Implications of Public and Private Reporting of Quality Data: Mechanisms for Driving Quality Improvement

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Implications of Public and Private Reporting of
Quality Data Mechanisms for Driving Quality
Improvement
Deirdre E. Mylod, Ph.D.dmylod_at_pressganey.comVice
President, Public PolicyPress Ganey Associates,
Inc.June 27, 2006
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Overview

• Relationship between publicly benchmarked and
  private benchmark reports for measures of quality
• Clinical, Safety, HCAHPS
• Normative Rates of Change Year 1 to Year 2 for
  privately reported patient evaluations
• Relationship between hospital characteristics and
  successful quality improvement using private
  reports
• Relationship between hospital activities and
  quality improvement related to private measures
  of patient evaluations
• Public Reporting of Leapfrog Data
• Participation in IHI
• Access and Use of Data

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Private vs. Public Reporting

• Are the two related?
• Private patient surveys are related to public
  clinical measures at the hospital-level.
• Gesell, S.B., Clark, P.A., Mylod, D.E., Wolosin,
  R.J., Drain, M., Lanser, P., Hall, M.F. (2005).
  Hospital-level correlation between clinical and
  service quality performance for heart failure
  treatment. Journal for Healthcare Quality, 27(6),
  33-44.

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Hospital-level correlation between heart failure
patients overall satisfaction and percent of
heart failure patients given assessment of left
ventricular function.
r .5 p lt .01
N31
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Hospital-level correlation between heart failure
patients overall satisfaction and percent of
heart failure patients given discharge
instructions.
r .6 p lt .01

N26
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Private vs. Public Reporting

• Are the two related?
• Private patient surveys are related to public
  safety measures at the hospital-level.

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Hospitals willing to publicly report to Leapfrog
have significantly higher patient satisfaction in
private patient reports.
84.0
82.7
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Private vs. Public Reporting

• Are the two related?
• Private patient surveys are related to public
  patient surveys at the patient- and
  hospital-level.
• Mylod, D.E., McCaffrey, K. (2006, March).
  Assessment of Convergent Validity of HCAHPS
  Using the Press Ganey Inpatient Survey. Poster
  presented at the 10th National CAHPS User Group
  Meeting, Baltimore, MD.

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Private vs. Public Reporting
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Hospital-level correlation between private
patient surveys and public patient surveys
r .9 p lt .01
N67
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Normative Rates of Change- Five Year Outlook
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Proportion of Hospitals Getting Better/Worse
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Proportion of Hospitals Significant Change
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Proportion of Hospitals Significant Change
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How Much Change Do Hospitals See
Quartile with biggest increase
Quartile with greatest decline
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Facility Characteristics Not Systematically
Related to Change

• No consistent relationships between propensity to
  change and
• Bed size
• Teaching status
• Region of the country

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Facility Characteristics Related to Change

• Starting Performance
• Hospitals with lower patient satisfaction are
  more likely to improve.
• Patient Safety Journey
• Hospitals that are wiling to submit data to
  Leapfrog are more likely to improve.
• Hospitals active in their quality improvement
  journey toward safer care (IHI 100k).
• Active Use of Patient Survey Data
• Hospitals that analyze access online data more
  frequently, generate more reports and give more
  users permission to use data improve more over a
  year.

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With private patient surveys, the lower a
hospital scored in 2004, the more likely it was
to improve by 2005.
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Willing to Submit Data to Leapfrog
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Hospitals identified by Leapfrog as showing Good
Early Stage Effort achieve more positive change,
and almost no negative change, in private patient
surveys (2004-2005).
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In the presence of not being the best in patient
satisfaction, willingness to report to Leapfrog
is associated with more positive change in
patient satisfaction.
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100k Hospitals More likely to have significant
improvement and less likely to have significant
decline
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Hospitals that access their private patient
survey data via an online analysis tool more,
improve more over one year.
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Hospitals that generate more custom reports of
their private patient survey data, improve more
over one year.
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Hospitals that give permission to more staff
members to access to the private patient survey
data, improve more over one year.
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Next Steps Prospective Study of Characteristics
of Culture and Activities Linked To Change

• Overarching Framework
• Culture-wide concern/commitment about performance
• Culture of transparency
• Ongoing, in-depth analysis of data (not just
  collection)
• Behaviorist assessment of uses of feedback
• Infrastructure for quality improvement
• Activities of quality improvement