Quality and Safety Transparency: The Public Reporting Landscape

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Quality and Safety Transparency The Public
Reporting Landscape
ltlt!-- PICOTITLE " Quality and Safety
Transparency The Public Reporting Landscape" --gt
lt!-- PICODATESET mmddyyyy03292006--gt
Barbara Rudolph, Ph.D. Director, Leaps and
Measures March 29, 2006
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The Quality Chasm

• Between 44,000-98,000 Americans die from medical
  errors annually (Institute of Medicine, 2000
  Thomas et al., 2000 Thomas et al., 1999)
• Only 55 of patients in a recent random sample of
  adults received recommended care, with little
  difference found between care recommended for
  prevention, to address acute episodes or to treat
  chronic conditions (McGlynn et al., 2003)

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The Quality Chasm

• 18,000 Americans die each year from heart attacks
  because they did not receive preventive
  medications, although they were eligible for them
  (Chassin, 1997 Institute of Medicine, 2003a)
• More than 50 of patients with diabetes,
  hypertension, tobacco addiction, hyperlipidemia,
  congestive heart failure, asthma, depression and
  chronic atrial fibrillation are currently managed
  inadequately (Institute of Medicine, 2003c)

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The Quality Chasm

• Medication-related errors for hospitalized
  patients cost roughly 2 billion annually
  (Institute of Medicine, 2000)
• Nosocomial infections alone, which are
  preventable account for more than 90,000 deaths
  per year. (CDC, MMWR Morb Mort Weekly Report,
  2000)

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The Leapfrog Groups Mission

• Trigger giant leaps forward in the safety,
  quality and affordability of health care by 
• Supporting informed health care decisions by
  those who use and pay for health care  
• Promoting high-value health care through
  incentives and rewards

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The Leapfrog Group Strategy on Hospital
Measurement and Public Reporting      

• Comparative performance measures provide
  information for decision-making for consumers and
  purchasersLeapfrog selects measures that are
• Evidence-based
• High impact
• Understandable by Consumers
• Achievable by Providers
• NQF endorsed

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Safety Leap Summary

• An Rx for Rx
• Computer Physician Order Entry (CPOE)
• Up to 8 in 10 serious drug errors prevented
• Sick People Need Special Care
• ICU Daytime Staffing with CCM Trained M.D. live
  or via tele-monitoring, or risk-adjusted outcomes
  comparison
• 29 mortality reduction (JAMA, 11/02)
• The Best of the Best
• Evidence-based Hospital Referral (EHR) or
  risk-adjusted outcomes comparison
• gt 30 mortality reduction for 7 complex
  treatments
• Overall Safety
• Rolled-up score of the remaining 27 of the 30 NQF
  Safe Practices (CPOE, IPS and EHR are the other 3
  of the 30 NQF Safe Practices)

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Evidence-based Hospital Referral Volume,
Outcomes, and Process
Average daily neonatal ICU census gt 15 for all
babies regardless of diagnosis
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Leapfrogs Hospital Quality and Safety Survey
Display
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Public Reporting Entities

• Federal Agencies (AHRQ, CMS)
• State Health Data Organizations
• Employers/Purchasers (Leapfrog, GE, Alliance,
  etc)
• Consulting Groups
• Health Plans (BCBS)
• Magazines (US News World Report Consumer Union)
• Consumer Organizations (NY Patient Advocacy)

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Role of the States in Public Reporting

• Mandates for data collection and reporting
• Provide resources to fully implement public and
  consumer reporting
• Overcome industry and special interest
• resistance
• Keep politics in checkdata collection and
  reporting is a public good
• Providing adequate funding (combination of
  provider assessment and GPR) to maintain stable
  data collections

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Issues Related with Data Collection

• Legislative scope varies
• Data suppliers broad to encompass a range of
  data suppliers or specific (inpatient, ambulatory
  surgery, ED, only)
• Funding sources vary (appropriations,
  assessments)
• Legislation may dictate a process or may not
• Governance Data commissions or advisory bodies
• Delegated authority (hospital association or
  other third party)
• Data content
• Hospital billing standard or as defined by state
• May prohibit collection of certain data elements
  (patient, physician identifier, non-billing
  elements)

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State Data for Quality Measurement

• 38 states with mandated inpatient systems
• Thirty-two states collect ambulatory surgery data
  from hospitals (and in some states, freestanding
  AS Treatment Centers also)
• Twenty-six states collect Emergency Department
  data from hospitals
• Most make data available for purchasers,
  researchers, hospitals
• Individual hospital identificationutilization,
  charges, capacity to use AHRQ Indicators,
  preventable hospitalizations, small area
  analysis, web-based data query systems

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Hospital Discharge Data

• are all-payer data (including self and uninsured)
  for all patients admitted to acute care
  (non-federal) hospitals in the state for a
  fiscal/calendar year/or quarterly periods, and
  collected into an annual data base. Records are
  collected by hospitalization, not by individual,
  and are represented at the discharge level rather
  than as aggregated statistics.

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Statewide Hospital Inpatient Data
Programs Prepared by NAHDO 2005
DC
Legislative mandate
Voluntary collection
No collection
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Quality and Safety Reporting

• Leading State Reports
• Infections (PA, FL, IL, MO)
• Mortality (CABGPA, NJ, NY, CA, MA)
• Adverse Events (MN, NJ)
• Complications (UT, OR)
• Hospital Quality (NJ)
• Patient Safety Indicators (TX, OR, FL, NY)

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States with Legislative Mandates to Collect
Hospital Data Second Generation Transparency Laws
2004
Patient Safety Reporting System
PA Nosocomial Infection Reporting
SB 1487 Public reporting Hospital infections
DC
H.B. 1629 Patient charge Outcomes data On Internet
S.B. 59 Central line infections Ventilator
PNM Class I surgery wound infs
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Issues Related to Data Dissemination

• Legislative disclosure provisions vary
• Some states prohibited from releasing hospital
  identifiers
• Other states are charged with releasing
  consumer-friendly cost and quality comparative
  reports
• Severity adjustment methodologies may be
  legislatively required
• State analytic capacity varies, affecting the
  level of dissemination activities

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The State-of-the-Art of Online Hospital Public
Reporting A Review of Forty-Seven Websites, Sept
2004, Delmarva Foundation and JCAHO
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The State-of-the-Art of Online Hospital Public
Reporting A Review of Forty-Seven Websites, Sept
2004, Delmarva Foundation and JCAHO
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Massachusetts Physician Volume Reporting
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Evidence Public Reporting Drives Change

• Experimental study by Judith Hibbard found
• 9 mo after public reporthospitals more likely to
  engage in quality improvement if results reported
  publicly, compared to private report and no
  report
• After two months, surveys of consumers said they
  changed views on hospitals in reportwere able to
  accurately recall hospitals ranked as high or low
  performers (At two months, 24 talked to others
  about the results at two years almost 50 talked
  to others about the report)
• About 1/3 of hospitals in public report
  significantly improved performance in areas where
  previously poor performeronly 5 declined
• In contrast ¼ of the private report hospitals
  showed significant improvement while 14
  declined.

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Results from Hospital Quality Alliance/CMS

• 3558 hospitalsreported one or more measures as
  of 4/1/05
• Found substantial gaps in performance--High
  performance in one measure did not necessarily
  predict high performance in other conditions
• Smallest hospitals had highest scores for
  pneumonia
• Much higher performance for AMI half of
  hospitals scored above 90
• Performance higher in this study than in
  Jencks2000-2001 study of same conditions for
  Medicare beneficiaries

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Crossing the Quality Chasm
Public reporting makes a differenceand
incentives help!
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Resources for Public Reporting

• Indexes for Reporting to the Public
• Alliance/NAHDO Patient Safety Indicator Index
• Leapfrog indexes for 5 conditions for the
  Hospital Rewards Program
• Consumer Reporting Templates
• Alliance Quality Counts Report
• AHRQ Template (available in June 2006)
• NAHDO Quality Reporting Workgroupfunded by RWJ
• Listserv
• Toolkit for Infection Public Reporting

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Websites

• www.nahdo.org
• www.qualitycounts.com
• www.leapfroggroup.org
• www.phc4.org
• http//www.oregon.gov/DAS/OHPPR/HQ/index.shtml
• http//www.nahdo.org/qualitywg/6_16_0520call20ag
  enda.pdf
• http//www.delmarvafoundation.org/html/content_pag
  es/Press_Releases/2005/08_18_05.pdf