Reporting hospital quality

Ben Yandell, PhD, CQESystem Associate Vice President

Clinical Information Analysis (CIA)Norton Healthcare

KHC Reporting Workgroup

• Use existing, externally-defined indicators• Hospital Compare website by CMS*• Select indicators used in– value-based purchasing – readmission reduction program

• Update quarterly

* CMS is the Centers for Medicare & Medicaid Services; a federal agency

5 scores

1. Outcomes2. Ratings by patients3. Clinical process4. Efficiency5. Readmissions

With component details available

Outcomes

• 30-day survival after hospitalization- heart attack - heart failure - pneumonia

• Hospital-acquired infections- bloodstream - urinary tract infection - surgical-site

• Complications- Pressure Ulcer (“bed sore”) - Blood clot - Bloodstream infections- Pneumothorax (“collapsed lung”) - Sepsis (a severe reaction caused by infection)- Surgical incision problems - Unintended puncture or cut during surgery- Postoperative Hip Fracture (usually due to a fall)

Death rate for heart attack patients(CMS Hospital Compare. Medicare patients; risk-adjusted 30-day)

Outcomes

Ratings by patients

• Overall rating of hospital • Communication with nurses• Communication with doctors• Responsiveness of hospital staff • Pain management • Communication about medications • Cleanliness and quietness• Discharge information• “Consistency” – based on the lowest-scoring item

Overall hospital rating (CMS Hospital Compare. All inpatients; % rating 9 or 10 out of 10)

Ratings by patients

Efficiency

• Medicare expenses from 3 days before through 30 days after hospitalization.

Average annual spending per Medicare beneficiary for all Medicare-reimbursed care: hospital, physician, rehabilitation, durable medical equipment, etc.

Efficiency

• 3% more efficient – Kentucky average• 2% more efficient – U.S. average; Baptist• As predicted – Jewish & St. Mary’s• 1% less efficient – Norton Hospitals, Floyd

Memorial, Clark Memorial, Indiana average• 2% less efficient – U of L

Hospital Compare 1/11/14; calendar year 2012 data

Clinical process

• Heart attack patients receiving medication to dissolve blood clots received it within 30 minutes of arrival

• Pneumonia patients received recommended initial antibiotic • Surgical patients received recommended antibiotic• Antibiotic discontinued as recommended after surgery• Urinary catheter removed on postop day 1 or 2• Beta-blocker continued postop• Surgical patients received recommended blood-clot

prevention• Hospitalized patients received influenza immunization

Urinary catheter removed after surgery(CMS Hospital Compare. All inpatients; urinary catheter removed within day or two.)

Clinical process

Footnote 2. Data based on sample.

Readmissions

• Heart Attack• Heart Failure• Pneumonia• Chronic Obstructive Pulmonary Disease• Total Hip and Total Knee Replacement

Readmission after hip or knee replacement(CMS Hospital Compare. Medicare patients ; risk-adjusted 30-day)

Readmissions

5 scores

1. Outcomes2. Ratings by patients3. Clinical process4. Efficiency5. Readmissions

With component details available