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Program Lead: Patrick ConwayM.D., Principal Deputy Administrator, Administrator for Innovation and Quality, and CMS Chief Medical Officer
FY 14-15: Agency Priority Goal
Improve patient safety.
Priority Goal
Goal Overview
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Strategies
All strategies are based on data driven evidence-based proven models of quality and support agency partners. They also are aligned with the HHS Strategic Plan objectives, the National Action Plan to Prevent HAIs: Roadmap to Elimination, and the National Quality Strategy. Infection control practices are based on CDC guidelines.
The key strategic elements of this goal necessary to produce successful outcomes include:
- Collaboration among multiple stakeholders in the healthcare community.
Collaboration among multiple stakeholders in the healthcare community is necessary to spread and sustain reductions in HAIs on a broad scale. Collaboration creates synergy around CAUTI prevention and reduction efforts by leveraging the combined programmatic efforts of stakeholders, both across HHS and outside HHS, including those of the Department of Defense (DoD), the Veterans' Administration (VA), state governments, professional organizations, academia, provider and patient groups. Through continued emphasis on coordinating programs and strengthening our network of resources, we are able to provide technical assistance, testing, and financial support for the development and implementation of strategies to prevent HAIs, particularly those focused at the level where patient care occurs. Application of evidence-based guidelines for CAUTI prevention through the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) can be accomplished on a national scale by disseminating this knowledge through healthcare experts in the field. Through programs such as the QIO’s 11th Statement of Work, Partnership for Patients AHRQ’s CUSP national initiatives and state and local collaboratives, science-based guidelines can be both spread to a wide audience and tailored to state, local and facility needs.
- Tracking and monitoring data that drives improvement.
Using data to drive intervention and results is another essential element to goal success. The CDC puts out annual national and state-level SIR figures for CAUTI to track HAI reduction outcomes and help identify where programmatic resources may be most needed. The CDC’s state-based HAI prevention activities include data feedback at the facility-level to drive improvement and the CDC continues to develop and refine programs that promote the use of data for HAI prevention. For example, recent incorporation of the Targeted Action for Prevention (TAP) functionality into NHSN is allowing quality improvement entities, working in conjunction with the CDC, to identify and direct resources to those hospitals and units identified as having the greatest excess number of CAUTIs. AHRQ’s Medicare Patient Safety Monitoring System (MPSMS) will be used to compare broad trends in CAUTI to those seen in NHSN. Lastly, CMS, CDC and state health departments continue to collaborate on HAI data validation strategies to optimize the accuracy of data reported.
- Linking higher quality, safer and more efficient care to payment.
CMS' Value-Based Purchasing Program links payment to acute care hospitals to their performance. The CMS’ Hospital Inpatient Quality Reporting Program (HIQR) provides the vehicle through which participating hospitals report specific HAIs, into the National Healthcare Safety Network (NHSN) in order to receive their full annual payment update. CMS' payment rules that require hospitals under the Inpatient Prospective Payment System (IPPS) to report CAUTI cases in intensive care units, have increased HAI data reporting into the NHSN database. In January 2015, CMS’ Hospital Inpatient Quality Improvement Program further linked HAI reporting to payment by requiring IPPS hospitals to report CAUTIs in non-ICUs in order to receive their annual payment update in subsequent years. CMS’ Hospital- Acquired Condition Present-On-Admission (HAC-POA) program does not allow for increased reimbursement when CAUTI is listed as a secondary diagnosis and deemed to have been acquired during a hospital admission.
- Research and testing that refine evolving HAI prevention guidelines, optimize implementation strategies and tools and integrate health information technology.
AHRQ supports an extensive program of HAI research and implementation that includes spreading the use of CUSP for CAUTI nationwide and expanding the application of CUSP to other HAIs, to healthcare settings beyond the hospital, and to other patient safety issues (e.g., perinatal safety). In addition, through its Prevention Epicenters research program, CDC supported a study to evaluate use of electronic medical records to identify patients who may have an unnecessary urinary catheter in place. This could serve as a powerful prevention tool because the single most important strategy for preventing CAUTI is removal of catheters from patients who no longer need them (CDC).
Progress Update
Q4 FY 2015 MILESTONE: On September 24, 2015, seventeen Hospital Engagement Networks (HENs) were awarded for a 12 month period of performance. The SOW in support of this next period of performance requires specific emphasis on CAUTI reduction inclusive of a robust plan aimed at decreasing catheter utilization. Tools such as those available from the CDC (CDC NHSN - TAP strategy) as well as in-depth root-cause analysis of contributing factors both in the ICU and other units are proposed by the HENs as mechanisms to continue CAUTI reduction. Coordination with other stakeholders are being developed and shared in an effort to develop ongoing synergy to maximize resources.
Partnership for Patients also examines Medicare Patient Safety Monitoring System (MPSMS) data in addition to NHSN to examine results. The varying definition of CAUTI in MPSMS (based on physician diagnostic elements) and its used of incident rate make it difficult to compare CAUTI NHSN and MPSMS data, however we should note that both sources share a downward trend in CAUTI reductions. A version of the (physician-diagnosed) CAUTI data from MPSMS is on-line as part of the information disseminated so far on data from Partnership for Patients. This can be found on http://www.ahrq.gov/professionals/quality-patient safety/pfp/index.htm.
- In Q4, AHRQ’s nationwide CUSP for CAUTI project reached its conclusion. Project data are being thoroughly analyzed, and final results will be available in December 2015.
- AHRQ previously reported that, as of March, 2015, the project recruited eight cohorts representing 955 hospitals and 1,595 hospital units across forty (40) States, the District of Columbia, and Puerto Rico. An additional ninth cohort of ICUs was recruited, and these ICUs implemented CUSP with increased technical assistance and attention to catheter utilization.
- Among the units participating in CUSP for CAUTI, 746 units reached a point 14 months after initiating CUSP implementation and reported data on CAUTI rate reductions at that point.
- Overall, these units achieved a 13.5% relative reduction in CAUTI rates.
- Non-ICUs achieved a 23.4% relative reduction in CAUTI rates, whereas ICUs achieved a 5.9% reduction in CAUTI rates. The CAUTI rate reduction in non-ICUs is greater than in ICUs in part because ICUs have higher rates of catheter utilization than non- ICUs.
- As noted in the Next Steps section below, at the end of FY 2015 AHRQ funded a project that will apply CUSP to reduce persistently elevated CAUTI and CLABSI rates in ICUs. This project is a collaborative effort of AHRQ, CDC, and CMS.
- CMS QIN.QIOs: QIOs completed their active recruitment phase for directed assistance to reduce HAIs, including CAUTI in every state in the nation. A total of 701 hospitals were recruited specifically for the reduction of CAUTI. The TAP strategy was employed in close collaboration with the CDC by all QIN.QIOs to ensure resources were employed according to data-driven needs for improvement.
- QIN-QIOs entered into active intervention phase to reduce CAUTI in hospitals and progress with respect to targeted goals will be monitored annually.
- Partnership for Patients: (see “Milestone”).
-
The CDC has led a successful implementation of the TAP program in close partnership with CMS and AHRQ. Specific examples of the use of TAP this quarter include:
-
Distribution of updated CAUTI TAP tools to 78 contacts from all 14 QIN QIOs across 48 states, Puerto Rico and the Virgin Islands. This quarter, CDC has provided these tools to over 20 federal and non-federal partners including individual facilities.
-
Provision of several webinars including individualized webinars at the request of seven QIN QIOs to further educate on TAP implementation, educational guidance and customization of tools for regional and facility-specific needs.
-
- CDC has started work with the Health Research and Education Trust on a national effort to perform infection control assessments in hospitals which will include specific work on CAUTI prevention.
- OASH: OASH is conducting literature reviews; data collection and analysis in the disparities phase of its “Reducing Racial/Ethnic and Other Disparities in Preventable Adverse Healthcare-Associated Outcomes” a Project which includes prevention and reduction of CAUTIs in these populations.
Next Steps:
Although Reduction of CAUTI in hospitals was not maintained as an HHS Agency Priority Goal, CMS will retain this as a GPRA goal using the same collaborative means and monitoring schedule as is used in the APG format. Taking into account CAUTI definition changes that began in January 2015 and a reset of the NHSN CAUTI SIR baseline to 1.0 in December of 2015, CMS has targeted a 5% reduction in the national hospital-acquired CAUTI SIR by September 2016 and an overall 10% reduction by the end of 2017.
We will continue to use a combination of programmatic levers and evidence-based infection control interventions in order to show substantial reductions in CAUTI.
- CMS’ QIO program - CMS and CDC continue to work together using TAP data to direct hospitals with the greatest numbers of CAUTIs to QIN.QIOs in their regions. This serves as a continued illustration of the data-driven and collaborative principles so heavily a part of this goal.
- An evidence-based abstract, co-authored by both CDC and CMS, "Development of a Catheter-associated Urinary Tract Infection Facility Assessment Tool to Target Prevention" was written and accepted. It will be presented as an oral presentation for ID Week October 7-11, 2015 in San Diego, CA.
- The published abstract is available on the Open Forum Infectious Diseases (OFID), the new Open Access Journal from the Infectious Disease Society of America (IDSA).
- CDC will continue to provide education and technical support to partner organizations engaged in CAUTI prevention such as CMS’ QIO.QINs and HENs as well as in partnership with AHRQ programmatic resources.
- CDC is also exploring the use of a risk-adjusted urinary catheter utilization metric (i.e., standardized utilization ratio) as a potential quality metric to reduce inappropriate urinary catheter use.
- AHRQ: The nationwide CUSP for CAUTI project reached its conclusion in August 2015, and final results regarding CAUTI rate reductions will be available in December 2015.
- An AHRQ-funded project will focus on applying CUSP to reduce persistently elevated CAUTI and CLABSI rates in ICUs. This project, which was funded toward the end of FY 2015, is a follow-up to AHRQ’s nationwide CUSP for CAUTI and CUSP for CLABSI projects. This project is being conducted as a collaboration among AHRQ, CDC, and CMS: AHRQ will provide funding, guidance, and technical assistance to participating units on CUSP intervention; CDC will use NHSN data to identify lower performing ICUs and provide additional technical assistance; and CMS will mobilize QIN.QIOs as intervention agents.
- OASH: Anticipate Secretarial comments on proposed 2020 HAI targets for National Action Plan to Prevent HAIs: Roadmap to Elimination and resumption of regular HHS HAI Steering Committee meeting hosted by OASH.
We continue to examine the etiology behind lack of projected CAUTI reductions. Analysis thus far reveals a need to focus additional efforts in ICU locations, reduce inappropriate urinary catheter use, and target prevention gaps with evidenced-based prevention implementation strategies focus additional efforts in ICU locations, reduce inappropriate urinary catheter use, and target prevention gaps with evidenced-based prevention implementation strategies. In addition, we continue to strengthen learning and action networks and HAI prevention and reduction efforts between our multiple private and public stakeholders. These efforts contribute bi-directional learning, the spread of best practices and optimizing outcomes. Improvements in measurement strategies are actively being addressed in conjunction with the healthcare community including ways to increase clinical objectivity and accuracy of CAUTI reporting. Strategies and methods of changing behavior are needed particularly in ICU settings where CAUTI rates tend to remain higher than in non-ICUs. Work to increase and spread evidence- based practices along with implementation strategies and tools to embed them in facilities is ongoing. Work across transitions of care warrants concerted efforts to make broad scale improvements in this arena.
Next Steps
No Data Available
Expand All
Performance Indicators
Hospital-acquired catheter-associated urinary tract infections (CAUTI) standardized infection ratio (SIR)
Contributing Programs & Other Factors
- Quality Improvement Organizations
- Partnership for Patients
- State-based Healthcare Associated Infections Programs
- Comprehensive Unit-based Safety Program (CUSP)
- Healthcare Associated Infections Research and Implementation Projects in AHRQ’s Patient Safety Portfolio
- National Action Plan to Prevent Healthcare Associated Infections: Roadmap to Elimination
- National Healthcare Safety Network
Expand All
Strategic Goals
Strategic Goal:
Strengthen Health Care
Statement:
Strengthen Health Care
Strategic Objectives
Statement:
Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured
Description:
HHS is securing and extending health insurance by implementing provisions created by the Affordable Care Act such as working with states to set up health insurance exchanges, expanding Medicaid coverage to low-income Americans, and prohibiting insurance companies from dropping people when they get sick.
Statement:
Improve healthcare quality and patient safety.
Description:
HHS is improving healthcare quality and patient safety by developing physician- and hospital-quality reporting systems that link payments to the quality and efficiency of care and initiating a bundled-payment system that will align payments for services delivered across an episode of care, such as a heart bypass or hip replacement, rather than paying for services separately. HHS is also reducing healthcare-associated infections, adverse drug events, and other complications of healthcare delivery through quality and safety promotion efforts.
Statement:
Emphasize primary and preventive care linked with community prevention services
Description:
The Affordable Care Act is expanding insurance coverage for Americans, supporting improvements in primary care, and makings new investments in community-based prevention. As part of this effort, HHS is focusing on creating key linkages between health care and effective community prevention services that support healthy living and disease management.
Statement:
Reduce the growth of healthcare costs while promoting high-value, effective care
Description:
HHS is identifying, testing, evaluating and expanding innovative payment and service delivery models to reduce program expenditures for Medicare, Medicaid, and CHIP, without compromising quality of care or patient health outcomes. HHS is establishing value-based payment policies, programs, and initiatives that reward providers for delivering high-quality and efficient care. In addition, HHS is exploring strategies to enable providers and payers to process financial and administrative transactions faster and at lower cost.
Statement:
Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations
Description:
With the growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patient's unique social and cultural experience and language needs. The Affordable Care Act highlights minority health by formally establishing minority health offices in the Department's agencies, and contains provisions to improve data collection and analysis. HHS is working to address disparities by promoting access to quality primary care and preventive services, developing a diverse, culturally-competent workforce, and preventing discriminatory practices.
Statement:
Improve health care and population health through meaningful use of health information technology
Description:
At the heart of HHS’s strategy to strengthen and modernize the healthcare system is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, and support reformed payment structures. To accomplish this, HHS is encouraging widespread adoption and meaningful use of health information technology through incentives, grants, and technical assistance.
Agency Priority Goals
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Strategic Goal:
Advance the Health, Safety, and Well-Being of the American People
Statement:
Advance the Health, Safety, and Well-Being of the American People
Strategic Objectives
Statement:
Promote the safety, well-being, resilience and healthy development of children and youth
Description:
HHS partners with service providers to sustain an essential safety net of services that protect children and youth, promote their emotional health and resilience in the face of adversity, and ensure their healthy development from birth through the transition to adulthood. HHS also works to achieve this objective by identifying and implementing evidence-based interventions; promoting greater coordination across programs; and strengthening the human services workforce.
Statement:
Promote economic and social well-being for individuals, families and communities
Description:
HHS agencies work together and collaborate across Federal departments to maximize the potential benefits of various programs, services, and policies designed to improve the well-being of individuals, families, and communities. Many HHS agencies fund essential human services to those who are least able to help themselves, often through the Department’s state, local, and tribal partners.
Statement:
Improve the accessibility and quality of supportive services for people with disabilities and older adults
Description:
HHS programs and initiatives have special significance for older adults and people of all ages who have disabilities. Older adults and individuals with disabilities may need services and supports to assist them in performing routine activities of daily living such as eating and dressing. Improving access to, and the quality of, supports and services for older adults and people with disabilities is an HHS policy priority and is seen throughout HHS programs.
Statement:
Description:
HHS works to promote prevention and wellness across its programs and agencies. As the Nation's principal prevention agency, CDC has primary responsibility for addressing chronic diseases through population and community health activities; working to support State, local, and tribal public health agencies; promoting health through education; and conducting outreach to vulnerable populations. Over the next several years, HHS's focus will be on creating environments that promote healthy behaviors to address the chronic diseases and health conditions that result in the most deaths, disability, and costs.
Statement:
Reduce the occurrence of infectious diseases
Description:
Addressing infectious diseases - including vaccine-preventable diseases, foodborne illnesses, HIV/AIDS and associated sexually transmitted infections, hepatitis, tuberculosis, health care-associated infections, novel influenza viruses, and infections transmitted by animals and insects - is an HHS priority. HHS is working with its governmental and nongovernmental partners to strengthen basic and applied research, surveillance, diagnosis, and treatment efforts to reduce the burden of infectious diseases in the U.S. and throughout the world.
Statement:
Protect Americans’ health and safety during emergencies, and foster resilience to withstand and respond to emergencies
Description:
Over the past decade, our Nation has renewed its efforts to address large-scale incidents that have threatened human health, such as natural disasters, disease outbreaks, and terrorism. Working with its Federal, State, local, tribal, and international partners, HHS continues to support capacity-building efforts and strengthened linkages between government, nongovernmental organizations, and the private sector. HHS is now guided by the first National Health Security Strategy, a comprehensive framework for how the entire Nation must work together to protect people's health in the case of an emergency.
Agency Priority Goals
Statement:
To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description:
At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year.
Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system.
The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward.
As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes.
We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include:
- Quality Improvement Organization (QIOs) Program
- Hospital Inpatient Quality Reporting (HIQR) Program
- Disseminating Data for Action using the National Healthcare Safety Network (NHSN)
- State HAI programs
- Partnership for Patients (PfP)
- Comprehensive Unit-based Safety Program (CUSP) for CAUTI Ongoing coordination through HAI strategic planning, HAI Regional and National Meetings
- Regular review and updates to the National Action Plan to prevent HAIs: "Roadmap to Elimination."
Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data.
Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily.
We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015.
Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement:
By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System in Head Start.
Description:
This Priority Goal calls for actions in FY 2014 and FY 2015 to improve the quality of early childhood education programs for low-income children. For the ACF Child Care program, the goal is to increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet the seven high quality benchmarks for child care and other early childhood programs, developed by HHS. QRIS is a mechanism by which to improve the quality of child care available in communities and increase parents’ knowledge and understanding of the child care options available to them. In order for a QRIS to be considered as meeting high-quality benchmarks, it must 1) be statewide; 2) be eligible to child care centers and family child care homes; 3) include quality improvement indicators that cover learning environments and curriculum, teacher/practitioner standards, and family partnerships and strengthening; 4) use training or on-site consultation to help child care programs attain or maintain quality improvement standards beyond licensing; 5) offer financial incentives for maintaining or increasing quality to child care centers and family child care homes; 6) include quality assessments of child care centers and family child care homes; and 7) use symbols or simple icons that indicate levels of quality as part of resource and referral/consumer education services to parents seeking child care. For FY 2011, a baseline of 17 states had implemented a QRIS that met all outlined high quality benchmarks. The baseline was calculated using FY 2012-2013 State Plans that were submitted in September 2011. In FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks, and the ACF Office of Child Care (OCC) has established a target of 32 states for FY 2015.
Currently, many states meet some, but not all seven, of the outlined benchmarks. States are making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached. For example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks. Between FY 2011 and FY 2014, 27 states and territories have made progress on at least one of the components of the measure. In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by ACF, will continue to help states work toward their goal of improving their QRIS.
Also as part of this Priority Goal, the ACF Office of Head Start (OHS) is striving to increase the percentage of Head Start children in high quality classrooms. Progress is measured by reducing the proportion of Head Start grantees scoring in the low range in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K). This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support. OHS successfully began data collection using random samples for the CLASS: Pre-K in the first quarter of FY 2012. Analysis of the full data set of CLASS scores for the cohort of 388 Head Start grantees that received on-site monitoring in the 2011-2012 Head Start “school year” occurred in October of 2012, and OHS established a baseline of 25 percent scoring in the low range.
An analysis of CLASS scores for the most recent cohort of 404 Head Start grantees that received on-site monitoring in the 2013-2014 Head Start “school year” (FY 2014 actual result) indicates that 23 percent of grantees scored in the low range, thus meeting the target of 27 percent. All grantees scoring in the low range (below 2.5) in FY 2014 did so for the Instructional Support domain. (Nationwide for the CLASS: Pre-K tool, scores are typically higher in the domains of Emotional Support and Classroom Organization than in the domain of Instructional Support.)
The FY 2014 result is a signicant improvement relative to the previous FY 2013 result, when the number of grantees scoring below a 2.5 was 31 percent. In response to the data from the FY 2013 CLASS reviews, OHS developed a system to provide more intentional targeted assistance to those grantees that score in the low range on CLASS. OHS is continuing to flag grantees that score in the low range, conduct more analyses on the specific dimension level, which are specific elements or skill areas within each of the three domains, and providing periodic reports to its Regional Offices so they can direct their TTA to specific grantees. For example, concept development, quality of feedback, and language modeling are the three dimensions within the domain of Instructional Support. Providing TTA at the more specific dimension-level supports grantees to focus in on the skills that need improvement.
There are some challenges to making progress in these areas. In the past two decades, a growing body of evidence has established the importance of quality child care in promoting healthy child development and school readiness and success for children. However, systemic changes take time to implement, and states are at different starting points. In the FY 2016 Budget request to Congress, the President continued to build a continuum of high-quality early childhood programs, including proposing an historic investment of $82 billion over 10 years to increase the availability of high-quality child care for children under four years old. On November 19, 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings. Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will help move states toward meeting this priority performance goal. In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities. OCC is gathering information about QRIS implementation through the CCDBG Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals. ACF recently announced the Early Childhood Training and Technical Assistance System, which transforms the current TA system for child care, T/TA for Head Start, and related programs into a coordinated system that will provide training, resources and materials to multiple stakeholder groups at regional, state and local levels to support school readiness. The new National Center on Early Childhood Quality Assurance will help OCC continue to support the infrastructure of an early childhood education quality improvement framework, including QRIS.
Additionally, with respect to Head Start, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon. Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. OHS is using multiple approaches to address this challenge, including policy levers, training and technical assistance, and professional development efforts.
Statement:
By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12% decrease from the 2012 baseline.
Description:
Smoking and second hand smoke is the leading preventable cause of death in the United States, killing more than an estimated 480,000 people in the U.S. each year. For every smoker who dies from a smoking-attributable disease, another 30 live with a serious smoking-related disease. Smoking costs the U.S. more than $300 billion a year, including nearly $170 billion in direct medical costs, and more than $156 billion in lost productivity. An estimated 58 million nonsmoking Americans are exposed to secondhand smoke, which causes more than 41,000 deaths in non-smoking adults each year . While smoking among U.S. adults is down significantly from a decade ago, the decline in adult smoking rates has slowed, concurrent with reductions in state investments in tobacco control program. Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Smoking cessation lowers the risk for lung and other types of cancer; it reduces the risk for coronary heart disease, stroke, and peripheral vascular disease. .
In 2010, HHS issued Ending the Epidemic – A Tobacco Control Strategic Action Plan, outlining a set of comprehensive actions framed around four key Healthy People 2020 tobacco control objectives:
1) reduce tobacco use
2) reduce the initiation of tobacco use
3) increase successful cessation attempts by smokers
4) reduce the proportion of nonsmokers exposed to secondhand smoke.
The National Prevention Strategy, released in 2011, includes tobacco control as one of seven priorities across the U.S. Government.
In 2012, cigarette and smokeless tobacco companies spent more than $9.6 billion, more than $1 million per hour that year, on advertising and promotional expenses in the United States to attract new users, retain current users, increase consumption, and generate favorable attitudes toward smoking. There is also a growing concern regarding new tobacco products that are being marketed to smokers as alternatives for use in smoke-free environments. Dual use of cigarettes and other tobacco products can maintain tobacco addiction and use among smokers who might otherwise quit. The marketing of purported reduced-risk products may increase overall tobacco use. Consumer mistaken perceptions of the “safety” of these products may pose a continuing obstacle for tobacco control.
States continue to reduce funding for comprehensive tobacco control. Research has shown that progress to prevent initiation and promote cessation in comprehensive programs is reversed when funding is no longer sustained.
HHS engages with multiple stakeholders in implementing tobacco control activities, which include: Congress, the public, minority communities, groups affected by tobacco-related health disparities, state and local tobacco control officials, tobacco control and public health non-governmental organizations, the scientific & research community, and businesses.
The U.S. Congress has provided direction and support for tobacco control activities in the following legislative actions:
• The Patient Protection and Affordable Care Act
• The American Recovery and Reinvestment Act (ARRA)
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA)
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA)
HHS oversees tobacco control and prevention committees covered by the Federal Advisory Committee Act. All meetings of these committees are open to the public and offer opportunities for stakeholder feedback.
Statement:
By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Description:
Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, Salmonella causes an estimated 1.2 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella serotype Enteritidis (SE), a subtype of Salmonella, is now the most common type of Salmonella in the United States and accounts for approximately 20% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Therefore, reducing SE illness from shell eggs is the most appropriate FDA strategy for reducing illness from SE. Preventing Salmonella infections depends on actions taken by regulatory agencies, the food industry and consumers to reduce contamination of food, as well as actions taken for detecting and responding to outbreaks. As part of the shared vision to reduce foodborne illness, HHS's Food and Drug Administration (FDA) has developed a Priority Goal to reduce Salmonella contamination in shell eggs, and the Centers for Disease Control and Prevention (CDC) is working with FDA to gather more data to better estimate sources of illness. Additionally, USDA, FDA and CDC are involved in many interagency efforts, including the Interagency Food Safety Analytics Collaboration (IFSAC). This interagency collaboration is working to improve methods used to estimate the proportion of foodborne illnesses associated with specific sources.
Strategic Objectives
Strategic Objective:
Statement:
Improve healthcare quality and patient safety.
Description:
HHS is improving healthcare quality and patient safety by developing physician- and hospital-quality reporting systems that link payments to the quality and efficiency of care and initiating a bundled-payment system that will align payments for services delivered across an episode of care, such as a heart bypass or hip replacement, rather than paying for services separately. HHS is also reducing healthcare-associated infections, adverse drug events, and other complications of healthcare delivery through quality and safety promotion efforts.
Agency Priority Goals
Statement: To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description: At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year. Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system. The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward. As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes. We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include: Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data. Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily. We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015. Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Strategic Objective:
Reduce the growth of healthcare costs while promoting high-value, effective care
Statement:
Reduce the growth of healthcare costs while promoting high-value, effective care
Description:
HHS is identifying, testing, evaluating and expanding innovative payment and service delivery models to reduce program expenditures for Medicare, Medicaid, and CHIP, without compromising quality of care or patient health outcomes. HHS is establishing value-based payment policies, programs, and initiatives that reward providers for delivering high-quality and efficient care. In addition, HHS is exploring strategies to enable providers and payers to process financial and administrative transactions faster and at lower cost.
Agency Priority Goals
Statement: To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description: At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year. Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system. The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward. As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes. We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include: Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data. Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily. We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015. Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Strategic Objective:
Statement:
Reduce the occurrence of infectious diseases
Description:
Addressing infectious diseases - including vaccine-preventable diseases, foodborne illnesses, HIV/AIDS and associated sexually transmitted infections, hepatitis, tuberculosis, health care-associated infections, novel influenza viruses, and infections transmitted by animals and insects - is an HHS priority. HHS is working with its governmental and nongovernmental partners to strengthen basic and applied research, surveillance, diagnosis, and treatment efforts to reduce the burden of infectious diseases in the U.S. and throughout the world.
Agency Priority Goals
Statement: To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10% reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current SIR of 1.03 to a target SIR of 0.92.
Description: At any given time, about one in every 25 hospitalized patients has a healthcare-associated infection while over 1 million HAIs occur across the U.S. healthcare system every year. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year. Of these hospital-acquired events, catheter-associated urinary tract infections (CAUTI) are among the most common. Research has shown that a significant portion of these infections can be prevented, avoiding patient morbidity and mortality from this HAI while reducing costs accrued to the healthcare system. The HAI Agency Priority Goal is to reduce the national rate of HAI by demonstrating significant, quantitative and measurable reductions in hospital-acquired CAUTI. As such; the FY2014-15 HAI Agency Priority Goal (APG) is to reduce the national CAUTI standardized infection ratio by 10% by September 2015 over the current 2012 baseline of 1.03. Of note, this SIR baseline was changed from 1.02 to 1.03 in this goal. This reflects the fact that the CDC released preliminary final numbers for 2012 in September 2013, the time at which this goal was written. However, hospitals still had through the end of the year to report final data to NHSN. Accounting for the last three months of data submitted by some hospitals caused a slight adjustment in the final (and thus baseline) 2012 SIR from 1.02 to 1.03. We make this adjustment in the HAI.APG to reflect the finalized SIR and to maintain consistency with other HAI reports moving forward. As we carry this portion of the goal from the FY2011-13 goal, a concerted effort between the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Office of the Assistant Secretary of Health (OASH) will continue to be a crucial to meeting goal targets. The main US Department of Health and Human Services (HHS) operating divisions that constitute this workgroup will focus on applying their HAI programmatic efforts in a way that aligns strategy and metrics, provides consistent messaging to its audience, uses data to target those facilities in most need of improvement, and creates synergy to achieve CAUTI reduction outcomes. We will continue to use combined HHS programmatic levers to contribute to the achievement of CAUTI targets. These initiatives include: Attention to several factors are necessary to assess progress toward goals in this new period. As in the previous HAI goal and consistent with a measurement strategy used by a majority of hospitals that participate in national HAI reporting initiatives, this goal will use the standardized infection ratio (SIR) as the measure, NHSN, the CDC-run infection surveillance system as the primary data source and report data points on a biannual basis. A six month lag in data will remain in order to ensure the most complete and accurate data being reported out and minimize statistically insignificant variations in the data. Lessons learned from the previous goal allow us to predict potential changes in the CAUTI SIR trend in the months following January 2015 now that CMS' Hospital Inpatient Quality Reporting (HIQR) program requires participating hospitals to report CAUTI in non-intensive care units to receive their full annual payment update. The influx of new CAUTI reporters in the middle of the previous 2011-13 HAI.APG was identified as one but not the sole, etiology behind an increase in the CAUTI SIR over the life of this goal. The differences in CAUTI SIRs in ICU and non-ICU settings along with the influx of new reporters among non-ICU locations in 2015 may impact this goal. The degree to which this could again be a factor again is unknown especially since through programmatic outreach, many hospitals already report non-ICU CAUTI data to NHSN voluntarily. We also anticipate application of the new CAUTI definition, which went into effect January 1, 2015, to the APG data we will report in subsequent quarters. Because our baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC will construct a new SIR by applying the new CAUTI definition to our current baseline SIR and data points proceeding January 1, 2015. In other words, we will translate SIR data including our baseline data prior to January 1st to SIR data that is reflective of the changes in the CAUTI definition. We will also be able to illustrate the CAUTI SIR baseline and trending data by applying the new vs the old definition in order to demonstrate the degree of difference or lack thereof resulting from this definitional change. CDC has changed the CAUTI definition in response to input from stakeholders and scientific data.The HAI Workgroup will present full details on the definition change in relation to this goal and our targeted CAUTI SIR reductions to HHS leadership in November of 2015. Lastly, analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Intensive care units have significantly higher SIRs, higher number of catheter-days, and show less reductions in these indicators of progress than in the non ICU setting. The difference in CAUTI reductions between ICUs and non-ICU settings have been highlighted in analysis of both NHSN and CUSP for CAUTI data. Given the fact that sicker patients are admitted in ICUs, retaining a urinary catheter for longer may be a rooted in practice necessity or provider belief that it is a necessity and so concentrating on behavioral and systems process change may need to be further emphasized as we work in this setting to reduce CAUTI. The 10% goal for CAUTI reduction in this APG effort represents a composite goal that reflects greater reductions in non-ICU settings and lesser reductions in ICUs. Improvements in CAUTI however, have been demonstrated in large scale improvement programs when actively engaged in embedding evidence-based infection control protocol and a culture of safety unit and facility-wide. It’s also important to note that preliminary projections through the first three quarters of 2015 continue to show a fall in the CAUTI SIR and an on-track trajectory for achieving the CAUTI goal target.
Statement: By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Description: Salmonella is the leading known cause of bacterial foodborne illness and death in the United States. Each year in the United States, Salmonella causes an estimated 1.2 million illnesses, including fever and diarrhea, and between 400 and 500 deaths. Salmonella serotype Enteritidis (SE), a subtype of Salmonella, is now the most common type of Salmonella in the United States and accounts for approximately 20% of all Salmonella cases in humans. The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated). Therefore, reducing SE illness from shell eggs is the most appropriate FDA strategy for reducing illness from SE. Preventing Salmonella infections depends on actions taken by regulatory agencies, the food industry and consumers to reduce contamination of food, as well as actions taken for detecting and responding to outbreaks. As part of the shared vision to reduce foodborne illness, HHS's Food and Drug Administration (FDA) has developed a Priority Goal to reduce Salmonella contamination in shell eggs, and the Centers for Disease Control and Prevention (CDC) is working with FDA to gather more data to better estimate sources of illness. Additionally, USDA, FDA and CDC are involved in many interagency efforts, including the Interagency Food Safety Analytics Collaboration (IFSAC). This interagency collaboration is working to improve methods used to estimate the proportion of foodborne illnesses associated with specific sources.
