Leapfrog Hospital Quality and Safety Survey, Michigan Results, Changes for 2006

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Leapfrog Hospital Quality and Safety Survey,
Michigan Results, Changes for 2006 2007
Barbara Rudolph, Ph.D. Director, Leaps and
Measures March 30, 2006
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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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Principles to Achieve Mission

• Leapfrog members agree to
• Educate and inform enrollees
• Compare at the provider level
• Reward superior provider value
• Patient volume
• Unit price (pay for performance)
• Public recognition

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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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Mechanism for Data Collection at the Hospital
Level

• Hospital survey available via The MEDSTAT Group
  and Michigan Health and Hospital Survey
• Ongoing voluntary Web survey
• Outreach to hospitals in Roll-Out areas, but
  nationally available
• Data publicly reported, format based on feedback
  from consumers and hospitals (survey and results
  www.leapfroggroup.org )

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Computerized Physician Order Entry (CPOE)

• Each hospital fulfilling this Leap
• Assures that prescribers enter 75 of hospital
  medication orders via a computer system that
  includes decision support software to reduce
  prescribing errors
• Requires that prescribers electronically document
  a reason for overriding an interception prior to
  doing so
• Linked to pharmacy, admitting-discharge-transfer
  (ADT) information systems.

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Findings CPOE

• A Summary of Cost and Benefit Estimates
• Serious errors averted range from 55 to 88
  percent.
• Estimates of errors avoided per year range from a
  low of 567,298 to a high of 907,677
• Average net CPOE savings per inpatient bed day
  (by hospital bed size) ranges from 8.69 for a
  200 bed hospital to 16.00 for a 1,000 bed
  hospital representing a global cost savings of
  approximately 2 billion

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ICU Physician Staffing

• A hospital fulfilling this leap assures that all
  patients in its adult or pediatric general
  medical and/or surgical ICUs are managed or
  co-managed by physicians certified in critical
  care medicine who
• Are ordinarily present in the ICU (on-site, or
  via telemedicine that meets Leapfrog
  specifications) during daytime hours a minimum of
  8 hours per day, 7 days per week, and during this
  time provide clinical care exclusively in the
  ICU and
• At other times . . . returns more than 95 of
  ICU pages within 5 minutes, based on a quantified
  analysis of pager response time and can rely on
  a physician or FCCS-certified non-physician
  effector who is in the hospital and able to
  reach ICU patients within 5 minutes in more than
  95 of cases, based on a quantified hospital
  analysis of pager response time.

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Findings IPS

• A Summary of Costs and Benefits
• We estimate a 30 reduction in deaths at
  hospitals that have adopted IPS.
• With the full adoption of IPS at urban hospitals,
  53,031 adult and 1,102 child lives would be saved
  each year saving 10.6 billion.
• NET SAVINGS per day vary from about 360 per bed
  under the worst case scenario to about 980 per
  bed under the best case scenario across three
  size of ICUs (6, 12, and 18 bed).

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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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Outcomes CABG and PCI

• State reported risk-adjusted mortality for CABG
  in NY, NJ, CA, and PA (Top Quartile)
• State reported risk-adjusted mortality for PCI in
  NY (Top Quartile)
• Risk-adjusted CABG mortality from STS (at or
  above average performance)
• Risk-adjusted PCI mortality from ACC (at or above
  average performance)

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Process Measures-developed by Zynx

• 80 or greater adherence to at least 2 of the
  measures in each high risk procedure or
  condition.
• CABG (Process measure examples)
• All patients undergoing CABG should receive
  aspirin upon hospital discharge.
• All patients undergoing CABG without
  contraindications should receive a beta-blocker
  within 24 hours after surgery.
• PCI (example)
• Patients without contraindications who have
  undergone PCI should receive aspirin
• AAA
• High Risk Infants (only 1 measure)

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Findings EHR

• A Summary of Cost and Benefit Estimates
• With the full adoption of EHR at urban hospitals,
  11,208 lives would be saved each year.
• The total economic value of lives saved ranges
  from 17 to 29 billion.
• Because of gaps in the literature, we were unable
  to estimate dollar values of other costs or
  savings.

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NQF Safe Practices (27 additional)

• Safe Practices for Better Healthcare A
  Consensus Report
• 30 Practices that should be universally used in
  applicable clinical care settings to reduce risk
  of harm to patients
• Original 3 leaps are included
• Leapfrog aggregated the remaining 27 practices to
  make the 4th Leap NQF Safe Practices

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NQF Safe Practices

• Safe Practices were assigned point values based
  on impact on patient safety
• Total points 1000
• Framework for scoring specific safe practices
• Awareness leaders are aware of the problem and
  the impact on their performance
• Accountability leaders have personal
  accountability for performance
• Ability extent to which hospitals invest in
  education, skill development, staff time and
  to address the issues
• Actions ongoing programs that have regular
  measurement and process improvement elements
• Partial credit for progress and commitment to
  take action

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Benefits of 27 Safe Practices

• Benefits
• Enables more hospitals to participate in Leapfrog
  - applicable to small and rural as well as large
  hospitals
• Enables hospitals to convey a more complete
  picture of the work theyre doing to improve
  patient safety
• Provides a roadmap for hospitals to improve
  safety

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Hospital Response to Safety Index
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Leapfrog Update and 2006-07 Outlook

• 2006 Survey
• March May refresh
• Same standards and survey content, some update to
  scoring
• Ask for results for process measures . . . ties
  in to LHRP
• 2007 Standards Update . . . new survey release
  v4.0 in March 2007
• NQF expected to update Safe Practices
• Expect greater specificity in NQF portion of
  survey
• Likely to include valve surgeries
• Likely to include surgeon volumes for EBHR
  procedures
• Leapfrog Hospital Rewards Program (LHRP)
• Leapfrogs Health Plan User Groups

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Tools to Assist in Survey Completion

• Endnotes
• Frequently Asked Questions (2 sets)
• Survey Helpdesk leapfrog.medstat_at_thomson.com
• 734-913-3030

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Public and Corporate Display

• Leapfrog Website (www.leapfroggroup.org)
• Employer and Healthplan Websites
• For example see Mountain State BlueCross
  BlueShield at www.msbcbs.com

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Leapfrogs Hospital Quality and Safety Survey
Display
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Results of 2005 Survey
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2005 Performance of Michigan Hospitals
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Urban HospitalsFully Meet Leap (2003-2005)
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Michigan-US Comparison
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Incentives and Rewards
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Leapfrog Hospital Rewards Program (LHRP)A
National Incentive Reward Initiative

• Leapfrog Hospital Rewards Program can be
  implemented by purchasers and coalitions in their
  current environments
• Adapts the CMS-Premier demonstration program for
  the commercial sector
• Provides incentives for performance improvement
  in both effectiveness (quality) and efficiency
  (cost)
• Hospitals can participate with minimal additional
  reporting
• All aspects of the program were reviewed by
  experts and vetted by stakeholders

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LHRP Performance Measures

• Five clinical areas CABG, AMI, PCI, CAP,
  Deliveries / Newborn
• Hospitals can participate in any or all of the
  five of the clinical areas, scored separately on
  each condition
• Effectiveness Measures
• By clinical condition
• Leapfrog Hospital Quality and Safety Survey, and
• JCAHO ORYX Core Measures
• Experts weighted the individual measures within
  each clinical condition based on existing
  evidence of the potential to reduce mortality
• Resource-based efficiency measure
• ALOS, severity standardized routine and special
  care separately
• Inflated by readmission rate
• Supplemented with plan/purchaser-specific payment
  data

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Hospitals Statistically Arrayed into Performance
Groups

• Rewards share savings due to
• Consistent performance in Group 1
• Consistent improvement from group to group

Group 1
Group 2
Average
Group 3
Group 4
http//leapfrog.medstat.com/hrp
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Health Plan User Groups
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Leapfrogs Health Plan User Groups

• Facilitate discussion between Leapfrog members
  who have significant business relationships with
  large national health plans.
• Health plans to Encourage effective enrollee
  communications. To receive a score of above
  average, a plan must have Leapfrogs survey
  results embedded in provider search tools.
• Work collaboratively with Leapfrogs Regional
  Roll Out leaders to increase hospital reporting
  to the hospital survey and to promote hospitals
  general understanding of the Leaps.
• Support standardized measures. All plans join
  NQF and must adhere to the Consumer Disclosure
  Projects guidelines. http//healthcaredisclosure.
  org/
• Promote Transparency of quality data for
  hospitals and physicians for the plans entire
  book of business.