Project QUEST is an aggressive attempt to develop performance measures that improve quality and lower costs.
"Among the practitioners in a hospital, only one is specifically trained to focus on medication use, and that's the pharmacist," said Kasey Thompson, Pharm.D., director of patient safety at ASHP. "So pharmacists must be involved in any performance measurement initiative such as this one. In most such projects, the vast majority of quality indicators involve medication management."
"QUEST: High Performing Hospitals" is a comprehensive three-year project. Participating hospitals will report data to Premier on clearly defined performance measures related to quality, efficiency, safety, and patient satisfaction. Premier plans to analyze the data, share best practices, and ultimately provide incentives for hospitals in the top quartile. It is now creating an advisory board to help supervise the project and seeking hospitals willing to participate. (QUEST is an acronym for Quality, Efficiency, Safety, with Transparency.)
The QUEST project is based on the many principles used in the Hospital Quality Incentive Demonstration project (HQID), the recent pay-for-performance initiative overseen by Premier and the Centers for Medicare & Medicaid Services. "We intend to build on that program," said Peterson. HQID, begun in October 2003, involved more than 260 hospitals and 33 evidence-based clinical quality measures. Participants submitted data to Premier and CMS on process and outcomes measures in five clinical areas: acute myocardial infarction, congestive heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement. The initial phase of the program will focus on mortality, appropriate care, and efficiency, with harm avoidance and patient satisfaction the focus in Year 2. CMS awarded $8.7 million in incentive payments earlier this year to the top hospitals in the program.
The emphasis on relating quality and cost reflects the findings of an analysis Premier conducted of the HQID project: Had all pneumonia, heart bypass, heart attack (acute myocardial infarction), and hip and knee replacement patients nationally received most or all of the HQID set of care processes in 2003, it could have resulted in nearly 5,652 fewer deaths; 6,000 fewer complications; 10,000 fewer readmissions; and one million fewer days in the hospital nationwide-and hospital costs could have been as much as $1.4 billion lower.
QUEST is being conducted with the participation of the Institute for Healthcare Improvement in Boston. IHI's "5 Million Lives" campaign is an ongoing voluntary initiative to protect patients from five million incidents of medical harm between December 2006 and December 2008. IHI is offering technical assistance and improvement expertise to the QUEST program.
THE AUTHOR is a writer based in Gettysburg, Pa.