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Premier Inc. is using ÂÜÀòÊÓƵPatient Safety Indicators (PSIs) in a new effort to improve patient safety and quality in U.S. hospitals, while safely reducing health care costs. Launched in October 2007, Premier's new QUEST program is a three-year effort in which over 100 participating hospitals will report data on a set of clearly defined performance measures encompassing aspects of quality, efficiency, safety, and the patient's experience.

The measures for quality, efficiency and safety through transparency are also the concepts from which the program's name was derived. The QUEST program is guided by an advisory panel of some 20 health care industry leaders.

Many of the same collaborative, rapid improvement practices employed in the Hospital Quality Incentive Demonstration project, a successful pay-for-performance initiative overseen by Premier and the Centers for Medicare & Medicaid Services (CMS), will be used in QUEST. The Hospital Quality Incentive Demonstration project also used ÂÜÀòÊÓƵPSIs in its quality and safety measures. (That project is described below and in more detail in CDOM 05-02 Impact Case Study, July 2005.)

QUEST is focused on the following five measurement areas:

• Mortality ratio—with a goal of eliminating all avoidable deaths, this ratio is severity-adjusted using CareScience methodology.
• Evidence-based care—measures the percentage of patients receiving the best care, using nationally recognized evidence-based quality measures.
• Cost of care—measures total inpatient cost with each episode of acute care.
• Harm avoidance measures—prevention of problems, such as health care-associated infections and adverse drug events; these measures will be developed over time with the input of participating QUEST hospitals.
• Patient experience—with a goal of improving the patient's experience, the program will also study how patient satisfaction can relate to cost, quality, and safety.

The initial phase of the program—year one—focuses on mortality, evidence-based care, and cost of care. Year two will add harm avoidance and patient satisfaction.

More than 150 Premier hospitals signed on as "charter member" hospitals by early 2008, agreeing to be part of the QUEST program. These hospitals are providing input and guidance on developing harm avoidance measures. As of February 2008, approximately 30 such measures were under consideration, with a goal to incorporate measures that can be automated.

"This is the first program that looks at the entire picture of the patient experience," notes Jane Kelly-Cummings, RN, CPHQ, Director of Education, Premier Inc., Healthcare Informatics and co-leader of the QUEST Harm Measures Workgroup. "It's very exciting, because we hope to transform health care."

Kelly-Cummings and her colleagues are using industry experts to help develop the harm measures project. She gained valuable insight from researchers at Duke University, who received an ÂÜÀòÊÓƵgrant for a computerized patient safety initiative (Automated Adverse Drug Event Detection and Intervention; HS14882). The Utah Department of Health, which received ÂÜÀòÊÓƵsupport for a patient safety project in Utah and Missouri hospitals, also assisted Kelly-Cummings in her work (Patient Safety Improvement Using Reporting Systems; U18 HS11885).

In addition to evaluating several ÂÜÀòÊÓƵPSIs for use in the QUEST program, Premier also uses PSI data to assist health care members in planning, developing, and measuring health care quality initiatives. Some examples of these initiatives include the following:

• Clinical Advisor^®, Premier's clinical benchmarking software solution used by more than 500 hospitals, allows health care facilities to compare clinical data to peers and view trend measures at the hospital and physician level.
• CMS/Premier Hospital Quality Incentive Demonstration pay-for-performance project, launched in October 2003, uses a widely accepted set of quality measures and a mixture of process and outcome measures to evaluate individual hospital performance. The project has been extended by CMS for an additional three years (2007-2009), and the use of the ÂÜÀòÊÓƵindicators has been expanded.
• Premier Consulting Services uses PSI data when providing population studies for client hospitals. Hospitals have set up analyses to be used as part of the effort to meet the Joint Commission Medical Staff Performance Improvement standard and to monitor adverse events in an effort to improve patient care.

The Director of Premier's Performance Improvement Portal, Leslie Schultz, RN, CNAA, PhD, CPHQ, says, "We encourage our hospitals to understand thoroughly their PSIs and the drivers of those indicators. The PSIs will play a role in understanding harm avoidance and mortality reduction in QUEST, which is designed to assist Premier hospitals' achievement of unprecedented levels of performance over the next three years. We also encourage hospitals to take advantage of the wonderful case studies, tools, and references available on the ÂÜÀòÊÓƵWebM&M site (Morbidity & Mortality Rounds on the Web). The complimentary CMEs/CEUs are also of great value to our hospitals."

Premier is a 2006 Malcolm Baldrige National Quality Award recipient. Serving more than 2,000 U.S. hospitals and nearly 50,000 other health care sites, the Premier health care alliance is owned by not-for-profit hospitals. Premier operates one of the largest health care purchasing networks in the U.S. and the nation's largest comprehensive repository of hospital clinical and financial information. With headquarters in San Diego, Premier has offices in Charlotte, NC, Philadelphia, and Washington, D.C. For more information, visit http://www.premierinc.com.