How MedStar Health Has Successfully Integrated Cardiovascular Quality Processes Across Multiple Sites

Standardization of quality across a hospital system is critical to building the foundation for integrated and efficient care delivery throughout the system. That is the experience of three hospitals in the MedStar Health organization — Washington Hospital Center, Union Memorial Hospital and Southern Maryland Hospital Center — that have worked together to integrate best practices around collecting, analyzing and applying their cardiovascular care data to promote continuous improvement in quality and patient outcomes.

MedStar Health is a recognized leader in heart and vascular care, with more than 200 specialists across 10 hospitals and physicians’ offices throughout the greater Washington, D.C., area and central Maryland. MedStar’s outstanding national and international reputation is complemented by its nine-year alliance relationship with Cleveland Clinic’s Heart, Vascular & Thoracic Institute (HVTI). The alliance offers value through a variety of in-depth collaborative activities between the two health systems, including the sharing of best practices in various clinical and operational realms of cardiovascular care.

Sharing experiences around integrating quality processes

Since both organizations are multihospital systems that have added hospitals over time, sharing of best practices for cross-hospital standardization of quality data collection and utilization has been a particularly beneficial area of focus. This involves everything from ensuring a shared structured approach to data metrics to consistency in cardiovascular registry management, quality meetings and outcomes dashboards.

Cleveland Clinic’s HVTI Advisory Services team has worked with their counterparts at the three MedStar hospitals participating in the alliance relationship — Washington Hospital Center, Union Memorial Hospital and Southern Maryland Hospital Center — to share insights from Cleveland Clinic’s experience in systemwide integration of quality and registry practices. This work has contributed to enhanced standardization across the MedStar hospitals in a range of areas. A few examples are outlined below.

Cardiovascular registries

Although the three MedStar hospitals report cardiovascular registry data separately, they realized they could gain efficiencies through greater centralization of their registry efforts. In response, the HVTI Advisory Services team shared how Cleveland Clinic works as a system through its centralized cardiovascular registry department. That experience served as a helpful factor as the quality and registry teams of the MedStar hospitals worked to standardize registry interfaces and workflows and identify shared ways to optimize staff utilization, ensure timely abstraction and adjudication, and promote active communication of feedback.

The three hospitals’ quality and registry teams continue to use their joint monthly calls with the Cleveland Clinic team to further exchange best practices and identify processes that can be replicated at all of their sites.

Systemwide outcomes dashboard

The MedStar teams recognized that standardization of registry practices calls for standardizing outcomes dashboards as well, to promote consistent reporting of collected data at all sites. Dashboard standardization also ensures that outcome metrics are presented in a comprehensive and timely way and can achieve maximum impact through effective visualization of data and trends.

The three hospitals’ registry and quality teams collaborated to develop a systemwide outcomes dashboard. Cleveland Clinic shared its systemwide dashboard as a general model for reference, which the MedStar teams drew from as appropriate to meet their specific needs and preferences. This effort also extended to interfaces with the technology platform used to populate registry data into the dashboard; these interfaces were replicated across MedStar sites for efficiency and optimal performance.

Best practices in using quality metrics

Beyond integrating data technology, achieving a systems approach to quality monitoring and improvement requires standardizing which metrics to focus on and how best to connect those metrics to positive patient outcomes. As the three MedStar teams worked to closely align which metrics to prioritize for maximum impact, Cleveland Clinic shared its standardized approach to quality metrics, along with policies and improvement plans it has used to improve key metrics in a consistent way across multiple sites. For example, MedStar and Cleveland Clinic have collaborated on optimizing the door-to-balloon time for ST-elevation myocardial infarction (STEMI) by implementing an emergency room bypass policy and utilizing a STEMI handoff tool.

Making the most of quality meetings

The alliance relationship provides another opportunity for the three MedStar hospitals to enhance their collaboration around registry and quality issues: combined quarterly quality meetings. At these regularly held video meetings, multidisciplinary teams from the MedStar hospitals and Cleveland Clinic’s team jointly review all three hospitals’ metrics together (Figure).

Registry/quality personnel and clinicians — including physician leads — from all sites come together to discuss shared challenges, share best practices for solutions and benchmark their metrics against each other to improve performance across the system. These interactive quality meetings have become an ideal forum for helping translate the teams’ enhanced data collection and analysis efforts into improved patient outcomes on priority metrics.

Figure. Schematic showing how combined quarterly quality meetings are run among the three MedStar Health hospitals’ registry and quality teams, using catheterization lab quality as an example. Meetings are focused on metrics and centered on MedStar’s outcomes as a system, with benchmarking among the three hospitals for jointly defined metrics. All sites discuss and share issues and best practices to promote consistent work plans and patient care throughout MedStar Health.

Learning from shared experiences

“Integration of registry and quality efforts across sites is a challenge that all multihospital systems have had to contend with, including Cleveland Clinic,” says Edward Soltesz, MD, MPH, Cleveland Clinic’s Director of Cardiac Surgery Affiliate and Alliance Programs. “We are pleased to be able to share our experiences in this realm with MedStar and to learn from them in turn. Coordination is not as easy to achieve as it may seem. What is certain is that the quality of patient care stands to benefit from it.”

“The evolution of ‘systemness’ is a critical journey for hospitals and providers as more and more of us find ourselves linked through both internal mergers and external alliances and affiliations,” adds Stuart F. Seides, MD, Physician Executive Director of MedStar Heart & Vascular Institute. “Nowhere is that more evident than in the realm of quality assurance, with real value generated through shared best practices, efficiencies and know-how.”

For more information on affiliations and alliances with Cleveland Clinic’s HVTI, email Amanda Lesesky at leseska@ccf.org.