Ways that PRHI is Advancing Reform
Quality and Safety Reforms
The Jewish Healthcare Foundation (JHF), from the creation of the Pittsburgh Regional Health Initiative in 1997 to the launching of Health Careers Futures in 2003, has anticipated and helped shape the key elements of reform. By forming PRHI, one of the nation’s first regional, multi-stakeholder health improvement collaboratives, JHF was determined to prove that better quality of care, nearing perfection, is possible even in a complex, high-risk industry like health care. Basic performance improvement strategies like “Lean” could be applied to health care, resulting in safer and more efficient care. Creating its own quality improvement methodology—Perfecting Patient CareSM (PPC), PRHI was among the first organizations in the U.S. to demonstrate unequivocally that eliminating hospital-acquired infections was an irrefutable, reasonable and possible goal.
PRHI had a hand in transforming health care — one unit or project at a time — through its Champions of Work Redesign programs. PRHI initiated these programs starting with a Nurse Navigators Fellowship to empower frontline nurses, continuing with Physician Champions, Pharmacy Agents for Change, and most recently EMS Champions. These projects provided further evidence that PPC techniques were viable in all settings and for many problems and conditions.
PRHI has been a vocal advocate for the establishment of a Federal Patient Safety Authority, similar to agencies established for aviation, nuclear power and mine safety in the United States.
PRHI was early in identifying the frequency of hospital readmissions as a high cost and yet preventable healthcare problem. Readmission rates offer a measure for actual outcomes of care, moving quality measurement beyond process-of-care measures. With support from the Richard King Mellon Foundation, PRHI’s Readmission Reduction initiative has shown that nearly 44% of hospital readmissions for patients with chronic obstructive pulmonary disease (COPD) can be avoided with good care management , including home visits and discharge planning, patient education, and care coordination (click to watch a Teachable Moment on reducing 30-day COPD readmissions). PRHI’s research team is identifying patients with common chronic diseases most at risk for readmissions in a series of Readmission Briefs, using data from the unique Pennsylvania Health Care Cost Containment Council.
JHF supported the establishment of the Network for Regional Healthcare Improvement (NRHI) in 2004 to provide technical assistance to, facilitate information sharing among, and encourage national support for regional health improvement collaboratives. Regional Health Coalitions recognized that perverse financial incentives present major barriers to efficient, high-value healthcare. As part of its “Healthcare Payment Reform Series,” NRHI produces nationally-circulated seminal papers widely regarded as the most comprehensive, understandable and pragmatic guides to payment reform available.
Delivery System Redesign
PRHI has initiated several large scale projects to redesign the delivery of health care. In one such project, PRHI is a funding partner with the Commonwealth Fund, and serves as a Regional Coordinating Center of the national Safety Net Medical Home Initiative. PRHI trainers support 10 local federally qualified health centers in their efforts to become patient-centered medical homes.
PRHI brought $40 million to southwestern Pennsylvania when it was selected as the Community Partner in the Centers for Medicare & Medicaid Services’ Electronic Health Record (EHR) Demonstration. PRHI recruited 280 small physician practices to receive incentive payments for implementing and using EHRs to improve quality. To help physicians reach quality targets, 250 providers, staff and practice administrators participated in PRHI’s Transforming Care in Provider Practice (TCPP) training. Today PRHI leverages its experience and expertise in EHR implementation by serving as a Regional Extension and Assistance Center for Health Information Technology.
Finally, anticipating the potential of Accountable Care Networks, we built on previous work with readmission reduction across settings of care to consideration of new models of service delivery. Our investigation has been informed by our partnership with Clalit Health Plan in Israel, particularly Clalit’s model of secondary care centers and their outstanding outpatient and primary care. This early work has made PRHI a trusted leader in Accountable Care Networks, leading to the recently awarded $10.4 million Health Care Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI) for its Accountable Care Network Project.
Behavioral Health Interventions within Primary Care
PRHI research uncovered the prevalence of behavioral health comorbidities in frequently hospitalized patients with chronic diseases, such as diabetes, COPD and heart disease. Unmanaged depression or substance use disorders create complications for managing chronic physical illnesses, poor quality of life for the patient, and the potential over-utilization of healthcare resources. Because primary care settings offer abundant opportunities for early identification, intervention, and treatment of comorbid behavioral health problems, JHF, in partnership with The Fine Foundation and the Staunton Farm Foundation, funded the Integrating Treatment in Primary Care (ITPC) demonstration project in three community health centers. Results showed improvement in behavioral health and chronic disease management. The success of ITPC led to PRHI’s current three-year Partners in Integrated Care initiative, which disseminates and implements evidence-based depression and unhealthy substance use services in primary care settings.