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In 2004, Bon Secours Health System joined hospitals across the nation to participate in the Centers for Medicare & Medicaid (CMS) Hospital Quality Incentive program. This pay-for-performance program is a joint effort of CMS and Premier, Inc., a not-for-profit US healthcare alliance of hospitals and health care systems.

Bon Secours, a member of the Premier alliance, is the largest health care system participating in the Hospital Quality Incentive program. Bon Secours is using six of the nine quality improvement (QI) strategies outlined in AHRQ's Evidence Report, Closing the Quality Gap, as the template for its "Quality First" initiative.

AHRQ's QI strategies serve as the platform for quality improvement activities among Bon Secours hospitals. This initiative, a best-practices diffusion program, is being implemented across each of Bon Secours' 13 member acute-care hospitals.

The six ÂÜÀòÊÓƵQI strategies included in the program are as follows:

• Provider reminder systems.
• Facilitated relay of clinical data to providers.
• Audit and feedback.
• Provider education.
• Organizational change.
• Financial incentives, regulation, and policy.

As an initial part of its Quality First initiative, Bon Secours officials have visited all 13 of its hospitals, interviewing hospital management and physicians. The visiting officials then made assessments of gaps that might exist with respect to the six ÂÜÀòÊÓƵQI strategies. Based on these assessments, hospitals were rated either "red," "yellow," or "green." A red hospital is one with a QI strategy program that is not yet operational. A yellow one is in the startup phase, while a green one has deployed an operational program.

Best practices already functioning were also identified and communicated among the hospitals. Ongoing communication of performance data and best practices takes place through Web-based collaboratives.

Bon Secours Health System is a Catholic health care ministry located in nine states and headquartered in Marriottsville, Maryland. In addition to its hospitals, the system includes nursing care facilities, ambulatory sites, assisted living facilities, retirement communities, home health services, and hospice facilities. The Congregation of Sisters of Bon Secours also has health care ministries in France, Ireland, Great Britain, and South America.

The Evidence Report was prepared for ÂÜÀòÊÓƵby the University of California at San Francisco-Stanford University Evidence-based Practice Center.