Pneumonia Knockout Campaign

** NC Hospital Foundation grant-funded program**

In March 2017, the NCHA Board of Trustees approved a quality goal to reduce statewide pneumonia (PNE)  [glossary_exclude]mortality[/glossary_exclude] and readmission rates.  Specifically,

the goal was to: (1) Reduce pneumonia [glossary_exclude]mortality[/glossary_exclude] rates by 7.5% and (2) reduce pneumonia readmission rates by 5.4%.  Achieving these goals will prevent 950 readmissions, save 1,000 lives and more than $8.8 million.


94 member acute care hospitals & health systems pledged to participate in the Pneumonia Knockout Campaign. NCHA staff, with guidance from a statewide Advisory Group, provided technical support, data, education and best practice learning/sharing to member organizations and community providers to support this work.

  • In 2017, North Carolina ranked 49 of 50 states for its pneumonia mortality rate, with 73% of hospitals below the CMS national benchmark.
  • Pneumonia is most often acquired in the community, outside of the hospital setting.
  • CDC recommends pneumococcal vaccination for all adults 65 years or older. According to 2016 data from the Behavioral Risk Factor Surveillance System, only 23% of N.C. Medicare beneficiaries 65 years old or older report they have received the CDC-recommended regimen of both PPSV23 and PCV13 pneumococcal vaccinations.

Participating hospitals and health systems were asked to identify one to two opportunities to improve pneumonia care based on their internal performance on the identified measures. Community partners and post-acute care providers were invited to participate with hospitals and health systems.

The Pneumonia Knockout Campaign Advisory Group provided subject matter expertise, professional perspectives, and contributed to the development of programming targeting the reduction of pneumonia mortality and pneumonia readmissions. The group provided education and resources to both community and clinical settings; in addition, they supported public education and outreach efforts outside the hospital setting.

NCHA partnered with  Amy Boutwell, M.D., M.P.P., President of Collaborative Healthcare Strategies, a thought leadership and technical assistance firm that advises delivery system transformation efforts nationally, to develop a pneumonia readmissions toolkit for North Carolina. Dr. Boutwell advises several large-scale collaborative efforts aimed at system redesign to reduce readmissions and improve care across settings and over time. These include several Federal initiatives funded by the Centers for Medicare & Medicaid Services (CMS), such as the Quality Improvement Organization “Care Transitions” Aim, the Partnership for Patients Hospital Engagement Networks, and the CMS Learning Systems for Accountable Care Organizations and Bundled Payments.

Dr. Boutwell kicked off a year long educational series:  ASPIRE to Knockout Pneumonia  Readmissions in North Carolina in March, 2018. The acronym ASPIRE covers six steps for hospital teams to move through in their readmission reduction work:

ASPIRE Pneumonia Knockout Readmissions Webinar Series
March 1, 2018 Pneumonia Knockout Readmissions Webinar Series # 1: Using the AHRQ ASPIRE Tool to Reduce Pneumonia Readmissions
Webinar Recording >>
April 5, 2018 Pneumonia Knockout Readmissions Webinar Series # 2: Align with Related Efforts and Resources, Identify Gaps
Webinar Recording >>
May 3, 2018 Pneumonia Knockout Readmissions Webinar Series # 3: Design a Portfolio of Strategies and Operational Dashboard
Webinar Recording >>
June 7, 2018 Pneumonia Knockout Readmissions Webinar Series # 4: Actively Collaborate Across the Continuum
Webinar Recording >>
August 2, 2018 Pneumonia Knockout Readmissions Webinar Series # 5: Deliver Effective Post-Discharge Transitional Care
Webinar Recording >>
September 6, 2018 Pneumonia Knockout Readmissions Webinar Series # 6: ASPIRE+: The Implementation Model to Drive Results
Webinar Recording >>
October 4, 2018 Pneumonia Knockout Readmissions Webinar Series #7: In-Person Workshop Preparation
Webinar Recording >>
December 6, 2018 Pneumonia Knockout Readmissions Webinar Series #8: Action Plan Implementation Report-Out and Next Steps
Webinar Recording >>

ASPIRE to Knockout Pneumonia Readmissions In-Person – November 2, 2018
Workshop Packet (PDF)
Designing & Delivering Whole-Person Transitional Care (Docx)
Transition Engagement Form (Docx)
Bay Area Readmission Reduction Collaborative
“Circle Back” call with SNFs
“Coaching” – Mrs. MacDonald
“Interdisciplinary Transitional Care” – Mr Anderson
“MVP Care” – Mr. Eison

NCHA Education Resources
Jan. 30, 2017 Pneumonia Knockout Webinar: Reducing Mortality through a Modified Early Warning System (MEWS)
Dec. 20, 2017 Pneumonia Knockout Webinar: Mapping Your Road to Improvement: Develop an Action Plan
Nov. 16, 2017 Pneumonia Knockout Webinar: Using the CMS Hospital-Specific Reports to Learn More About Your Patients With Pneumonia
July 13, 2017 Pneumonia Knockout: Hospital Sharing & Learning Day

Provider Campaign Resources
Pneumonia Knockout Immunization Campaign Toolkit
Provider Campaign Checklist
Vaccination Sheet (English/Spanish)
Vaccination Timing for Adults Pocket Guide
Pneumonia Knockout Poster (11X17)
Customizable, Themed PPT Templates

30-Day Pneumonia Mortality Resources
Article: Declining mortality among hospitalized patients with community-acquired pneumonia
Research: Association of Do-Not-Resuscitate Orders and Hospital Mortality Rate Among Patients With Pneumonia
Article: Nursing-Related Determinants of 30-Day Mortality for Hospitalized Patients
Analysis: Use of Mortality Measures by Massachusetts Hospitals
Research: The Performance of US Hospitals as Reflected in Risk-Standardized 30-Day Mortality and Readmission Rates for Medicare Beneficiaries with Pneumonia

30-Day Pneumonia Readmissions Resources
ASPIRE Guide: Designing & Delivering Whole-Person Transitional CareThe Hospital Guide to Reducing Medicaid Readmissions
Success Story: One Healthcare System’s Effective Strategy to Improve Pneumonia Outcomes

Measurement Strategy Resources
Pneumonia Knockout Scorecard: Pneumonia Knockout Scorecard Reducing Pneumonia Mortality and Readmissions in North Carolina
CMS FAQ: Risk-Standardized Outcome and Payment Measures
Truven Hospital Reimbursement Research: Risk-Standardized Rates for 30-Day Mortality and Readmissions Vary Significantly by Race
JAMA Article: Relationship of Hospital Performance with Readmission and Mortality Rates for Patients Hospitalized with Acute Myocardial Infarction, Heart Failure, or Pneumonia
Research: Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study
Video: Hospital-Specific Reports Tutorial
Video: Introduction to the Hospital Return Days Measures

Pneumonia Clinical Care Resources
Research: Adherence to guidelines for hospitalized community-acquired pneumonia over time and its impact on health outcomes and mortality
Research: Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients
Research: Severe community-acquired pneumonia: timely management measures in the first 24 hours
Research: Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort
Article: Quality Care For Pneumonia in the Elderly
White Paper: IHI Framework for Improving Joy in Work

Pneumonia Post Acute Care Resources
Article: Pneumonia in Older Residents of Long-Term Care Facilities

Federally Qualified Health Centers (FQHC) Resources
April 9 Pneumonia Knockout FQHC Webinar Project Kick-Off

  • 10 Steps to implementing standing orders for immunization in your practice setting
    10 steps to implementing standing orders focuses on influenza vaccination, but the basic principles can be used to implement standing orders for other vaccines.
    Article Click Here
  • Using Standing Orders for Administering Vaccines: What You Should Know
    FAQ provides an overview for healthcare professionals about the use of standing orders for vaccination
    Article Click Here
  • Pneumococcal vaccine (PCV13 and PPSV23) – adults
    Eligible health professionals may vaccinate adults who meet any of the criteria on this form
    Article Click Here
  • Improving Vaccinations PDSA – Examples of actions taken by Integrated Delivery Systems
    Article Click Here

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