The Minnesota Critical Care Working Group 1: Monitoring and coordinating statewide critical care surge response in the COVID-19 pandemic, March 2020 through July 1, 2021.

Background: In response to the COVID-19 pandemic and as part of the statewide healthcare coalition response the Minnesota Critical Care Working Group (CCWG), composed of Interprofessional leaders from the state's nine largest health systems was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July1, 2021.

Research Question: Can a statewide Critical Care Working Group develop contingency and crisis level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team?

Study Design And Methods: CCWG members (Intensivists, ethicists, nurses, MDH and MHA leaders) met by audio video conferencing as often as daily assessing COVID and non-COVID hospitalization data, developed surge indicators reflecting contingency versus crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response.

The Minnesota Critical Care Working Group 2: Crisis conditions during the COVID-19 Pandemic, July 2021 through March 2022.

Background: At the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge.

Research Question: Can a statewide Working Group collaboratively analyze real time evidence to identify crisis conditions and engage state leadership to implement care processes?

Study Design And Methods: CCWG/EWG met via video conferencing during the Fall 2021 severe surge to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions including group consensus on operating conditions; Federal Tele-Tracking data; MOCC patient placement data; and two surveys created and distributed to hospitals and healthcare professionals.

Proposing An Innovative Bond To Increase Investments In Social Drivers Of Health Interventions In Medicaid Managed Care.

Interventions to address social drivers of health (SDH), such as food insecurity, transportation, and housing, can reduce future health care costs but require up-front investment. Although Medicaid managed care organizations have incentives to reduce costs, volatile enrollment patterns and coverage changes may prevent them from realizing the full benefits of their SDH investments. This phenomenon results in the "wrong-pocket problem," in which managed care organizations underinvest in SDH interventions because they cannot capture the full benefit.

Developing a Patient- and Family-Centered Research Agenda for Hospital Medicine: The Improving Hospital Outcomes through Patient Engagement (i-HOPE) Study.

Background: Patient, caregiver, and other stakeholder priorities have not been robustly incorporated into directing hospital-based research and improvement efforts.

Objective: To systematically engage stakeholders to identify important questions of adult hospitalized patients and to create a prioritized research agenda for improving the care of adult hospitalized patients.

Design: A collaborative approach to stakeholder engagement and research question prioritization.

Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience.

Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life.

Measuring caregiver activation to identify coaching and support needs: Extending MYLOH to advanced chronic illness.

Introduction: Family and friends of seriously ill patients are key partners in providing support and health care at home, managing relationships with clinicians, and navigating complex health care systems. Becoming a knowledgeable, confident, and effective caregiver is a developmental process we term 'caregiver activation' and could be facilitated by clinicians equipped with suitable tools. Managing Your Loved One's Health (MYLOH) is a new tool to identify gaps in caregivers' knowledge, skills, and access to clinical and personal support.

Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay.

Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care.

Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure.

Association of Safety Culture with Surgical Site Infection Outcomes.

Background: Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI).

Study Design: Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals.

Enhancing Clinical Content and Race/Ethnicity Data in Statewide Hospital Administrative Databases: Obstacles Encountered, Strategies Adopted, and Lessons Learned.

Objectives: Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases.

Principal Findings: Grantees faced common challenges, including recruiting data partners and ensuring their continued effective participation, acquiring and validating the accuracy and utility of new data elements, and linking data from multiple sources to create internally consistent enhanced administrative databases. Successful strategies to overcome these challenges included aggressively engaging with providers of critical sources of data, emphasizing potential benefits to participants, revising requirements to lessen burdens associated with participation, maintaining continuous communication with participants, being flexible when responding to participants' difficulties in meeting program requirements, and paying scrupulous attention to preparing data specifications and creating and implementing protocols for data auditing, validation, cleaning, editing, and linking.

Incorporating the Last Four Digits of Social Security Numbers Substantially Improves Linking Patient Data from De-identified Hospital Claims Databases.

Objective: Assess algorithms for linking patients across de-identified databases without compromising confidentiality.

Data Sources/study Setting: Hospital discharges from 11 Mayo Clinic hospitals during January 2008-September 2012 (assessment and validation data). Minnesota death certificates and hospital discharges from 2009 to 2012 for entire state (application data).

Minnesota Hospital Association Statewide Project: SAFE from FALLS.

Since 2007, the Minnesota Hospital Association (MHA) has developed, managed, and promoted a statewide fall and injury reduction program to reduce inpatient falls and injuries, SAFE from FALLS. Because of statewide success in reducing falls from 2007-2010, the MHA set the goal in 2010 to eliminate serious fall-related injuries, especially head injuries. The outcomes that large-scale, multifacility health care organizations can have in reducing hospital-based falls resulting in serious injury (25% reduction) are presented, along with lessons learned.

Preventing device-related pressure ulcers: using data to guide statewide change.

Data collected through Minnesota's mandatory statewide reporting system indicate that prevention of hospital-acquired pressure ulcers continues to be a challenge, particularly for patients who require the use of stabilization collars or other immobilizers, respiratory equipment, orthotics, and tubing. This article describes the process of identifying a pattern of device-related pressure ulcers through statewide pressure ulcer reports and developing a set of recommendations for prevention.

Recruit, respect, and retain: the impact of baby boomer nurses on hospital workforce strategy--a case study.

Hospitals are increasingly concerned about shortages of registered nurses due to the impending retirement of Baby Boomer nurses. A hospital case study of older nurse retention investigated the concerns of Boomer nurses to understand how workforce strategies can effectively retain older nurses. Using interdisciplinary, multi-stakeholder approaches and tools, the study went beyond the broad recommendations in the literature to help an organization identify targeted and effective strategies for retention, identified barriers, and assessed organizational readiness to implement changes with older nurses in mind.

Promoting collaboration and transparency in patient safety.

Background: The Minnesota Alliance for Patient Safety (MAPS) collaborative was founded in 2000 by the Minnesota Hospital Association (MHA), the Minnesota Medical Association, and the Minnesota Department of Health.

Creating A Culture Of Learning, Justice, And Accountability: MAPS made it a priority to make the health care workplace one that encourages learning from adverse events. MAPS is pioneering a statewide model of a "just" culture--one that supports learning yet holds individuals accountable for errors.