The Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

1
The Relationship Between Organizational Factors
and Performance Among Pay-for-Performance
Hospitals

• Vina ER, Rhew DC, Weingarten SR, Weingarten JB,
  Chang JT.

2
Background

• Pay for Performance (P4P)
• Hospital Quality Incentive Demonstration (HQID)
  Project
• Rewarding high performance hospitals with 2
  bonus on Medicare payments

3
Objective

• To identify the key quality improvement (QI)
  factors associated with higher performance in
  hospitals in a P4P program

4
Sampling frame

• Hospitals participating in the HQID project
  across 5 clinical conditions or procedures
• Acute myocardial infarction (AMI)
• Heart failure (HF)
• Pneumonia (PN)
• Total hip or total knee replacement (THR/TKR)
• Coronary artery bypass graft (CABG)

5
Study sample
6
Overall Composite Quality Score (O-CQS)

• Overall Composite Quality Score (O-CQS)
• Calculated by Premier, Inc.
• Utilized O-CQS from year 2(October 1, 2004 -
  September 30, 2005)
• Combines composite process score (CPS) and
  composite outcome score (COS)

7
Structured telephone interview

• Telephone interviews were conducted by Zynx
  Health investigators (blinded to each hospitals
  performance ranking) July, 2007 - October, 2007
• Average interview 35 minutes
• Respondents were asked to focus on theirQI
  activities during the past year

8
QI domains

1. Quality improvement (QI) interventions
2. Data feedback systems (quality compliance)
3. Physician leadership
4. Organizational support for QI
5. Organizational culture

9
Results

• 92 hospitals were eligible for the study
• 84 (91) completed the interview
• 45 were in the top 2 deciles
• 39 were in the bottom 2 deciles

10
Hospital characteristics
11
QI interventions
P lt .01
12
QI interventions
P lt .01
13
QI interventions Electronic capabilities
14
Data feedback
15
Physician leadership

• Among hospital CMOs with the general role of
  improving quality,
• Percentage who recruited physician champions
  (82.1 vs 69.4, Plt.05).

16
Organizational support
17
Organizational support
18
Organizational support
19
Organizational culture
20
Organizational culture
21
Organizational culture
22
Organizational culture
23
Organizational culture
24
Limitations

• Voluntary participants in a P4P program
• Participants not blinded own performance rankings
• Unable to evaluate association of QI efforts to
  future performance

25
Conclusions

• Main factors associated with high performance
• Organizational structure
• Organizational support for QI
• Organizational culture

26
Policy implications

• Strategies should encourage development of
  improved organizational structure, support and
  culture for quality
• Develop and strengthen resources to support QI
  activities

27
Acknowledgements

• Zynx Health, Inc.
• Premier, Inc.
• Centers for Medicare Medicaid Services

28

• Questions?

29
References

• (1) Centers for Medicare and Medicaid Services
  (CMS) / Premier Hospital Quality Incentive
  Demonstration Project. Internet 2008 January
  3Available at URL http//www.premierinc.com/qua
  lity-safety/tools-services/p4p/hqi/hqi-whitepaper0
  41306.pdf
• (2) Centers for Medicare and Medicaid Services
  (CMS) / Premier Hospital Quality Incentive
  Demonstration Project. Internet 2008 January
  3Available at URL http//www.premierinc.com/qua
  lity-safety/tools-services/p4p/hqi/resources/hqi-w
  hitepaper-year2.pdf
• (3) Lindenauer PK, Remus D, Roman S et al.
  Public reporting and pay for performance in
  hospital quality improvement. N Engl J Med 2007
  February 1356(5)486-96.
• (4) Bradley EH, Herrin J, Mattera JA et al.
  Quality improvement efforts and hospital
  performance rates of beta-blocker prescription
  after acute myocardial infarction. Med Care 2005
  March43(3)282-92.
• (5) Bradley EH, Herrin J, Mattera JA et al.
  Quality improvement efforts and hospital
  performance rates of beta-blocker prescription
  after acute myocardial infarction. Med Care 2005
  March43(3)282-92.
• (6) Marciniak TA, Ellerbeck EF, Radford MJ et al.
  Improving the quality of care for Medicare
  patients with acute myocardial infarction
  results from the Cooperative Cardiovascular
  Project. JAMA 1998 May 6279(17)1351-7.
• (7) Metersky ML, Galusha DH, Meehan TP. Improving
  the care of patients with community-acquired
  pneumonia a multihospital collaborative QI
  project. Jt Comm J Qual Improv 1999
  April25(4)182-90.

30
References

• (8) Ferguson TB, Jr., Peterson ED, Coombs LP et
  al. Use of continuous quality improvement to
  increase use of process measures in patients
  undergoing coronary artery bypass graft surgery
  a randomized controlled trial. JAMA 2003 July
  2290(1)49-56
• (9) Fonarow GC, Abraham WT, Albert NM et al.
  Influence of a performance-improvement initiative
  on quality of care for patients hospitalized with
  heart failure results of the Organized Program
  to Initiate Lifesaving Treatment in Hospitalized
  Patients With Heart Failure (OPTIMIZE-HF). Arch
  Intern Med 2007 July 23167(14)1493-502.
• (10) Fung CH, Lim YW, Mattke S, Damberg C,
  Shekelle PG. Systematic review the evidence that
  publishing patient care performance data improves
  quality of care. Ann Intern Med 2008 January
  15148(2)111-23.
• (11) Berwick DM, James B, Coye MJ. Connections
  between quality measurement and improvement.
  Medical Care 200341(1)I30-8.

31
BACK-UP SLIDES
32
(No Transcript)
33
(No Transcript)
34
QI Interventions
35
QI Interventions
P lt .05 P lt .01.
36
Results, Summary