Trends and Issues in Rural Hospital Measurement: The QIO Perspective

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Trends and Issuesin Rural Hospital Measurement
The QIO Perspective
TASC 90 Conference Call Wednesday, February 7,
2007
Karla Weng, MPH, CPHQ Stratis Health

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Agenda

• Provide brief overview of QIO role in supporting
  rural hospital quality and patient safety
• Share measurement results to date
• CAH core measure reporting
• CAH core measure QI efforts
• Rural hospital AHRQ patient safety culture
  baseline
• Discuss trends and issues

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QIO Rural Hospital Efforts Background

• National Goal
• The QIO shall promote transformational change in
  CAHs and rural PPS hospitals by working on
  clinical performance quality measures and
  organizational safety culture relevant to care
  provided in these hospitals.
• Most QIOs required to do rural hospital
  work(Task 1c2) in 8th Scope of Work
• 8 states/territories exempted
• Approximately 50 of QIOs cite implementing at
  least one rural specific initiative prior to
  the8th Scope of Work

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QIO Rural Hospital EffortsTask 1c2 Overview

• 1. Get non-reporting CAHs to submit data to
  QualityNet Exchange
• 2. Support reporting CAHs in improving care in
  selected areas
• 3. Improve organizational patient safety culture
  in a selected group of rural PPS hospitals and/or
  CAHs
• Rural Organizational Safety Culture (ROSC)
  Identified Participant Group (IPG)

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So how are we doing so far, approximately 18
monthsinto a 3-year effort?
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1. Statewide Non-Reporting CAHs

• Performance Goal
• Promote reporting of data on at least one
  clinical measure. Achieve a 50 increase in
  reporting CAHs.
• Clinical Measures are from Centers for Medicare
  Medicaid Services/Hospital Quality Alliance
• As of Quarter 2 (Q2) 2006, 72.0 of CAHs are
  submitting data.
• Increase of 26.8 since Q4 2004 (45.2)
• Estimate nearly 60 of QIOs have met the 50
  relative improvement goal based on Q2 2006 data

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National of CAHs Submitting Data
Note Only includes CAHs converted as of 7/31/05.

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2. Statewide CAH Quality Improvement

• Performance Goal
• CAHs reporting on at least 1 measure must achieve
  10 reduction in failure rate on a selected
  measure from baseline to remeasurement
• Baseline Q3 Q4 2004
• Remeasurement the last two quarters available
  prior to the QIO evaluation (likely either Q3
  Q4 2006, or Q4 2006 and Q1 2007)

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2. Statewide CAH Quality Improvement (cont.)

• 415 CAHs met the criteria to be considered
  reporting for QIO evaluation (There were 1,145
  CAHs as of 7/31/05).
• Number of reporting CAHs varies by state from
  0 36
• QIO evaluation measures collected 9/1/06
• Most QIOs/CAHs selected pneumonia and heart
  failure measures as areas for focused QI efforts.

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Performance Measure Selected for Improvement by
QIOs/CAHs
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3. Identified Participant Group Rural
Organizational Safety Culture (ROSC)

• Performance Goal
• Work with at least 6 hospitals to achieve a
  reduction in failure rate of at least 1 between
  baseline and remeasurement of survey results on 3
  specific leadership questions from the AHRQ
  Patient Safety Survey
• Many QIOs are working with more than the required
  hospitals (6) on the rural organizational culture
  work.
• 383 hospitals submitted to CMS for QIO evaluation
  as part of the ROSC IPG
• Range 6 23

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3. Identified Participant Group ROSC (cont.)

• AHQA Patient Safety Culture Survey Leadership
  Questions for QIO Evaluation
• Hospital management provides a work climate the
  promotes patient safety. (F1)
• The actions of hospital management show that
  patient safety is a top priority. (F8)
• Hospital management seems interested in patient
  safety only after an adverse event happens. (F9)

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3. Identified Participant Group ROSC (cont.)

• Average Baseline Scores Leadership Questions
• National average 73
• Range 59 - 83
• Note Not all states included. Some states
  exempt.
• Common areas for hospital improvement
  (anecdotally)
• Non-punitive error reporting
• Communication openness
• Hospital handoffs and transitions

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ROSC IPG Baseline SurveyState Average
Leadership Scores
Note Some states exempt.
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What other trends and issues in rural hospital
measurement are we seeing?
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Progress Measures

• QIOs collected additional information from the
  ROSC IPG hospitals in their state in August 2006.
  National results
• 72 of IPG hospitals are using a measure
  dashboard
• 22 using a dashboard for employee performance
  reviews
• 12 using a dashboard for employee compensation
  packages
• 58 using dashboard data for strategic plans
• 44 using dashboard data for other purposes
• 65 involving board, medical staff, executive
  leadership in development and update of
  dashboard measures

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HI QIOSC Survey Overview

• HI QIOSC surveyed all QIOs in June 2006
• Objectives
• Help describe and quantify strategies related to
  CAH reporting, QI efforts, and relationships with
  key rural stakeholders at a state level
• Gather input about potential future QIO work in
  rural settings
• Method
• Online survey distributed to the QIO community
• 42 responses received, representing 39 of the44
  states working on Task 1c2

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HI QIOSC Survey Results CAH Reporting

• Two primary strategies for increasing the number
  of reporting CAHs
• Coordination/collaboration with state partners
  such as Flex Program, Hospital Association,
  and/or CAH Network to promote participation
• Technical assistance and consultation,
  eitherin-person, Web-based, or phone to address
  concerns and provide direct support for set-up
  and utilization of the CART tool and QualityNet
  Exchange

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HI QIOSC Survey Results CAH Reporting (cont.)

• Most QIOs cited these strategies in conjunction
  with one another
• A few QIOs cited making data submission a
  requirement of ROSC IPG participation

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HI QIOSC Survey Results CAH QI

• Broader list of strategies than for CAH reporting
• Four major categories
• Supporting/convening collaborative or community
  of practice opportunities, often in conjunction
  with stakeholders
• One-on-one consultative support, either via phone
  or on-site visits
• Inclusion in activities planned for other IPGs
  such as Appropriate Care Measure or Surgical Care
  Improvement Project (e.g., collaboratives,
  conference calls,)
• Focusing on data providing regular data reports
  with comparisons, offering education/support for
  interpreting data reports
• Most QIOs cited multiple strategies

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HI QIOSC Survey Results Stakeholders

• Most QIOs are engaging with key state level
  stakeholders to support rural initiatives
• Approximately 80 of responding QIOs cited they
  have implemented joint activities with their
  State Office of Rural Health, with nearly 60 of
  those citing that theyve worked together on
  strategic planning for rural support in their
  state.
• Over 90 of responding QIOs cite an active
  partnership and/or implementation of at least
  some joint initiatives with the state hospital
  association for rural hospitals in their state.

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HI QIOSC Survey ResultsFuture QIO Work

• Question asked
• As your QIO has been working with small rural
  hospitals, what do you see as the best
  opportunities for future QIO impact/support in
  quality and patient safety?

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HI QIOSC Survey ResultsFuture QIO Work

• Two types of responses
• Things QIOs can do
• convene, educate, provide technical assistance,
  develop infrastructure
• Topic/content areas QIOs could focus on
• Patient Safety/Culture
• HIT
• Basic QI Skills
• Rural measures
• Same topics as PPS but tailor measures for
  rural

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HI QIOSC Survey Results Future QIO Work (cont.)

• Question asked
• Some potential areas under discussion include ED
  care, transfer communication, and coordination
  across the continuum. Input on these and other
  areas
• Strong support for all three proposed areas
• Additional topic areas suggested multiple times
  include
• Rural EMS/Ambulance Services
• Patient Safety
• HIT
• Specific coordination between CAH and
  attached/owned LTC

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Reflections

• The available data show that QIOs are moving
  toward meeting the established goals.
• Significant increase in CAH and rural hospital
  data collection and use of measurement as quality
  management tool
• Good base of partnerships being built at the
  local level
• Much more opportunity for expanded areas of
  measurement and QI technical assistance in rural
  communities

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Contact Information

• Supporting QIOs as part of the HI QIOSC
• Jennifer P. Lundblad, PhD, MBAStratis Health
• [phone]jlundblad_at_stratishealth.org
• Karla Weng, MPH, CHPQ
• Stratis Health
• [phone]
• kweng_at_stratishealth.org
• Estelle Brouwer, MPPStratis Health
• [phone]
• ebrouwer_at_stratishealth.org

This material was prepared by Stratis Health, for
the Oklahoma Foundation for Medical Quality, the
Medicare Hospital Interventions Quality
Improvement Organization Support Center,, which
is under contract with the Centers for Medicare
Medicaid Services (CMS), an agency of the U.S.
Department of Health and Human Services. The
contents presented do not necessarily reflect CMS
policy.