NACHRI Analytics The Definition of Value from the Hospital Perspective

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NACHRI AnalyticsThe Definition of Value from
the Hospital Perspective

• Moderator
• Mary Gorman - Vice President

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Webinar Logistics
Webinar will last approximately one hour a 45
minute presentation and 15 minutes for
questions Sessions will be recorded and posted
to NACHRI website within 48 hours Everyones
phone will be muted until we open the floor up
for questions. Please do not put your phone on
hold If you are have difficulty during the
webinar, please call 703/684-1355 and ask for
Charles Murray or Kahari McCall
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What is NACHRI Analytics?
A suite of data, benchmarking, and quality
improvement programs, which combined with
methods of analysis NACHRI applies - can make a
difference for your hospital and childrens
health care
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Webinar Series Objectives
To inform about the services and databases
available to members To provide examples of how
NACHRI Analytics support childrens hospitals
operations and advance the health and wellbeing
of all children To encourage broader
participation in these databases and utilization
of these services across the membership
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NACHRI Analytics Discover the Value of Our
Research and Analysis
September Webinar Series

• Schedule
• Introduction to NACHRI Analytics Webinar
  Wednesday, Sept. 3
• Clinical Productivity and Staffing Program (CPSP)
  Webinar, Thursday, Sept. 4
• Annual Survey Webinar Friday, Sept. 5
• VPS Webinar Tuesday, Sept. 9
• FOCUS Groups Webinar Wednesday, Sept. 10
• Data-driven Public Policy Webinar Thursday,
  Sept. 11
• Pediatric Quality Measurement (PQMS) Webinar
  Tuesday, Sept. 23
• Case Mix Webinar Wednesday, Sept. 24
• Pediatric Quality Indicators (PDIs) Webinar
  Thursday, Sept. 25

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Strategic Directions

• .robust, credible, and reliable data are
  available.
• .members are knowledgeable about and have easy
  access to NACHRI data resources and services.
• .NACHRI is an indispensible source for data and
  applied research.

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NACHRI Analytics

• Public Policy Sept. 11
• Pediatric Quality Indicators Sept. 25

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NACHRI Analytics

• CPSP Sept. 4
• Annual Survey Sept. 5
• VPS Sept. 9
• FOCUS Groups Sept. 10
• PQMS Sept. 23
• Case Mix Sept. 24

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NACHRI Analytics

• The Definition of Value From the Hospital
  Perspective
• Presenters
• Debbie Jones, R.N., B.S.N.
• Patient Care Systems Analyst
• Kosair Childrens Hospital
• Aileen Sedman, M.D.,
• Professor Emerita University of Michigan Medical
  School
• Past Director Practice Management and Associate
  Chief of Clinical Affairs

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Practical use of the Clinical Productivity and
Staffing Program (CPSP),VPS and Focus Groups

• Debbie Jones RN, BSN
• Patient Care Systems Analyst
• Kosair Childrens Hospitals

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• CPSP Overview
• Internal staffing and unit statistics comparisons
• External like-unit comparisons
• Transparency

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Peer Group

• Dynamic
• Size
• Type of Unit
• Major diagnosis/procedure

• Static
• Same state
• Regional proximity
• Predetermined list
• US News and World Report

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75thile
50thile
25ile
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US News and World Report top 30 pediatric
hospitals
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VPS/PICU FOCUS Group

• Annual Report
• Application
• Support of PICU Focus Group Projects

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NACHRI ANALYTICS

• CPSP VPS PICU Focus Group
• EXCELLENT PATIENT OUTCOMES

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• Questions?

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Use of Case Mix Database by University of
Michigan Mott Childrens HospitalWebinar
September 30, 2008

• Aileen Sedman M.D., F.A.A.P.
• Professor Emerita University of Michigan Medical
  School
• Past Director Practice Management and Associate
  Chief of Clinical Affairs

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Case mix database

• Data from 82 Childrens Hospitals
• APR-DRGs--1437 diagnoses
• Cases at four levels of acuity
• ALOS, Cost per Case, Case Mix Index (Acuity
  Score) compared to all other hospitals in the
  database but also general hospitals
• Also can calculate readmission rates, mortality
  rate, pediatric quality indicator rates

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Findings

• Mott Level 1 asthma had slightly increased ALOS
  and cost per case than NACHRI hospitals overall
  from (Mott n511, NACHRI n64,312
• Level 2,3,4 we were the same or better than
  national average.
• Level 1 cases--Not on the pulmonary service, no
  standardized care, a lot of time wasted waiting
  for rounds and for family education to take place

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Four interventions

• Created standardized order sets
• Allow respiratory therapists to wean O2 and
  nebulizer treatments according to preset protocol
  without requiring physician presence
• Education coordinator notified the day of
  admission to meet with family and go over action
  plan
• Reviewed coding procedures with coders and
  faculty to make sure all comorbities (hypoxia,
  nutritional abnormalites, fever, dehydration) to
  make sure patients in level 1 actually belonged
  there.

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Annual ALOS for APR-DRG 141 Asthma (APR-DRG V.20)
2.50
ALOS
UMMCH
2.00
Peer Group
(n40)
1.50
1999
2000
2001
2002
2.16
2.00
1.92
1.75
UMMCH
Peer Group (n40)
2.14
2.06
2.03
2.00
Discharge Year
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Readmission Rates for APR-DRG 141.1
Based on those asthma cases that were
readmitted less than 30 days after initial asthma
visit
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Mortality Rates for APR-DRG 141.1
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Conclusions of this Study

• APR-DRGs are a useful tool for clinical redesign
  because you can discretely analyze care of
  diseases according to their level of acuity
  across hundred of institutions
• Clinicians accept this tool as useful

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Pediatric Quality Indicator Program

• Software created by the Agency for Health
  Care Research and Quality to be applied to a
  Hospitals Administrative data which identifies
  potentially preventable complications by
  recognizing certain ICD9-CM codes.

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AHRQ Pediatric Quality Indicators (PDI)

• Accidental Puncture or Laceration (PDI 1)
• Decubitus Ulcer (PDI 2)
• Foreign Body Left During Procedure (PDI 3)
• Iatrogenic Pneumothorax in Neonates at Risk (PDI
  4)
• Iatrogenic Pneumothorax in Non-neonates (PDI 5)
• Pediatric Heart Surgery Mortality (PDI 6)
• Pediatric Heart Surgery Volume (PDI 7)
• Postoperative Hemorrhage or Hematoma (PDI 8)
• Postoperative Respiratory Failure (PDI 9)
• Postoperative Sepsis (PDI 10)
• Postoperative Wound Dehiscence (PDI 11)
• Selected Infections Due to Medical Care (PDI 12)
• Transfusion Reaction (PDI 13)

Source http//www.qualityindicators.ahrq.gov/
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PDI Risk AdjustmentVery Different from previous
Patient Safety Indicators

• Logistic Regression Model
• Age (8 groups)
• Gender
• Comorbidities
• Reason for Admission (DRG)
• Regression coefficients developed using pediatric
  cases from HCUP State Inpatient Databases
  different set of coefficients for each individual
  PDI

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NACHRI and PDIs

• Did a collaborative study analyzing each PDI
• Produced rates of PDIs for each hospital with
  explanatory notes showing why they are invalid or
  valid
• Produced comparative graphs showing your hospital
  compared to all other childrens hospitals

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Accidental Puncture / Laceration

• DenominatorAll medical and surgical patientslt17
• Any pt coded with the occurrence of accidental
  puncture via ICD-9-CM code
• n3,168/3yrs
• 7 POA
• 32 not preventablecases occurred secondary to
  lysis of adhesions often in repeat cardiac,or
  abdominal surgeries (gastroschisis,
  oomphalocele), resection of large vascular tumors
• ie lacerations were not purposeful but often
  could not be avoided in order to do the surgery
• Clinicians listed the causes of preventable
  lacerations as those occurring with insertion of
  line or device placements that caused laceration
  of lung, blood vessel, or GI tract

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PDI 2 Decubitus Ulcer

• Denominator is all pts 0-17 with a LOS gt5 days
• N1,688/3yrs
• 40 of the cases were POA
• Not preventable 21 of the timeproblem is often
  characterization of actual decubiti vs skin
  breakdown esp in neonates. 51 were preventable
  including decubiti on the head in infants
• Still leaves approximately 450 cases of
  preventable decubiti in children , some requiring
  skin grafts

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Congenital Heart Surgery Mortality

• Risk adjustment for Congenital Heart
  SurgeryRACHS1
• Created by Dr. Kathy Jenkins a cardiologist at
  Boston Childrens Hospital with many other heart
  surgeons, cardiologists included
• Stratifies according to six levels of procedures
• Also takes into acct gestational age, other
  defects or chromosomal abnormalities
• PDAs/pacemaker type cases not included
• Cases that dont fit model not included so tends
  to decrease number of cases includedtries to
  compare apples to apples

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Selected Infection Due to Medical Care

• Denominator is all medical and Surgical patientslt
  age 17
• N8922/3yrs
• POA 43
• 40 preventable
• Therefore approximately 1900 children had
  acquired preventable infections in our hospitals

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Individual Hospital Response

• At UofMich any chart coded with a PDI (after POA
  is removed) is reviewed by a quality nurse
• Charts found to have preventable events are
  reviewed by OCA, then sent to the appropriate
  division for review and further discussion of
  preventability. Division is asked to do
  appropriate analysis on all preventable events
  and apply to system wide improvements if
  necessary
• If complications are found to be preventable
  under our watcha bill is not sent for the
  portion that was preventable

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Individual Hospital Responsetrying to prevent
the complications

• Use of Braden Qa scale to predict risk of
  decubiti with use of special padding, specialized
  beds, increased surveillance

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NACHRI BSI Collaborative

• Emphasized two different approaches
• Establishment of insertion bundles
• Establishment of maintenance bundlescritically
  important in lines which are maintained long term
  because of limited access

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In conclusion

• Case mix program can help you compare diagnoses
  directly compared to other hospitals in a risk
  adjusted manner
• Can help you look at pediatric quality indicators
  compared to other hospitals
• Helps prioritize where to put your resources
• Data is brought to each division with diagnoses
  appropriate for them yearly as part of their
  divisional reviewhelps the divisions stay in
  tune with national data and helps keep them
  informed as to national benchmarksie they can no
  longer say they are the best without data to
  back it up

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• Questions??

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NACHRI Annual MeetingOctober 14 17, 2008Salt
Lake City Utah

• NACHRI Analytics Presentation
• Wednesday, October 15, 2008
• 245 p.m. 445 p.m.
• Becoming a Champion of Childrens Health through
  NACHRI Analytics, Imperial B

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NACHRI Annual MeetingKnowledge Center

• Tuesday, October 14
• 300 p.m. 500 p.m.
• Wednesday, October 15
• 1145 a.m. 130 p.m.
• 500 p.m. 600 p.m.
• Thursday, October 16
• 900 a.m. 1000 a.m.
• 100 p.m. 230 p.m.

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Contact Information

• Mary Gorman
• 703/797-6008
• mgorman_at_nachri.org
• www.childrenshospitals.net