Medicare Beneficiary Quality Improvement Project (MBQIP)

Care transitions refer to the movement of patients from one health care provider or setting to another. For people living with serious and complex illnesses, transitions in setting of care are prone to errors. For example, one in five patients discharged from the hospital to home experience an adverse event within three weeks of discharge. An adverse event is defined as an injury resulting from medical management rather than the underlying disease. The most common adverse events are medication related; they often can be avoided or mitigated. The current rate for hospital readmissions among Medicare beneficiaries within 30 days of discharge is nearly 20%, contributing to lower patient satisfaction and rising health care costs.

While emergency care is important in all hospitals, the emergency department is particularly important in rural hospitals where the distance to urban medical centers makes the effective triage, stabilization, and transfer of patients essential. Communication problems are a major contributing factor to adverse healthcare events in hospitals, accounting for 65% of sentinel events tracked by The Joint Commission. In addition, research indicates that deficits exist in the transfer of patient information between hospitals and community primary care physicians, and between hospitals and long-term care facilities. For example, when a patient arrives at an emergency department needing time-sensitive care that includes transfer to a tertiary care center, the rural hospital’s ability to quickly assess, arrange, and get the patient out the door with the necessary and appropriate information can be of life or death importance.

Data indicating how well a rural hospital serves this important stabilize-and-transfer care transition role is not currently widely available. This measure allows hospitals to collect information on emergency department transfer communication, and use the data to improve quality of care, safety and outcomes for patients transferred from their emergency department.

The Hospital Inpatient Quality Reporting (IQR) Program is intended to equip consumers with quality of care information to make more informed decisions about health care options. It is also intended to encourage hospitals and clinicians to improve the quality of inpatient care provided to all patients. The hospital quality of care information gathered through the program is available to consumers on the Hospital Compare website. The Hospital IQR Program requires "sub-section (d)" hospitals to submit data for specific quality measures for health conditions common among Medicare beneficiaries, which typically result in hospitalization. For MBQIP, a rural-relevant subset of Heart Failure and Pneumonia inpatient measures were selected for CAHs to voluntarily report.

Patients and their families are essential partners in the effort to improve the quality and safety of health care. Their participation as active members of their own health care team is an essential component of making care safer and reducing readmission.

Robust efforts to engage patients and families in their care are woven throughout all aspects of the Partnership for Patients to achieve system-wide adoption of patient and family engagement best practices.

A 2008 study demonstrated measurable benefits to providing patient-centered care with a positive impact on patient satisfaction, length of stay and cost per case. By improving communication with patients, via providers at the bedside or institutionally through committees focused on systemic changes in patient care, patient outcomes can and will improve.