Organ Donation Breakthrough Collaborative Institute of Medicine June 20, 2005 Jade Perdue, M.P.A Department of Health and Human Services Health Resources and Services Administration Healthcare Systems Bureau Division of Transplantation
3 Goals Organ Donation Breakthrough Collaborative Methodology and Results Spread Strategy Organ Transplantation Breakthrough Collaborative
The Issue 10K 13K deceased eligible organ donors in the U.S. annually 2003-6,457 actual deceased donors recovered **Represents 61-68% Estimated Donor Pool**
Aim of Organ Donation Breakthrough Collaborative Committed to saving or enhancing thousands of lives a year by spreading known best practices to the nation s largest hospitals, to achieve organ donation rates of 75% or higher in these hospitals. Former Health and Human Services Secretary Tommy G. Thompson April 2003
[>90% - 100%] 90 80 70 60 50 40 30 20 10 0 Conversion Rate Distribution among the 300 Largest Hospitals (Eligible>=8) [>20% - 30%] [>30% - 40%] [>40% - 50%] [>50% - 60%] [>60% - 70%] [>70% - 80%] [>80% - 90%] Conversion rate category 09/02-08/03 (pre-collaborative most current 12 months) [>10% - 20%] [0% - 10%] Number of hospitals
Collaborative Engine Establish Topic & Aim Faculty Planning Group Identify Change Concepts Enroll Participants Prework A LS 1 P S ListServe D LS 2 A Conference Calls Data Reporting P S D LS3 HRSA Support Teams Conduct Many Plan, Do, Study, Act Cycles During Action Periods Between LS S Site Visits & Filming Rapid Sharing KMS A P D LS 4
Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do From:: Associates in Process Improvement
4 Strategies for Improvement Unrelenting Focus on Change, Improvement and Results Rapid Early Referral and Linkage Integrated Donation Process Measurement Aggressive Pursuit of Every Donation Opportunity
High Leverage Changes Advocate Organ Donation As the Mission Involve Senior Leadership to Get Results Deploy A Self-Organizing OPO/Hospital Team Practice Early Referral, Rapid Response Learn Effective Requesting Implement Donation After Cardiac Death
Collaborative Participants Collaborative 1: September 2003 to Sept. 2004 95 Hospitals 43 Organ Procurement Organizations Collaborative 2: September 2004 to May 2005 131 Hospitals (12 Pediatric) 50 Organ Procurement Organizations *Participating Large Hospitals Account for ~50% of Donor Potential in Nation
Process and Outcome Measures Conversion Rate Referral Rate Medical Examiner Denials Timely Notification Appropriate Requestor Donor Before Non Donor
[>90% - 100%] 90 80 70 60 50 40 30 20 10 0 Conversion Rate Distribution among the Largest Hospitals (Eligible>=8) [>20% - 30%] [>30% - 40%] [>40% - 50%] [>50% - 60%] [>60% - 70%] [>70% - 80%] [>80% - 90%] Conversion rate category 09/02-08/03 (pre-collaborative most current 12 months) 04/04-03/05 (most current 12 months) [>10% - 20%] [0% - 10%] Number of hospitals
Unprecedented Monthly Donation 700 Records 650 Organ Donors 600 550 500 450 400 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1999 2000 2001 2002 2003 2004 2005
Three Tiers of Improvement Work National System OPO Organization OPO/Hospital Practices
HRSA Commitment to Spread Knowledge Management System Leadership Coordinating Council & Improvement Leader Events (3/Yr) Annual National Learning Congress HHS Medals of Honor OPO Redesign Initiative World-Class Consulting Support Organ Transplantation Breakthrough Collaborative
Organ Transplanted Per Donor by OPO, 2004 4 Organ Transplanted Per Donor 3.5 3 2.5 2 1.5 1.5 0 1 3 5 7 2 4 6 8 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 Source: OPTN database as of 2/2005
Organ Transplantation Breakthrough Collaborative Save or enhance thousands of lives a year by maximizing the number of organs transplanted from each and every donor achieve an average of 3.75 organs transplanted per donor. Former Health and Human Services Secretary Thompson April 2004
Five New Strategies Culture of Intent Relationships Advanced Practice in Clinical Management Push Pull
The Possibility to Double Donors/year Annual Transplants 50% 6,000 75% 9,000 Recipients/year 3/D 18,000 4/D 36,000
Comments and Questions Jade K. Perdue, M.P.A. Department of Health and Human Services Health Resources and Services Administration Healthcare Systems Bureau Division of Transplantation E-mail: jperdue@hrsa.gov Phone: 301-443-3124
Why Are We Succeeding? Proven Improvement Methodology Transparency of Data and Process Joint Accountability for donation between OPO and Hospital Commitment to Sustainability Multi-dimensional Support Mechanisms
4 New Goals 1. Standard Criteria Donors: 4.3 2. DCD Donors: 2.75 3. ECD Donors: 2.5 4. At Least 10% of Donors Are DCD
Conversion Rate by OPO 12 Months Pre-collaborative 9/02-8/03 80% 70% 60% C onversion rate 50% 40% 30% 20% 10% 0% 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59
Collaborative 1 Conversion Rates 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% Pre-Collaborative Collaborative Post- Collaborative O-02 D-02 F-03 A-03 J-03 A-03 O-03 D-03 F-04 A-04 J-04 A-04 O-04 D-04 F-05 A-05
Collaborative 2 Conversion Rates 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% Pre-Collaborative Collaborative Post- Collaborative O-03 D-03 F-04 A-04 J-04 A-04 O-04 D-04 F-05 A-05 J-05 A-05 O-05 D-05 F-05 A-05