In three years, 157 hospitals participating in the Premier healthcare alliance’s QUEST: High Performing Hospitals national collaborative have saved an estimated 24,820 lives and reduced healthcare spending by nearly $4.5 billion, according to Premier.
 
QUEST can be adopted by any hospital in the nation seeking to track performance against a higher standard of care. If all hospitals in the country had been able to achieve similar results, Premier projects an additional 87,250 lives and $34 billion more could be saved across all payers each year.

Spanning 31 states, QUEST includes a nationwide sample of urban/rural, large/small, teaching/non-teaching and safety net hospitals.

Together the hospitals volunteered to share data and define a common framework with consistent measures of top performance – something that has never existed in healthcare, Premier officials say.

During QUEST’s first three years, hospitals tracked and compared their performance levels to match or exceed the top 25 percent of hospitals in all categories except cost, which was set at the top 50 percent. To reach these standards, hospitals needed to:

• Reduce mortality at least 18 percent;
• Reduce the average cost of care to less than $5,720 per discharge;
• Reliably deliver all evidence-based care measures to patients in the areas of heart attack, heart failure, pneumonia and surgical care at least 84 percent of the time;
• Improve the hospital experience so that patients favorably rate their stay and would recommend the facility to others; and
• Eliminate preventable harm events.

“QUEST creates new, higher targets that any hospital can strive for,” said Terry Andrus, CEO of East Alabama Medical Center. “Once we saw what could be achieved, we had a very systematic way to focus and work on performance improvement. All the QUEST measures are very clear, making it easier for us to articulate the vision of where we want to be, and get buy-in from doctors, nurses, administrators and our board. It’s crystallized our quality work and given us a clear path forward.”

East Alabama Medical Center and 120 other hospitals participating in QUEST achieved top performance standards that directly led to patient care improvements and other quality gains. These advances have historically eluded most healthcare improvement programs. In fact, QUEST hospitals are far outpacing current industry trends and national averages.

For example:

• When compared to a national group with similar characteristics, the mortality rate among QUEST hospitals was 29 percent lower than national averages, according to Medicare data from federal fiscal year 2009, the most recent year of this information.
• Data from the U.S. Bureau of Labor and Statistics suggests that QUEST hospital inpatient costs only increased by about 2 percent above the rate of inflation over three years (2008-2010). In contrast, non-participant costs increased by an average of 17 percent above inflation.

“QUEST gave us the ability to look at ourselves differently,” said Donna Isgett, senior vice president of corporate quality and safety, McLeod Health. “When we just looked at our data we thought we were doing well, but when we compared to others we realized we weren’t among the best.”

QUEST hospitals have been measuring 24 specific harm events that align closely with national priorities, including the Medicare value-based purchasing program, the Centers for Medicare & Medicaid Services non-payment policy, and the Partnership for Patients hospital quality improvement and safety initiative.

However, while many organizations have targeted hospital-acquired conditions (HACs) based on these and other federal policies, QUEST data shows that a broader focus on harm may be required, Premier executives say. As a result, QUEST is now examining more than 140 HACs that have been shown to cause deaths, added length of stay and unnecessary costs. These new measures will be rolled into the program over time.
 
“QUEST hospitals show what’s truly possible in healthcare," said Susan DeVore, Premier president and CEO. "Together they have proven that top performance can be achieved by any hospital, no matter where they are, what their patient mix or their reimbursement levels. QUEST is discovering the keys to providing the best quality care and teaching others how to replicate their accomplishments so that we don’t have pockets of excellence – we have system-wide excellence."