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Rapid Sepsis Testing Generates Value-Based Care Gains at AHN BY CHRISTOPHER CHENEY | JANUARY 29, 2020
Rapid sepsis testing at Allegheny Health Network has boosted care quality with improved clinical outcomes and reduced costs. Sepsis is the body's extreme reaction to an infection, which can result in life-threatening symptoms such as multiple organ failure. Annually, more than 1.7 million people get sepsis in the United States, with about 270,000 fatalities, according to Centers for Disease Control and Prevention statistics. One-third of patient deaths in hospitals involve sepsis, the CDC says.
Time to effective treatment is a critical factor for patients infected with sepsis bacteria, says Thomas Walsh, MD, medical director of the Antimicrobial Stewardship Program at Pittsburgh-based AHN. "Every hour delay in antibiotic administration is associated with decreased survival."
For the past eight months, AHN has been using the AcceleratePheno test system to analyze bloodstream infections and determine the best antibiotic therapy for sepsis patients.
Before adopting the relatively new technology, Walsh says it could take AHN two to five days to detect sepsis and match the strain of sepsis bacteria to a narrow-spectrum antibiotic. Now, that process has been shortened to seven hours.
In addition to cutting time to treatment, which improves clinical outcomes, reducing the use of broad-spectrum antibiotics has significant benefits, he says. "We can avoid the downstream effects of unnecessarily broad antibiotic use such as propagating antimicrobial resistance and higher rates of Clostridium difficile."
Antimicrobial resistance to antibiotics is one of the most daunting public health problems of this generation, the CDC says.
GENERATING POSITIVE RESULTS For sepsis patients who were not treated in an ICU, AHN has posted several clinical gains, Walsh says.
"We dropped the time that we were able to identify bacteria from 39 hours to 90 minutes. We were able to decrease the time to knowing which antibiotics would be optimal from 46 hours to 7 hours," he says.
Walsh continues, "For patients who were initially on an inadequate antibiotic, we were able to reduce the time to get them on effective antibiotics from 51 hours to 11 hours. We reduced our length of stay from 8 days to 5.5 days. Our total duration for antibiotics went from 14 days to about 9.5 days."
Similar results have been achieved for sepsis patients treated in an ICU, he says. "For patients who were critically ill who were on inadequate antibiotics initially, we dropped the time to effective antibiotics from 43 hours to 12 hours. That led to a two-day drop in length of stay for those patients. For duration of antibiotics use in the ICU, we went from 15 days to 10 days."
The Accelerate Pheno testing has reduced cost of care, Walsh says. "For these kinds of rapid tests, to run one of the tests is usually between $150 and $200. The cost of being in the hospital is usually between $600 and $1,000 per day. If a patient is in an intensive care unit, the cost is usually between $1,000 and $2,000 per day. So, if you can use this new technology and get patients home two days quicker, you are saving about $1,000–$2,000 per day."
The rapid testing also has reduced medication costs, he says. "We are using less broad-spectrum antibiotics, which tend to be more expensive than narrow-spectrum antibiotics."
INCORPORATING RAPID TESTING INTO THE SEPSIS CARE PATHWAY The rapid testing technology must be combined with efficient workflows, Walsh says. "For us, the critical part was tying this testing to our antimicrobial stewardship team, which is a team of infectious disease doctors who help our bedside physicians use the appropriate antibiotics to maximize our clinical benefit while minimizing the collateral damage of broad-spectrum antibiotic use."
He says there are three primary steps in the care pathway associated with the rapid testing:
Once a blood culture flags positive for possible sepsis bacteria, microbiology technicians start the Accelerate Pheno testing and call nurses on the floor to alert them that bacteria is growing in the patient's blood and test results will be available within seven hours. The technicians also page the antimicrobial stewardship team, so they are aware as well.
The patient is given a broad-spectrum antibiotic as soon as possible.
When the testing results are available, the technicians call the nurses on the floor, who relay the message to the patient's attending physician that sepsis bacteria have been matched to effective antibiotics. The stewardship team is also alerted, and an infectious disease clinician and a pharmacist review the test results and the patient's medical record. Then the stewardship team members call the patient's care team to make recommendations for antibiotic administration.
HealthPartners receives CMS Health Equity award February 04, 2019
BLOOMINGTON, Minn.--(BUSINESS WIRE)--HealthPartners is one of only two organizations in the nation to receive the Health Equity Award from the Centers for Medicare and Medicaid Services. The award recognizes areas where HealthPartners has implemented new models to increase access to care and reduce health disparities.
“It's a great honor to be recognized for our deep commitment to health equity, and the progress we've made to improve health and access to care for everyone,” said Andrea Walsh, president and CEO, HealthPartners.
Examples of HealthPartners work to promote health equity include:
Clinics: more patients get lifesaving test for colon cancer. Screening for colon cancer is important because it can find and remove abnormal growths before they turn in to cancer. To help more patients of color get this life-saving test, HealthPartners began offering a fecal immunochemical test (FIT) kits. The FIT test is more comfortable and convenient than a colonoscopy. As a result of this effort, there was a significant increase in the number of people of color getting tested. That reduced the screening rate gap between white patients and patients of color.
Health plan: more patients get needed medication for depression. Patients need to stay on anti-depressant medication for at least six months to get the most benefit from it. But among members enrolled in Medicaid, there were more members of color who were not getting this care compared to white members. HealthPartners launched a program that helped more patients of color complete medication treatment.
Regions Hospital: better care for mental illness. At Regions Hospital, patients with limited English proficiency (LEP) needed to stay in the hospital longer than patients whose preferred language is English. One reason is because patients who spoke languages other than English could not participate in group therapy which can help people recover more quickly. To correct this, Regions trained staff interpreters to provide simultaneous interpreting. This method is used for interpreting for world leaders and it enabled patients to participate in group therapy. This technology is helping patients with LEP recover more quickly so that they can return home about four days sooner.
Advocate Aurora Health planning to use 100% renewable energy by 2030 by Paige Minemyer |
Advocate Aurora Health is the latest health system to bet big on renewable energy.
The system intends to operate fully on renewable energy sources by 2030, it announced this week. Advocate Aurora Health runs 27 hospitals and more than 500 outpatient facilities in Wisconsin and Illinois.
Reaching this goal, according to the system, would reduce its carbon emissions by 392,657 metric tons per year, equivalent to removing 84,000 cars from the road each year.
“As the 10th-largest not-for-profit integrated health system in the country, it’s imperative that we help lead the way toward a health environment that can support healthy people,” Mary Larsen, Advocate Aurora Health’s director of environmental affairs and sustainability, said in a statement.
“Transitioning to clean energy reduces air pollution that is responsible for many chronic health conditions and mitigates the health impacts of climate change,” she said.
Meanwhile, Boston Medical Center and the Massachusetts Institute of Technology teamed up in 2016 on a wide-ranging renewable energy plan. In 2016, Universal Health Services' George Washington University Hospital joined a purchasing consortium in D.C. aimed at building 52-watt solar capacity to meet an 80% greenhouse gas reduction target by 2040.
Kathy Gerwig, vice president of employee safety, health and wellness for Kaiser and the system’s environmental stewardship officer, told FierceHealthcare in an interview in the fall that the such a shift can have immediate public health benefits.
“It’s an immediate win—this isn’t something that’s going to pay off in 10 or 20 years from now,” she said.
Advocate Aurora Health said it considers its efforts as part of an overarching response to asthma, which is a common chronic condition in the Midwest. The system will also evaluate any major construction or renovation projects to see where on-site renewable energy could be implemented.
It’s expected to use a combination of on-site, off-site and purchased energy sources for the initiative. Advocate Aurora Health’s hospitals will also focus on being more energy efficient, the system said.
Fresh Food Program Makes a Difference in Type 2 Diabetes Patients see drops in HbA1c, reductions in medication by Joyce Frieden,News Editor, MedPage Today
WASHINGTON -- Giving patients with type 2 diabetes access to healthy food at no charge can result in large improvements in their disease and overall quality of life, Allison Hess said here.
"We're seeing on average a two-point reduction [in HbA1c] across the board -- and we don't have any side effects," Hess, who is associate vice president for health and wellness at Geisinger Health System, in Benton, Pennsylvania, said at the World Health Care Congress. "And in fact we have people coming off of their medications."
Geisinger's journey with food as medicine began after the health system looked at its results for treating type 2 diabetes patients. "Despite all the resources and all the effort, we still didn't feel like we were moving the needle quite as much as we had hoped," said Hess. "We also looked at the cost and we were concerned with our growing spend" on these patients.
So the health system began looking at social determinants of health as a possible reason for why so little progress was being made; they zeroed in on diet and exercise, particularly diet. To find out whether patients were food insecure, the plan embedded two food insecurity statements into their type 2 patients' medical record to get patients' responses while they were being roomed:
Within the past 12 months, we worried whether our food would run out before we got money to buy more (Yes or No)
Within the past 12 months, the food bought just didn't last and we didn't have money to get more (Yes or No)
If any patient answered "yes" to either question and met other criteria, they were referred to a Geisinger program called "Fresh Food Farmacy." The program, which began in July 2016, provides patients with two meals' worth of food per day, 5 days per week, to the entire household for as long as is needed. The food is available at a 3,000-square-foot facility on a Geisinger hospital campus in Coal Township, Pennsylvania. The Farmacy, which looks much like a supermarket, also includes a food warehouse and a classroom for offering nutrition classes.
At the beginning of the program, participants are limited mostly to food that allows them to prepare certain specific healthy recipes, but after a while they can have free choice among the foods offered, Hess said. The selection mostly includes "diabetes appropriate" food such as fresh fruits and vegetables; "we try to limit canned food." Almost all of the foods are sourced from local food banks, and those that aren't come from "vendor partners" of the health system.
The partnership with the food banks makes the food very inexpensive -- the cost is about $1,200 per year to feed a family of four, said Hess. "We couldn't do it without them as our partner."
Criteria for being referred to the program include:
Diagnosis of type 2 diabetes
HbA1c of ≥8%
Patient of Geisinger specialty or primary care
Patients who express interest in the program are encouraged to come to a "welcome class" at which they also meet their care team: an RN health manager, a pharmacist, a dietitian, a wellness associate, and a community health associate. "What's interesting is all of the care team members were already available, but because we put it into a program and added a food component, all of a sudden they're taking advantage of things they always had access to but may not have realized," said Hess. Patients who decide to enroll must meet again with the care team and enroll in a diabetes self-management class.
Each team member plays a specific role in taking care of the patient's needs, she continued. For example, the community health worker can address transportation and other non-medical needs. "We found out there were other social determinants of health -- [some people] had housing issues, and there were also people struggling to pay their heating bill in the winter."
"We're catching people at the point where they're kind of giving up," she added. "They have very high A1cs -- 10%, 11%, 12%, 13% -- and they're frustrated. Every time they go to the doctor, they [hear] they need to [change their diet] but they can't afford it." One patient in the program actually cuts up fruits and vegetables at his regular job, but he couldn't afford to buy them.
The program, which is currently funded through foundation grants, is also saving money for the health system. Rita, age 55, is one of the patients in the program. She is raising three grandchildren, and caring for a husband on dialysis. She weighed 181 lbs and had an HbA1c of 13.8%. When she came into the program in January 2017, she had "given up on herself completely," said Hess.
Nine months later, her HbA1c stood at 5.8% and her weight was down to 155; she is now a champion of the program. With Geisinger experiencing an average $8,000-$12,000 cost savings for each percentage point reduction in HbA1c, there were "huge" cost savings in Rita's case, Hess said.
Another patient who joined the program started with costs of more than $200,000 annually; that cost is now down to $40,000, according to Hess. In addition to the blood glucose changes, patients frequently experience decreases in cholesterol and blood pressure, and some early results are also showing decreases in emergency department visits, she added.
Geisinger doesn't promote its program as being for weight loss. "We do that very intentionally," said Hess. "We wanted this to be a nutrition program. [But] the byproduct is that they ask, 'What do you have for weight loss?' So we have put other programs in place that now have people continuing to lose weight."