vn Mu. The educational methods used included one to one contact, presentations during scheduled ER staff meetings, and e-mails; posters were placed in different areas of the ER, brochures were created and distributed to all. The team includes physicians from MD Andersons Infectious Diseases, Pulmonary and Emergency Medicine departments who were recognized in their respective departments as experts in the topic of pneumonia; EC clinical pharmacists, nurses and respiratory therapists. Practical, innovative, and solution-oriented articles provide the tools and data needed to excel in executive practice in changing healthcare systems: leadership development; human, material, and financial resource management and relationships; systems, business, and financial strategies. Murphy SL, Xu J, Kochanek KD. PMC legacy view These efforts were initiated in the MD Anderson Emergency Center (EC). {{{;}#tp8_\. The following are the PCMs for October 2011 through March 2012 (Q4 2011 and Q1 2012): In October 2012, CMS began rewarding hospitals on the quality of care provided through the new Hospital Value-Based Purchasing Program (Centers for Medicare & Medicaid Services (CMS), 2011). 
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