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What’s New in 2009: The Leapfrog Hospital Survey

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... Hospital Acquired Conditions (HACs) Catheter-related blood stream infections Common Acute Conditions (CACs) Normal Deliveries Evidence-based Hospital Referral ... – PowerPoint PPT presentation

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Title: What’s New in 2009: The Leapfrog Hospital Survey


1
Whats New in 2009 The Leapfrog Hospital Survey
  • Survey Townhall CallsApril 15, 2009April 21,
    2009May 1, 2009

2
Town Hall Call Overview
  • Introduction
  • Survey Team
  • Where to locate slides
  • Leapfrog and the Hospital Surveywhy complete?
  • Goals for 2009 survey
  • Survey Submission Logistics/Timeline/Website
    Resources
  • Whats New for 2009
  • Detailed review of survey questions
  • Computerized Physician Order Entry (CPOE)
  • Safe Practices Score (SPS)
  • Hospital Acquired Conditions (HACs)
  • Catheter-related blood stream infections
  • Common Acute Conditions (CACs)
  • Normal Deliveries
  • Evidence-based Hospital Referral (EBHR)
  • Q A
  • Schedule for Town Hall Specialty Calls

3
Why Complete Leapfrog Survey?Unique in the Milieu
  • Represents employers/purchasers/consumers
    interests
  • Seeks public accountability/transparency
  • Rewards high performance
  • High impact performance measures not the low
    hanging fruit (e.g., CPOE, IPS, EBHR, HACs,
    Deliveries)
  • Full range of measuresstructural, process and
    outcome (but focused on outcome)
  • Regional and national in scopeall payer
    information
  • Standardized measures to assure same fruit is
    sampled
  • Harmonized with other major national performance
    measurement programsbut shows more complete
    picture of care delivery
  • Significant hospital input on survey revisions

4
Survey Review Process
  • Steps in the process to revise the survey have
    included 
  • (November, 2008) - Public review and comment
    period hospitals were invited to share comments
    and feedback on the proposed changes for the 2009
    Leapfrog Hospital Survey. 
  • (January, 2009) - Pilot test of revised survey
    20 hospitals were asked to test a draft of the
    2009 Leapfrog Hospital Survey and provide
    feedback to Leapfrog.

5
Behind the Changes in 2009
  • Goals for the new survey
  • Look for opportunities to streamline
    surveyreduce burden
  • Update language in Safe Practices to address
    maintenance by NQF
  • Continue to support CMS initiatives (HACs)
  • Align with other performance measurement groups
  • Provide normal delivery measures to address area
    of care that is important to consumers and
    purchasers
  • Maintain measures included in Leapfrogs Pay for
    Performance program

6
How did we do?
  • Maintained burden below the 2007 Survey pagesnow
    76 pages vs 106 pages
  • Language in Safe Practices updated to reflect
    changes endorsed as part of Safe Practices for
    Better Healthcare 2009 Update
  • Added two outcome measures and two process
    measures addressing normal deliveries
  • Added one hospital acquired condition identified
    by CMS and others--CLABSI
  • Aligned EBHR volume measures to address new
    Survival Predictor for CABG, PCI, AAA, AVR.
    Hospitals can continue to report their results
    from other data collectionslowering burdenbut
    providing full picture of care

7
Survey Submission Logistics, Timeline, Website
Resources
8
Survey Security and Integrity
  • Core principle hospital self-certification
  • Executive authority . . .and accountability
  • Survey security and integrity are critical
  • 16-digit security code
  • Authorization to access granted only to
  • CEO . . . can provide code directly to any
    delegate(s)
  • CEO-authorized delegate . . . Help Desk can email
    security codes. See survey home page link, Need
    security code?

9
Survey Helpdesk Available
  • Survey Helpdeskdesigned to respond within 1-2
    business days (unless it requires an expert panel
    member to respond)
  • Survey must be completed before CPOE Evaluation.
    Help Desk cannot respond in real time. Plan to
    complete early.
  • Dont wait until late June. If you have a
    problem, you likely will not make deadline.
  • Link on survey homepage
  • https//leapfrog.medstat.com/helpdesk.html

10
2009 Timeline
  • April 2, 2009 -- Leapfrog launched 2009 Survey
  • June 30, 2009 -- RRO-targeted hospitals report or
    be listed on Leapfrogs website as Did Not
    Respond
  • July 21, 2009 -- Leapfrog website lists new
    results
  • Top Hospitals List/Highest Value Hospitals
    --Recognition programs/initiatives will be done
    in 2009 beginning as early as mid-September

11
Website Resources
  • To assist hospitals in completing the Survey,
    Leapfrog makes the following tools available
  • Frequently Asked Questions
  • Overview of Whats New in 2009?
  • Fact sheets on Each Leap (including bibliography
    information)
  • White Papers on Severity-adjustment for LOS, and
    Survival Predictor
  • Scoring Algorithms
  • End Notes
  • Specifications for measuring and reporting rates
    of Hospital-Acquired Conditions
  • Link to purchase NQFs Safe Practices for Better
    Healthcare 2009 Update report

12
Website Resources for EBHR
  • Medical Coding for High-Risk Procedures and
    ConditionsProcedure code, diagnosis codes and
    other specifications for counting high-risk
    surgery volumes
  • Publicly Reported Outcomes for CABG and PCIFor
    hospitals in CA, MA, NJ, NY and PA publicly
    reported risk-adjusted mortality rates for
    responding to survey questions about PCI (MA, NY
    only) and CABG (all five states).
  • Process Measures -- SpecificationsDetailed
    specifications for Leapfrogs procedure-specific
    process measures of quality -- for CABG, PCI, AAA
    Repair, and high-risk deliveries.
  • Resource Utilization Measures Specifications
  • Detailed specifications for Leapfrogs CABG and
    PCI including
  • Coding for counting eligible cases
  • Coding and other criteria for identifying cases
    with risk factors
  • Specifications for reporting geometric mean
    length of stay
  • Criteria for identifying cases followed by
    readmission
  • Excel Tool for Computing Geometric Mean Length of
    Stay

13
Website Resources for Common Acute Conditions
(CAC)
  • Volume Standard Coding Medical Coding for
    Chronic Acute Conditions
  • Procedure/diagnosis codes and other
    specifications for counting AMI and Pneumonia
    volume
  • Process Measures - SpecificationsSpecifications
    for Leapfrogs nationally-endorsed
    condition-specific process measures of quality --
    for AMI, Pneumonia, and Normal Deliveries.
  • Resource Utilization Measures Specifications
  • Detailed specifications for Leapfrogs Common
    Acute Conditions (AMI and Pneumonia) including
  • Coding for counting eligible cases
  • Coding and other criteria for identifying cases
    with risk factors
  • Specifications for reporting geometric mean
    length of stay
  • Criteria for identifying cases followed by
    readmission
  • Excel Tool for Computing Geometric Mean Length of
    Stay
  • Outcome Measures for Normal Deliveries
  • Coding for counting eligible cases (denominator)
  • Criteria for determining numerator

14
Whats New for 2009
15
Survey Changes The Details
  • Computerized Prescriber Order Entry (CPOE)
    Evaluation Toolinstruction updates requiring
    completion of sample test scoring from test
    incorporated into public results.
  • Updated Safe Practices
  • Hospital-Acquired Conditions addition of
    Catheter-associated Blood Stream Infections
  • Common Acute Conditions Addition of Normal
    Deliveries
  • Evidence Based Hospital Referral Changes
  • Survival Predictor for CABG, PCI, AAA, AVR
  • Public Reporting Additions

16
Computerized Prescriber Order Entry (CPOE)
Evaluation Tool
  • The CPOE Evaluation Tool provides hospitals an
    opportunity to assess their implementation of
    system alerts for potential medication-related
    adverse events
  • Test involves the hospital loading
    computer-generated patient profiles and
    medication orders into their CPOE system and
    reporting back on the alerts they received
  • Hospitals scores on the tool will impact their
    overall CPOE results in 2009
  • Hospitals access the tool from the survey website
    once they have completed the CPOE section of the
    online survey (i.e. CPOE Q1YES). Failure to
    complete the applicable sections of the survey
    after submitting their test score will result in
    removal of CPOE score and hospital will be listed
    as Declined to respond in applicable sections.
  • Same security code as survey.

17
CPOE Evaluation Impact on Overall CPOE Score
  • General Overview of 2009 CPOE survey scoring
    algorithm
  • Fully implemented (4 bars)CPOE implemented,
    75 IP orders, and score 50 or better on at
    least four test categories on appropriate test
  • Substantial progress (3 bars)CPOE implemented,
    50-74 IP orders, and score of 50 or better on
    two test categories or, 75 IP orders but score
    below 50 on four test categories
  • Some Progress (2 bars)25-49 of IP orders and
    completed an evaluation.
  • Willing to Report (1 bar)Completed CPOE section
    of survey

Adult inpatient test for adult/general hospital
(pediatric test optional) pediatric test for
childrens hospital
18
CPOE Evaluation Scored Results, Sample
19
CPOE Evaluation Scored Results, Sample (contd)
20
Feedback on CPOE Evaluation Tool



  • No
    questionthis is a valuable experienceit is very
    important work and it should be applauded.
  • David Stockwell, Patient Safety Officer
  • Childrens National Medical Center

21
Updated Safe Practices
  • The 2009 Updated Safe Practices Report was issued
    in March of 2009. The report separated Safe
    Practice 1 - Culture of Safety - into 4 separate
    Safe Practices. In addition, three practices
    were added.
  • The 2009 Safe Practices chosen for hospitals to
    report on are those that have the strongest
    supporting evidence and are not measured in other
    sections of the survey
  • The 2009 Safe Practices section focuses on 17 of
    the 31 non-Leapfrog-created Safe Practices - this
    includes the splitting of Safe Practice 1 into 4
    Practices, and the addition of the Safe Practice
    for Urinary Tract Infections.
  • The Safe Practices have kept the 4A framework,
    but have been updated wording to reflect changes
    in the 2009 report.
  • A total of 737 points are available for the Safe
    Practices Score.
  • Page number references to the 2009 Updated Safe
    Practices are included in the survey to assist
    users in both understanding the practice and in
    accessing the evidence in support of the
    practice.

22
Safe Practices 2009
  • Basic design of survey ( 4 As) remains the same
  • Awareness
  • Accountability
  • Ability
  • Action
  • Changes to the content
  • Updates to existing measures in alignment with
    new report
  • Individual practice weighting remains the same as
    2008, except for splitting SP 1 into four
    sections and UTI which now brings overall score
    to 737

23
17 Safe Practices
24
Hospital-Acquired Conditions--CLABSI
  • New condition added to the hospital-acquired
    conditions
  • This survey cycle measures hospital-acquired
    pressure ulcers and hospital-acquired injuries
    (burns, falls, etc.) and has added
    Catheter-associated Blood Stream Infections
    (CLABSI)
  • CLABSI Results will be reported as a rate per
    central line days
  • CLABSI endorsed measurealigned with CDC
    reporting
  • This condition can be identified by hospitals
    using the same protocol that CDC is using, but
    excluding the symptom only cases
  • Hospitals will need to rely on laboratory
    confirmed cases

25
Common Acute Conditions Normal Deliveries
  • New condition added to the 2008 surveys two
    common acute conditions -- Acute Myocardial
    Infarction (AMI) and Pneumonianew section is on
    Normal Deliveries
  • Three of the Normal Delivery measures for these
    conditions are endorsed by the National Quality
    Forum (NQF) the fourth is still in review
  • Elective Deliveries between 37 completed weeks
    and 39 completed weeks
  • Elective, low-risk C-Sections
  • DVT prophylaxis for Cesarean Sections
  • Bilirubin Screening
  • Scoring thresholds for the measures are set based
    on historical national data and published
    research

26
Evidence Based Hospital Referral (EBHR) 2009
Changes
  • Additional statewide and regional public
    risk-adjusted mortality outcomes recognized
  • Michigan BC/BS Cardiovascular Consortium (BMC2)
    for PCI
  • Survival predictor released for CABG, PCI, AAA,
    AVR when risk-adjusted results unavailable.

27
EBHR Survival Predictors Added
  • No additional questions from last year
  • Survival predictorbased on volume and
    non-adjusted in-hospital deaths--a composite
    measure that predicts future hospital performance
    on mortality
  • Takes into account number of cases via weightsso
    that reliability related to small numbers is
    assured
  • DevelopersDrs. Justin Dimick and John Birkmeyer,
    U.Mich Medical School, Doug Staiger from
    Dartmouth
  • Reported as independent score on consumer pages
  • White paper available on LF website
  • http//www.leapfroggroup.org/media/file/SurvivalPr
    edictorWhitepaper.pdf

28
Questions?
29
Dates of Town Hall Specialty Calls
  • Check survey home page for dates and times
  • CPOE Evaluation Tool
  • Administrative Data How to Use for Answering LF
    Hospital Survey questions
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