Overview of Reporting Benchmarks for Best Performing Hospitals and

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Overview of Reporting Benchmarks for Best
Performing Hospitals and Methodologies for
Mortality Measures
Beth Eastman, AHCA Administrator Office of Data
Dissemination and Quality Assurance
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Hospital Performance Reports and Methodologies
for Mortality Measures by Organization

• Oregon Health Policy and Research
• Pennsylvania Health Care Cost Containment Council
• New Jersey Department of Health and Senior
  Services
• Texas Department of State Health Services
• Texas Hospital Checkup
• Maryland Health Care Commission
• Connecticut Department of Public Health
• Michigan Hospital Association
• Ocregister.com Online Newspaper
• Utah Health Data Committee

No mortality measures were found.
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Oregon Health Policy And Research

• Purpose Oregons report is a first but
  important step in measuring, and ultimately
  improving, the quality of health care in the
  state with a first focus on hospital services. As
  such, it also represents the generous and ongoing
  cooperation of numerous stakeholders, including
  the hospitals themselves.
• Measures
• Volume
• Death Rates
• Conditions
• Abdominal Aortic Aneurysm Repair
• Balloon Angioplasty (Percutaneous Transluminal
  Coronary Angioplasty/PTCA)
• Heart Attack (Acute Myorcardial Infarction/AMI)  
  
• Heart Bypass Surgery (Coronary Artery Bypass
  Graft/CABG) 
•  Heart Failure (Congestive Heart Failure/CHF)  
•  Hip Fracture  
•  Pediatric Heart Surgery    
• Pneumonia 
• Stroke  
• Web Address http//egov.oregon.gov/DAS/OHPPR/HQ
  /HospReports.shtml

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Visual Benchmark Criteria and Results
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Oregon Health Policy And Research
The death rate is the number of patients
admitted for a specific procedure or condition
who died in the hospital, divided by the total
number of patients admitted for that procedure or
condition.  However, because the patients age,
sex, or severity of condition may increase their
risk of death, the death rates for each hospital
are adjusted to account for these factors.  Other
factorsfor example, that some hospitals may
transfer out all but the most mild or most severe
casesare not accounted for in the
risk-adjustment methods used here.  Hence, while
death rates constitute a more sensitive indicator
of quality than mere procedure counts, they too
should be considered in tandem with comments
submitted by hospitals, as well as with other
information about quality of care.
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Pennsylvania Health Care Cost Containment Council

• Purpose PHC4's Hospital Performance Report can
  help to fill that vacuum of information and
  assist consumers and purchasers in making more
  informed health care decisions. This report can
  also serve as an aid to providers in highlighting
  additional opportunities for quality improvement
  and cost containment.
• Measures
• Volume of Cases
• Risk Adjusted Mortality Rating
• Risk Adjusted Length of Stay
• Risk Adjusted Length of Stay Outlier Rates and
  Ratings
• Risk Adjusted Readmission for Any Reason Rating
• Risk Adjusted Readmission for Complication or
  Infection Rating
• Average Hospital Charge (Adjusted by casemix at
  regional level)
• Conditions
• Conditions and Procedures (Next Slide)
• Web Address http//www.phc4submit.org/hpr/

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Pennsylvania Health Care Cost Containment Council
Conditions and Procedures
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Visual Benchmark Criteria and Results
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Pennsylvania Health Care Cost Containment Council

• The procedure and treatment groups that were
  included in the analysis were selected primarily
  because they showed high volume or mortality
  showed high variability in mortality among
  hospitals were described in the literature as
  high cost, high mortality conditions or the
  transfer rate (I.e., transfer to another acute
  care facility) was typically less than 5 percent
  ( so that a complete picture of the care
  delivered could be obtained by examining a single
  discharge record).
• The inclusions are
• Acute care facilities, regardless of bed size
• Procedure and treatment groups with high volume
  or mortality
• Procedure and treatment groups with high
  variability in mortality among hospitals
• The exclusions are as follows
• HIV infection in any diagnosis was excluded from
  all code-based conditions
• Duplicate Records
• Missing or invalid discharge status
• Non-adult (
• Patients who left against medical advice
• Patients transferred to acute care facilities

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New Jersey Department of Health and Senior
Services

• Purpose The New Jersey Hospital Performance
  Report was created to provide information on
  hospital quality to patients and their families
  as well as health care professionals. The
  information in this report is designed to help
  you choose a hospital and make other decisions
  about your health care.
• Measures
• Aspirin on Arrival
• Aspirin at Discharge
• Beta-blocker on Arrival
• Beta-blocker at Discharge
• ACE Inhibitor at Discharge
• Oxygen Assessment
• Pneumonia Vaccination Screening
• AntibioticTiming
• Conditions
• Heart Disease
• Pneumonia
• Web Address http//web.doh.state.nj.us/hpr/usingr
  eport.shtml

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Visual Benchmark Criteria and Results
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Texas Department of State Health Services

• Purpose Provides consumers of health care with
  reliable and comparable data on hospitals
  throughout the state.Measures
• Volume Indicators
• Mortality Indicators for Inpatient Procedures
• Mortality Indicators for Inpatient Conditions
• Utilization Indicators

Conditions
Web Address http//www.dshs.state.tx.us/THCIC/pu
blications/hospitals/IQIReport2002/IQIqueryByHospi
tal.shtm
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Visual Benchmark Criteria and Results
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http//www.dshs.state.tx.us/THCIC/Publications/Hos
pitals/IQIReport2002/IQIReport2002.shtm
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Texas Hospital Checkup
Measures

• Mortality Volume
• Specially trained ICU doctors
• Computerized prescription order entry system for
  doctors to reduce medication errors
• ALOS
• Average Total Charges
• Average Charge Day

Conditions

• Abdominal aortic aneurysm repair
• Balloon angioplasty
• Carotid artery surgery
• Heart bypass surgery
• Heart attack care
• Childbirth

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• Mortality (procedure 75 statistically
  reliable score)
• Actual deaths compared to expected deaths given
  how sick patients were

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Maryland Health Care Commission
Purpose The hospital
evaluation guide is designed to assist consumers
and their families in obtaining
quality hospital based care.

• Measures
• Volume
• Risk Adjusted LOS Days (State Average)
• Risk Adjusted Readmissions
• Aspirin on Arrival
• Aspirin at Discharge
• Beta-blocker on Arrival
• Beta-blocker at Discharge
• Recommended Medications
• Smoking Cessation Counseling
• ACE Inhibitor at Discharge
• Oxygen Assessment
• Recommended Blood Tests
• Pneumonia Vaccination Screening
• Antibiotic Timing
• Recommended Heart Function Tests
• Instructions upon discharge

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Visual Benchmark Criteria and Results
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Visual Benchmark Criteria and Results
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Connecticut Department of
Public Health Purpose The report provides
comparisons of adult general acute-care hospitals
in Connecticut for the period July 2003 through
September 2003. Connecticut hospitals are
compared on several measures, including quality
of care for patients diagnosed with a heart
attack, heart failure, or pneumonia, which are
three common and costly medical conditions for
which people go to the hospital.

• Measures
• Aspirin at Arrival
• Beta-blocker at Arrival
• ACEI for LVSD
• Aspirin at Discharge
• Beta-blocker at Discharge
• LVF Assessment
• Timely Antibiotics
• Pneumococcal Vaccination
• Oxygen Assessment
• Conditions
• Heart Attack
• Heart Failure
• Pneumonia
• Web Address http//www.chime.org/Quality/HPR.html
  

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Visual Benchmark Criteria and Results
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Michigan
Hospital AssociationPurpose To provide
consumers and purchasers with information to help
them make better-informed health care decisions.

• Measures
• Volume
• Mortality
• LOS

Web Address http//www.michiganhospitalprofiles.
org/
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Visual Benchmark Criteria and Results
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Michigan Hospital Association
Experts in quality measurement have strong
reservations about using severity-adjusted
mortality rates as an absolute gauge of the
quality of care provided by a hospital, because
many other factors also must be considered. For
example, a hospital treating more elderly
patients might have more patients with orders not
to resuscitate and would have more deaths. Other
factors include patient risk factors, lifestyle
choices and socioeconomic issues. Experts say
mortality is just one indicator of hospital
performance. It cannot be used as the primary
measure of the overall quality of care provided
by a hospital.
Exclusions

• Cases where the admit or discharge date is
  missing or invalid or where the length of stay is
  greater than a year.
• Patients discharged from rehabilitation
  facilities.
• Outliers for length of stay (identified by being
  outside the 95 percent confidence interval of the
  mean for each APR-DRG subclass). The length of
  stay outliers are not excluded from the mortality
  measures.
• Replicated cases. (When a hospital cannot, for
  some reason, submit data on all of its cases, the
  portion of the data that has been submitted is
  replicated to simulate a full years
  representation of volume in the Michigan
  Inpatient Data Base. Because these are not
  actual cases, they are not included in the
  analysis. Less than 1 percent of cases in the
  final MIDB are replicated.)

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Ocregister.com Online Newspaper
Purpose The Orange County Register provides
information for consumers to compare hospitals
medical outcomes, staffing, patient complaints,
and the judgments of professional hospital
inspectors.

• Measures
• Mortality
• Adverse Outcomes
• RN Hours
• Disciplined doctors
• DHS complaints
• JCAHO percentile
• Lawsuits
• Leapfrog Computerized Drug Orders
• Leapfrog ICU Staffing
• PEP-C
• PacifiCare Average Daily Charge
• ConditionsSee Report
• Web Address http//www.ocregister.com/news/2003/h
  ospitals/index_about.html

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Visual Benchmark Criteria and Results
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Ocregister.com Online Newspaper
Computed aggregate mortality rates based on the
individual rates for 21 types of medical cases.
They risk-adjusted the numbers to account for the
fact that some hospitals get a higher proportion
of really sick patients, who are more likely to
die. In performing this risk analysis age,
gender, principal and secondary diagnoses,
selected procedures performed, and whether or not
a patients condition was present at the time of
admission was considered. The calculations were
based on all California hospitals that met the
criteria for data quality, then calibrated to
reflect results among Orange County hospitals.
Mortality Percentage of patients who died in
21 selected types of medical cases, adjusted for
the fact that some hospitals receive sicker
patients. Data from 1998-2000. Note Mortality
and adverse-outcome rates for Tustin hospital may
be of borderline statistical significance because
of low case volume. Definitions of categories
shown on our gridsCases Number of patients
treated in each diagnostic categoryDeaths
number of patients in each category that
diedExpected Deaths Number of deaths that would
be expected based on relative severity of cases
received by the hospitalActual Death rate
Number of deaths divided by number of
casesExpected Death rate Number of expected
deaths divided by number of casesRisk-adjusted
Death rate Actual death rate divided by expected
death rate, multiplied by the Orange County
average death rate for that type of medical case.
This is the number used in the report card
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Utah Health Data Committee Office of Health
Statistics

• Measures
• Volume of the population at risk and the
  associated outcome
• Relative magnitude of Utahs rate compared to
  other states.

Conditions Obstetrical ComplicationsWound
InfectionAdverse Effects/Iatrogenic
ComplicationsCesarean Section DeliveryVaginal
Birth after C-SectionLaminectomy and/or Spinal
FusionTransurethral ProstatectomyRadical
ProstatectomyLaparoscopic CholecystectomyCoronar
y Artery Bypass GraftLow BirthweightPediatric
AsthmaDiabetes Long-term Complications
Web Address http//health.utah.gov/hda/report/inp
atient.htm
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