ISQUA17-2143MANAGING TOP RISKS IN HEALTHCARE THROUGH A SHARED INTEGRATED (ENTERPRISE) RISK MANAGEMENT APPROACH

Abstract

Objectives: Fulfilment of process performance measures reflecting clinical guidelines recommendations for hip fracture care have been shown to be associated with a loer 30-day mortality and readmission risk. 1 However, it remains largely unknown whether improvements in quality of care will require increased spending or whether improvements in quality of care will lead to a reduction in adverse patient outcomes, including fewer complications and readmissions, and less inappropriate use of health care and hereby to lower costs. We therefore examined whether fulfilment of process performance measures are associated with in-hospital costs among hip fracture patients. Methods: We performed a nationwide cohort study including 20,458 hip fracture patients ≥65 years based on prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. Quality of care was defined as fulfilment of seven process performance measures based on recommendations from the national multidisciplinary guideline for in-hospital hip fracture care: Systematic pain assessment, early mobilisation, basic mobility assessment before admission and discharge, post discharge rehabilitation program , anti-osteoporotic medication and prevention of future fall accidents. The process performance measures were analysed individually. In addition, quality of care was also modelled as a proportion of all fulfilled performance measures for the individual patient (0-25 %, 50-75 %, 75-100%). The outcome was defined as the sum of costs of the individual patient, including both orthopaedic and non-orthopaedic care based on the Danish Reference Cost Database. Total cost was examined within the index admission and within the first year. A natural log-transformation was used to correct for the right-skewness in cost data, and the cost differences were reported as ratios between arithmetic means. Data were analysed using multivariable regression techniques controlling for cov-ariates and cluster effects at unit level. Results: Fulfilment of nearly all process performance measures were all associated with lower total costs within the index admission. The adjusted ratio ranged from 0.91 (95% Confidence Interval (CI): 0.91-0.92) to 0.99 (95% CI: 0.98-0.99), corresponding to adjusted mean differences between EUR304 to EUR3538 for the individual process performance measures. Fulfilling between 50% to 75% or more than 75% of the process performance measures were also associated with lower total cost. The adjusted ratio were 0.98 (95% CI: 0.97-0.98) for receiving between 50% to 75% and 0.94 (95% CI: 0.94-0.95) for receiving more than 75% of the performance measures, corresponding to adjusted mean differences of EUR2645 and EUR3548, respectively. The association were weakened when taking into account all costs related to hospitalisations within the first year. However, most of the individual process performance measures as well as the composite score remained associated with lower cost. Conclusion: Our study underlines the importance of meeting process performance measures reflecting clinical guideline recommendations for in-hospital care of hip fracture patients as this may lead to lower 30-day mortality and lower risk for readmission without increasing the total hospital costs. Reference 1. Kristensen PK, Thillemann TM, Søballe K, Johnsen SP. Are process performance measures associated withclinical outcomes among patients with hip fracture? A population-based cohort study. Int Qual Health Care 2016;28:698-708. Objectives: Many leaders of healthcare organizations have indicated that industry-related integrated risk management (IRM) programs are complex and not well-suited for healthcare. Healthcare organizations in Canada are working together to implement a IRM to track top risks utilizing shared online risk register to effeciently track and manage key organizational risks and to share knowledge and best practice recommendations across the healthcare system. Methods: IRM has been identified as an important requirement to monitor and improve quality and safety in the leadership and gov-ernance area by the national healthcare accreditation body. HIROC, together with IRM Steering Committee comprised of risk management experts from various healthcare organizations, developed a web-based IRM Risk Register program in 2014. The output of this initiative were comprised of 1) a comprehensive guide synthesising knowledge of IRM best practices; 2) the taxonomy of key risks in healthcare organizations; and 3) the shared Risk Register application. Five guiding principles influenced the development of this program: go with the evidence, focus risks to key organizational objectives, gear to board and senior leadership needs, recognize that it is an evolving area, and "keep it simple". The program was successfully launched in January 2015 and the early results are promising. Results: Since the launch of the Risk Register in January 2015, 95 healthcare organizations ranging from teaching hospitals to community health centres to medical regulatory authorities are actively participating in the program. A national database of risks is being materialized and there are self-identified 1735 risks in the Risk Register. Of the 1735 risks, 628 are in active status, 550 are in initial review status and 557 are closed. Knowledge and leading practices gleaned from the risk register entries are analysed, de-identified and published/shared on a regular basis in the form of Community of Practice newsletters, online risk profile resource documents and Abstracts 19