Hospital Measures Reporting in OhioMichele Shipp, MD, DrPH

AHRQ QUALITY INDICATORS USERS MEETINGWednesday September 9, 2008

AHRQ ANNUAL CONFERENCE 2008

Selecting Indicators for Public Reporting:The Ohio Experience

Hospital Performance Measures Selection

Ohio Department of Health

Alvin Jackson, MD

Madelyn Dile, JD

Jodi Govern, JD

Kaliyah Shaheen, MPH

BACKGROUND

HOUSEBILL 197

HB 197 became law in November 2006Requires Ohio hospitals to report performance measure data to the Ohio Department of Health for the purpose of public reporting

HOUSEBILL 197

Required Measure Sets Centers for Medicare and Medicaid Services

(CMS) The Joint Commission (JC) National Quality Forum (NQF) endorsed

measures Agency for Healthcare Research and Quality

(AHRQ)

Creation of Advisory Council

A Hospital Measures Advisory Council was created by statute and consisted of: Director of Health (Council Chair) Two members of the House of

Representatives Two members of the Senate Superintendent of Insurance Executive Director of the Commission on

Minority Health Representatives from several agencies

Creation of other Groups

Mandated Groups A Data Expert Group An Infection Control Group

Ad Hoc Groups The Advisory Council created Pediatric

and Perinatal workgroups

Process for Measures Selection Data Expert Group monthly

meetings Creation of set criteria as guidelines Examination of measure

specifications Selection of measures Recommendations to Advisory

Council on selected measures* Measures related to Adult care, Chronic Diseases, Patient Safety – Slide 9

Measure Selection Criteria

Importance Do the measures reflect unequivocally important

aspects of patient care?

Preventability Can a poor score be prevented through proper

care?

Is excess variation in the data accounted for by factors unrelated to hospital quality?

Genuine quality improvement Can a hospital’s rate be improved without

improving quality?

Measure Selection Criteria (cont.)

Data integrity Can a hospital accurately collect the data from its

records?

Does the measure adequately measure the construct it attempts to measure?

Ability to publicly report Is the measure of use to consumers? Is the measure comprehensible to consumers? Do hospitals have a sufficient case load to

accurately report quality? Burden

Does calculating the measure place undue burden on hospitals?

Measure Selection Criteria (cont.)

Evidence-based Is there scientific research demonstrating the

accuracy and importance of the measure?

Variance Is there sufficient variability in performance

among hospitals to allow for comparison?

National Quality Forum endorsement Is the measure endorsed by the National

Quality Forum?

Overview of Selected Measures

All measures from 4 required sources considered

Total of 84 measures were recommended to the Advisory Council

47 CMS measures 17 AHRQ measures 10 JC measures 10 Infection measures

AHRQ: Patient Safety Indicators

The Data Expert Group recommended the following AHRQ Patient Safety Indicators to the Advisory Council

PSI-1: Complications of AnesthesiaPSI-3: Decubitus UlcerPSI-5: Foreign Body Left During ProcedurePSI-9: Postoperative Hemorrhage or HematomaPSI-16: Transfusion ReactionPSI-17: Birth Trauma—Injury to Neonate PSI-18: Obstetric Trauma– Vaginal Delivery with Instrument

PSI-19: Obstetric Trauma—Vaginal Delivery without instrument

PSI-20: Obstetric Trauma—Cesarean Delivery

AHRQ : Inpatient Quality Indicators

The Data Expert Group recommended the following AHRQ Inpatient Quality Indicators for inclusion

IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate IQI-21: Cesarean Delivery Rate IQI-22: Vaginal Birth after Cesarean Rate,

Uncomplicated IQI-33: Primary Cesarean Delivery Rate IQI-34: Vaginal Birth after Cesarean Rate, All

AHRQ: Recommended Measures After consideration and voting by the Advisory

Council, 7 of the 17 AHRQ measures were recommended to the Director of Health for public reporting

PSI -1: Complications of Anesthesia PSI-3: Decubitus Ulcer PSI-5: Foreign Body Left During Procedure IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate

If passed through the rule making process hospitals will begin reporting these measures in late 2009

Current Hospital Reporting in Ohio

April 2007 Hospital reporting start date by HB 197

ODH selected 11 measures for interim reporting

2 of these measures were from AHRQ

Reporting done April and October 2007, 2008

Hospital Reporting Beginning April 2007

Postoperative Respiratory FailureAdultPediatric

Iatrogenic PneumothoraxAdultPediatricNeonate

Current ReportingFeedback from Hospitals Postoperative Respiratory Failure Ohio has found the numbers are too

small for Iatrogenic Pneumothorax and may not be the best measure for the purpose of public reportingOnly 2 hospitals in the adult category and 1

hospital in the neonatal category had reportable data

Iatrogenic Pneumothorax - Pediatrics

October 1, 2006 – September 30, 2007

187 hospitals

Other Measures Currently Being Reported

Aspirin at Arrival for Acute Myocardial Infarction

Beta Blocker at Arrival for Acute Myocardial Infraction

Pneumococcal Vaccination for Pneumonia Blood Culture before Initial Antibiotic for

Pneumonia ACEI or ARB Left Ventricular Systolic

Dysfunction for Heart Failure Evaluation of Left Ventricular Systolic

function for Heart Failure

Next Steps

Adopt rules reflecting recommended measures Six to nine month process

Public comment periodPublic hearing

Reporting of new measures to begin no earlier than October 2009

Development of the consumer website To be operational by January 2010

If you have any questions please contact Kaliyah Shaheen at 614-995-4982 or kaliyah.shaheen@odh.ohio.govSeptember 2008

Thank You

Questions??