Hospital Measures Reporting in Ohio

1
Selecting Indicators for Public Reporting The
Ohio Experience
AHRQ ANNUAL CONFERENCE 2008
AHRQ QUALITY INDICATORS USERS MEETING Wednesday
September 9, 2008

• Hospital Measures Reporting in Ohio
• Michele Shipp, MD, DrPH

2
Ohio Department of Health

• Hospital Performance Measures Selection

• Alvin Jackson, MD
• Madelyn Dile, JD
• Jodi Govern, JD
• Kaliyah Shaheen, MPH

3
BACKGROUND
4
HOUSEBILL 197

• HB 197 became law in November 2006
• Requires Ohio hospitals to report performance
  measure data to the Ohio Department of Health for
  the purpose of public reporting

5
HOUSEBILL 197

• Required Measure Sets
• Centers for Medicare and Medicaid Services (CMS)
• The Joint Commission (JC)
• National Quality Forum (NQF) endorsed measures
• Agency for Healthcare Research and Quality (AHRQ)

6
Creation of Advisory Council

• A Hospital Measures Advisory Council was created
  by statute and consisted of
• Director of Health (Council Chair)
• Two members of the House of Representatives
• Two members of the Senate
• Superintendent of Insurance
• Executive Director of the Commission on Minority
  Health
• Representatives from several agencies

7
Creation of other Groups

• Mandated Groups
• A Data Expert Group
• An Infection Control Group
• Ad Hoc Groups
• The Advisory Council created Pediatric and
  Perinatal workgroups

8
Process for Measures Selection

• Data Expert Group monthly meetings
• Creation of set criteria as guidelines
• Examination of measure specifications
• Selection of measures
• Recommendations to Advisory Council on selected
  measures

Measures related to Adult care, Chronic
Diseases, Patient Safety Slide 9
9
Measure Selection Criteria

• Importance
• ? Do the measures reflect unequivocally important
  aspects of patient care?
• Preventability
• ? Can a poor score be prevented through proper
  care?
• ? Is excess variation in the data accounted for
  by factors unrelated to hospital quality?
• Genuine quality improvement
• ? Can a hospitals rate be improved without
  improving quality?

10
Measure Selection Criteria (cont.)

• Data integrity
• ? Can a hospital accurately collect the data from
  its records?
• ? Does the measure adequately measure the
  construct it attempts to measure?
• Ability to publicly report
• ? Is the measure of use to consumers?
• ? Is the measure comprehensible to consumers?
• ? Do hospitals have a sufficient case load to
  accurately report quality?
• Burden
• ? Does calculating the measure place undue burden
  on hospitals?

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Measure Selection Criteria (cont.)

• Evidence-based
• ? Is there scientific research demonstrating the
  accuracy and importance of the measure?
• Variance
• ? Is there sufficient variability in performance
  among hospitals to allow for comparison?
• National Quality Forum endorsement
• ? Is the measure endorsed by the National Quality
  Forum?

12
Overview of Selected Measures

• All measures from 4 required sources considered
• Total of 84 measures were recommended to the
  Advisory Council
• 47 CMS measures
• 17 AHRQ measures
• 10 JC measures
• 10 Infection measures

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AHRQ Patient Safety Indicators

• The Data Expert Group recommended the following
  AHRQ Patient Safety Indicators to the Advisory
  Council
• PSI-1 Complications of Anesthesia
• PSI-3 Decubitus Ulcer
• PSI-5 Foreign Body Left During Procedure
• PSI-9 Postoperative Hemorrhage or Hematoma
• PSI-16 Transfusion Reaction
• PSI-17 Birth TraumaInjury to Neonate
•  PSI-18 Obstetric Trauma Vaginal Delivery with
  Instrument
• PSI-19 Obstetric TraumaVaginal Delivery
  without instrument
• PSI-20 Obstetric TraumaCesarean Delivery

14
AHRQ Inpatient Quality Indicators

• The Data Expert Group recommended the following
  AHRQ Inpatient Quality Indicators for inclusion
• IQI-5 CABG volume
• IQI-6 PCTA volume
• IQI-12 CABG mortality rate
• IQI-30 PCTA mortality rate
• IQI-21 Cesarean Delivery Rate
• IQI-22 Vaginal Birth after Cesarean Rate,
  Uncomplicated
• IQI-33 Primary Cesarean Delivery Rate
• IQI-34 Vaginal Birth after Cesarean Rate, All

15
AHRQ Recommended Measures

• After consideration and voting by the Advisory
  Council, 7 of the 17 AHRQ measures were
  recommended to the Director of Health for public
  reporting
• PSI -1 Complications of Anesthesia
• PSI-3 Decubitus Ulcer
• PSI-5 Foreign Body Left During Procedure
• IQI-5 CABG volume
• IQI-6 PCTA volume
• IQI-12 CABG mortality rate
• IQI-30 PCTA mortality rate
• If passed through the rule making process
  hospitals will begin reporting these measures in
  late 2009

16
Current Hospital Reporting in Ohio

• April 2007 Hospital reporting start date by HB
  197
• ODH selected 11 measures for interim reporting
• 2 of these measures were from AHRQ
• Reporting done April and October 2007, 2008

17
Hospital Reporting Beginning April 2007

• Postoperative Respiratory Failure
• Adult
• Pediatric
• Iatrogenic Pneumothorax
• Adult
• Pediatric
• Neonate

18
Current ReportingFeedback from Hospitals

• Postoperative Respiratory Failure
• Ohio has found the numbers are too small for
  Iatrogenic Pneumothorax and may not be the best
  measure for the purpose of public reporting
• Only 2 hospitals in the adult category and 1
  hospital in the neonatal category had reportable
  data

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Iatrogenic Pneumothorax - Pediatrics
October 1, 2006 September 30, 2007
187 hospitals
20
Other Measures Currently Being Reported

• Aspirin at Arrival for Acute Myocardial
  Infarction
• Beta Blocker at Arrival for Acute Myocardial
  Infraction
• Pneumococcal Vaccination for Pneumonia
• Blood Culture before Initial Antibiotic for
  Pneumonia
• ACEI or ARB Left Ventricular Systolic Dysfunction
  for Heart Failure
• Evaluation of Left Ventricular Systolic function
  for Heart Failure

21
Next Steps

• Adopt rules reflecting recommended measures
• ? Six to nine month process
• Public comment period
• Public hearing
• ? Reporting of new measures to begin no earlier
  than October 2009
• Development of the consumer website
• To be operational by January 2010

22
Thank You
Questions??

• If you have any questions please contact Kaliyah
  Shaheen at 614-995-4982 or kaliyah.shaheen_at_odh.ohi
  o.gov
• September 2008