Going public

1
Going public
Louisville, Kentucky

• Ben Yandell, PhD, CQE
• ben.yandell_at_nortonhealthcare.org

2
Conclusion 1. The world has changed.
3
www.hospitalcompare.hhs.gov
4
A reasonable ranking of Louisvilles adult
acute-care hospitals?

• Hospitals ranked by JCAHOs ratings of their
  overall performance in
• heart attack (HA)
• heart failure (HF)
• pneumonia (PN)
• National Patient Safety Goals (NPSG).

From www.jcaho.org. Patients discharged October
2004 September 2005.
5
A reasonable ranking of Louisvilles adult
acute-care hospitals?
From www.jcaho.org. Patients discharged October
2004 September 2005.
6
Can you guess who produces this public report
about Kentucky hospitals?
7
Can you guess who produces this public report
about Kentucky hospitals?
The Kentucky Hospital Association
U.S. 11.16
8
www.nortonhealthcare.com
9
About 400 indicators or safe practices
10
(No Transcript)
11
(No Transcript)
12
Currently combine NICU data from Kosair
Childrens Hospital and Suburban Hospital in our
public report. Good example of difficulty of
finding a convincing national comparative
statistic.
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
These are s. Stuck in the world of things that
shouldnt happen. A good indicator is much
closer to 50.
AHRQ PDIs
17
(No Transcript)
18
Conclusion 2. Quality indicators are harder
to dismiss than they used to be.
19
ExampleBeta blocker prescribed at discharge

• NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR
  HOSPITAL CARE
• Measure Set Acute Myocardial Infarction
• Set Measure ID AMI-5
• Performance Measure Name Beta Blocker Prescribed
  at Discharge
• Description Acute myocardial infarction (AMI)
  patients without beta blocker contraindications
  who are prescribed a beta blocker at hospital
  discharge.
• Rationale The use of beta blockers for patients
  who have suffered an acute myocardial
• infarction can reduce mortality and morbidity.
  Studies have demonstrated that the use of beta
• blockers are associated with about a 20
  reduction in this risk (Yusuf, 1985). National
• guidelines strongly recommend long-term beta
  blocker therapy for the secondary prevention of
• subsequent cardiovascular events in patients
  discharged after AMI (Braunwald, 2000 and
• Ryan,1999). Despite these recommendations, beta
  blockers remain underutilized in older
• patients discharged after AMI (Jencks, 2000).

20
ExampleBeta blocker prescribed at discharge

• Excluded Populations
• Patients less than 18 years of age
• Patients transferred to another acute care
  hospital or federal hospital
• Patients who expired
• Patients who left against medical advice
• Patients discharged to hospice
• Patients with one or more of the following beta
  blocker contraindications/reasons for
• not prescribing a beta blocker documented in the
  medical record
• o Beta blocker allergy
• o Bradycardia (heart rate less than 60 bpm) on
  day of discharge or day prior to
• discharge while not on a beta blocker
• o Second or third degree heart block on ECG on
  arrival or during hospital stay and
• does not have a pacemaker
• o Systolic blood pressure less than 90 mm Hg on
  day of discharge or day prior to
• discharge while not on a beta blocker
• o Other reasons documented by a physician, nurse
  practitioner, or physician
• assistant for not prescribing a beta blocker at
  discharge

21
Pediatric Heart Surgery Mortality (AHRQ PDI 6)

• Numerator Number of pediatric heart surgery
  deaths.
• Denominator Discharges under age 18 with
  procedure codes for congenital heart disease or
  non-specific heart surgery and diagnosis of
  congenital heart disease.
• Exclude
• transcatheter interventions as single cardiac
  procedures without bypass
• septal defects as single cardiac procedures
  without bypass
• heart transplant
• premature infants with PDA closure as only
  cardiac procedure
• age lt 30 days with PDA closure as only cardiac
  procedure
• transferring to another short-term hospital
• neonates lt 500 gms.

Risk-adjusted for patient sex, birth weight,
prematurity, congenital anomalies, age, gt1
procedure
22
Conclusion 3. Public reporting isnt only
about informing the public.
23
Question
If you know that your hospitals death rate for a
certain procedure is 3.7, should the parents of
a child about to undergo that procedure know it,
too?
24
P.S. If this were your hospital

• Do you know that your hospitals death rate is
  3.7?(And do you have a clue if 3.7 is a
  reasonable rate?)
• Do the people who could influence that death rate
  know that its 3.7?
• Public reporting isnt onlyabout informing the
  public.

25
First half of 2003 (or first two quarters, if
started later)
Both early and late results were compared to the
most recent U.S. median.
26
Last half of 2005 (or most recent two quarters)
Both early and late results were compared to the
most recent U.S. median.