Quality and Safety in the State of Michigan
The state of Michigan leads the way in health care quality, safety and cost-effectiveness. We have more top hospitals than any other state except one. And we’re at work developing future best practices for health care for the entire nation. When it comes to health care in the state of Michigan, our prognosis is excellent.
Talking about one Michigan project, the leader of the patient safety movement in the United States Lucian Leape, M.D., says, “The Keystone Project in Michigan has raised the bar. Last year, 68 hospitals reported their ICUs had gone for 6 months or longer without a single episode of central-line blood stream infection or ventilator-associated pneumonia. They calculated that this outstanding achievement saved 1,578 lives and $165 million. If 68 hospitals in Michigan can do it, so can the rest of the 5,000 hospitals in the United States. Michigan has showed us how. All we need is the will.” Dr. Leape is a physician and professor at Harvard School of Public Health, and director of the Lucien Leape Institute at the National Patient Safety Foundation.
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Overall top performance
Only 33 hospitals in the nation made it to the 2008 Leapfrog Top Hospitals list -- UMHHC is one of them, and six of the hospitals are in Michigan. Hospitals were selected based on their results on the Leapfrog Hospital Quality and Safety Survey in four crucial areas: computer physician order entry; evidence-based hospital referral; ICU staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score, based on the National Quality Forum-endorsed safe practices.
(Source: The Leapfrog Group)
Two recent rankings show that Michigan has among the best children’s health care systems in the country, and U-M’s C.S. Mott Children’s Hospital is part of the picture. The Commonwealth Fund Report names Michigan as a national leader in giving children access to care and ensuring high-quality care. The U.S. News & World Report gives C.S. Mott Children’s Hospital top national rankings in all seven pediatric specialties.
(Source: The Commonwealth Fund and U.S. News, 2008)
- Hospitals in the Midwest lead the nation in performance.
Hospitals in the Midwest are setting new national standards for clinical outcomes, patient safety, financial performance, efficiency and growth in patient volume, according to a national study by Solucient. More than half of the winning hospitals in the study are from the Midwest, and 30 of the 100 Top Hospitals facilities are in two states - Michigan and Ohio. When researchers evaluated hospital performance on a state-by-state basis, nine out of 12 Midwest states placed in the top two quintiles. The Midwest also was the top region in hospital performance in the 2004 edition of the study.
The study uses a balanced scorecard approach and scores hospitals according to nine key organization-wide measures: risk-adjusted mortality, risk-adjusted complications, patient safety, core measures average, growth in patient volume, severity-adjusted average length of stay, expense per adjusted discharge, profit from operations and cash-to-debt ratio.
(Source: "Solucient 100 Top Hospitals: National Benchmarks for Success, 2006,” Solucient, 2006)
Safe
- Michigan is one of the top five states for hospital patient safety.
Minnesota, Wisconsin, Iowa, Michigan and Kansas ranked as the top states for hospital patient safety during the period studied by HealthGrades, a national health care ratings organization. HealthGrades applied Agency for Healthcare Research and Quality Patient Safety indicator methodology to three years of Medicare data in order to identify patient safety incident rates for nearly every hospital in the country.
(Source: “Third Annual Patient Safety in American Hospitals Study,” HealthGrades, Inc., April 2006)
- Michigan’s hospital ICUs are among the safest in the nation.
Michigan’s hospital intensive care units are safer following a two-year project to reduce medical errors and improve patient safety. The Michigan Hospital Association’s Keystone Center for Patient Safety & Quality and patient safety experts from The Johns Hopkins University directed the project. Using a predictive model and data collected from project participants between March 2004 and June 2005, the total savings in the 15-month span were: - patient lives saved: 1,578
- hospital days saved: 81,020
- health care dollars saved: $165,534,736
More than 120 Michigan ICUs and 70 Michigan hospitals participated in this project, called Keystone: ICU. Central intravenous lines are a major source of infection in ICUs that harm patients and increase lengths of stay, which, in turn, drive up costs. Participating hospitals reduced central IV line infections by nearly 50%. Also, overall ventilator-associated pneumonia rates continue to decrease.
(Source: Press release from Michigan Health & Hospital Association)
High-quality
- The quality of care in Michigan hospitals is superior to hospitals nationwide and in the other Great Lakes states.
Michigan hospitals now have lower costs, higher quality and provide greater value than hospitals nationwide and across the Great Lakes states.
(Source: “More Than a Decade of Quality, Efficiency and Value Improvements at Michigan Hospitals,” Michigan Hospital Association, January 2009)
- Michigan has 10 top hospitals – more than any other state except Ohio.
Michigan has 10 of the Solucient Top 100 hospitals. Solucient scored hospitals based on the following nine performance measures:
- risk-adjusted mortality index
- risk-adjusted complications index
- risk-adjusted patient safety index
- severity-adjusted average length of stay
- expense per adjusted discharge, case mix- and wage-adjusted profitability (operating profit margin)
- cash-to-total-debt ratio
- tangible assets (net plant, property and equipment) per adjusted discharge
- growth in patient volume.
(Source: "National Benchmarks for Success, 2005 Solucient, 2005)
- Michigan is one of only two states to receive an “A” in pain management.
Michigan was one of only two states to receive an “A” grade for progress in helping to alleviate suffering in patients who have pain. Michigan was recognized for repealing restrictive and ambiguous policy, adopting several recommendations of the End of Life Commission and for having strong collaboration among its boards of Medicine, Osteopathic Medicine and surgery, Pharmacy, and Nursing in adopting these policies.
Michigan also was recognized for following the Federation of State Medical Boards of the United States Medical Practice Act and Model Policies, and for requiring regulatory agencies to educate licensees about pain management issues.
(Source: "Achieving Balance in State Pain Policy: A Progress Report Card," Pain and Policy Studies Group, University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, 2006)
Cost-effective
- Michigan hospital costs are lower than hospitals nationwide and across the Great Lakes states because of quality improvements in the last decade.
In the past, Michigan hospital costs were higher than national averages and higher than the other Great Lakes states. Now, lower costs result from more than a decade of continuous quality and efficiency improvements made by Michigan hospitals, led by efforts to significantly reduce patient lengths of stay.
The study found that today’s average Michigan hospital patient pays about 6.1% (or $520 less) than patients pay to hospitals in other states. These efficiency improvements will save Michigan employers, families and other health care consumers more than $1 billion a year. Michigan hospital margins – or profits – were lower than at hospitals nationwide and in five of the Great Lakes states.
(Source: “More Than A Decade of Quality, Efficiency and Value Improvements at Michigan Hospitals,” Michigan Hospital Association, January 2009)
Impacts economy
- Health care is Michigan’s largest single private sector employer
Health care is Michigan’s largest single private-sector employer and will be a significant source of new jobs in the state for many years to come. Health care provides about 794,200 jobs (515,700 direct jobs and about 278,500 related jobs) that pump nearly $36.7 billion a year in wages, salaries and benefits into the economy. Michigan health care workers and their employers pay about $12 billion annually in taxes.
About 10 of every 100 Michigan jobs are directly in health care, and nearly 15 of every 100 Michigan jobs are directly or indirectly related to or induced by health care. In many Michigan counties and communities, health care is the largest employer by far. Fifty-seven of Michigan’s 83 counties have more than 1,000 health care jobs each.
(Source: “The Economic Impact of Health Care in Michigan,” fourth edition, Partnership for Michigan's Health, June 2008)
- Michigan’s medical schools and teaching hospitals make a major economic impact on the state and the nation.
A report from the Association of American Medical Colleges reveals that its member medical schools and teaching hospitals had a combined economic impact of $51 billion on their states and the nation in 2005. In Michigan, the University of Michigan Medical School and other academic medical centers across the state of Michigan had a combined economic impact of more than $18 million. Michigan’s medical schools and teaching hospitals also generated more than $976 million in state tax revenue in 2005.
In addition, UMHS and other academic medical centers in Michigan generated more than $661 million in out-of-state medical visitor-related revenue in 2005, including direct spending in local communities by out-of-state patients and their friends and families.
(Source: “The Economic Impact of AAMC-MemberMedicalSchools and Teaching Hospitals,” Association of American Medical Colleges, January 2007.)
- Health care is Michigan’s largest single private sector employer
Health care is Michigan’s largest single private-sector employer and will be a significant source of new jobs in the state for many years. About 10 of every 100 Michigan jobs are directly in health care; direct, indirect and induced jobs account for 16 out of every 100 jobs in Michigan.
Health care provides more than 478,000 direct and 258,000 indirect or induced jobs, all of which pump $31.6 billion a year in wages and salaries into Michigan’s economy. The report notes that U.S. Bureau of Labor statistics show that each health care job contributes about $55,000 to the local community’s economy.
(Source: “The Economic Impact of Health Care in Michigan,” third edition, Partnership for Michigan's Health, June 2006)
Specific health care measures
- Michigan’s 2005 State Snapshot shows strongest and weakest measures.
The Agency for Healthcare Research and Quality’s 2005 State Snapshot of the state of Michigan reported:
The 2005 State Snapshots are snapshots of health care quality measures. The Snapshots include detailed, customized tables for each state and the District of Columbia, and are based on the Agency for Healthcare Research and Quality’s 2005 National Healthcare Quality Report and the 2005 National Healthcare Disparities Report.
- The state’s strengths lay in the arena of home health care, where, compared to other states, Michigan demonstrated improved drug management, bladder control, body dressings, breathing and toileting.
- The state needs to improve: collecting blood cultures from patients before administering antibiotics for pneumonia; infant morality and low birth weight rates; administering pneumonia patients’ first antibiotic within four hours of arrival at the hospital; and flu vaccinations for the 18-64 and 65-plus age groups.
(Source: Agency for Healthcare Research and Quality, 2005.)
- The state of Michigan excels in cancer prevention, accurate heart failure care and the declining use of physical restraints in nursing homes.
Compared with 49 other states and the District of Columbia, the state of Michigan excels in colon cancer screening for people age 50 and above, recommended care for acute heart failure among Medicare patients, and the declining use of physical restraints on chronic care nursing home residents.
The state of Michigan had average rates for: adequate dialysis for Medicare hemodialysis patients; suicide; adults age 65 and older who received pneumococcal vaccination, appropriate timing of adult Medicare patients receiving prophylactic antibiotics with surgery; and adults age 18 and over who reported that their health providers always listened carefully, explained things clearly, showed respect for what they had to say and spent enough time with them.
Compared with other states, the state of Michigan did not rank below average on any health care measurement.
The study organized the measures around four dimensions of quality – effectiveness, patient safety, timeliness, and patient centeredness – and covers four stages of care: staying healthy, getting better, living with illness or disability and coping with the end of life.
(Source: 2006 National Healthcare Quality Report, Agency for Healthcare Research and Quality, 2006.)
