WELCOME TO NACHRIS THE WHAT, WHY AND HOW OF BENCHMARKING BREAKFAST October 10, 2006 Boston Massachus

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WELCOME TO NACHRISTHE WHAT, WHY AND HOW OF
BENCHMARKING BREAKFASTOctober 10, 2006Boston
Massachusetts
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• BENCHMARKING
• INTERSECTION OF
• QUALITY AND DATA

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QUALITY VISION

• Childrens hospitals will achieve dramatic and
  sustainable improvement in delivering .care.
• Improvement will be demonstrated by .
  enhanced clinical outcomes, .care experiences
  and quality of life for children . value
  provided .

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QUALITY AND PATIENT SAFETY

• To facilitate dramatic and sustained
  improvement, NACHRI will
• Advocate so that national quality and patient
  safety initiatives address the needs of children
  and childrens hospitals.
• Build measurement capacity so that meaningful and
  reliable measure sets are available to assess and
  improve the quality and safety of childrens
  health care.
• Create programs and alliances to support
  childrens hospitals as leaders in transforming
  health care.

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QUALITY AND PATIENT SAFETY

• ADVOCACY EFFORTS
• Government Agencies
• -- Agency for Health Care Research and Quality
  -- Center for Medicare and Medicaid Services
• -- American Health Information Community
• Private/Industry Efforts
• -- National Quality Forum (NQF)
• -- Hospital Quality Alliance (HQA)
• Legislative
• Collaboration

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• Alliance for Pediatric Quality
• An Overview

August 28, 2006
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What is the Alliance?
A collaboration of four major national pediatric
organizations formed to measurably improve the
quality of health care for Americas children.
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Vision

• Every child will have the opportunity to grow
  up healthy, supported by a health care system
  where care is safe, effective, patient-centered,
  timely, efficient, equitable and based on the
  best possible science and technology.

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Goals

• 1. Promote the use of meaningful pediatric
  measures industry wide.
• The Alliance will accelerate the
  identification and use of measures by the
  pediatric community that will best drive change
  in the quality of health care for children. It
  will also define those measures that should
  emerge as measures of accountability for
  pediatrics.
• 2. Make sure health information technology works
  for kids.
• The Alliance will bring together multiple
  technology organizations and individuals to
  create one pathway for ensuring the adoption of
  pediatric data standards that work across all
  care settings.

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Strategies

• Work for consensus speak with one voice on
  behalf of children
• Endorse and promote projects that advance
  pediatric quality and health information
  technology in childrens health care
• Convene stakeholders
• Advocate in media and legislature

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QUALITY ANDPATIENT SAFETY

• MEASUREMENT EFFORTS
• JCAH0
• Pediatric Data Quality Systems (PEDi-Qs)
• Pediatric Quality Indicator Collaborative

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QUALITY ANDPATIENT SAFETY

• FACILITATING TRANSFORMATION EFFORTS
• Learning from the Leaders
• Eradicating Catheter Associated Blood Stream
  Infections in the PICU (CA-BSI Initiative)

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CA-BSI INITIATIVE

• Create a sustainable collaborative network
  that educates, empowers and strengthens the
  patient safety culture and improves the outcomes
  of children in more than 300 PICUs.

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CA-BSI INITIATIVE

• Co-Chaired by
• Richard Brilli, MD
• Marlene Miller, MD
• 29 Participating PICUs
• FOCUS on
• Insertion Practice
• Maintenance Practice
• Sustained Cultural Change
• Supported by
• American Board of Pediatrics Foundation

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• BENCHMARKING
• INTERSECTION OF
• QUALITY AND DATA

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DATA STRATEGIES

• Robust, credible and reliable data are available
  to support and represent childrens hospital
• Members are knowledgeable of data resources, able
  to submit and access data easily, and apply it to
  support decisions and advocacy efforts
• NACHRI will be an indispensable source for data
  and applied research that benefits macro level
  changes in childrens hospitals and child health
  care

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DATA STRATEGIES

• Robust, Credible Data
• Increase data submission to major
  institution-wide databases
• Rigorous data definition and quality standards

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DATA STRATEGIES

• Robust, credible and reliable data are available
  to support and represent childrens hospital
• Members are knowledgeable of data resources, able
  to submit and access data easily, and apply it to
  support decisions and advocacy efforts
• NACHRI will be an indispensable source for data
  and applied research that benefits macro level
  changes in childrens hospitals and child health
  care

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DATA STRATEGIES

• Indispensable source for data and applied
  research
• Support for the collective good
• -- CHGME
• -- Quality Indicator Assessment
• -- Measurement Development
• -- Advocacy for Medicaid
• -- APR-DRG development

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DATA STRATEGIES

• Robust, credible and reliable data are available
  to support and represent childrens hospital
• Members are knowledgeable of data resources, able
  to submit and access data easily, and apply it to
  support decisions and advocacy efforts
• NACHRI will be an indispensable source for data
  and applied research that benefits macro level
  changes in childrens hospitals and child health
  care

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DATA STRATEGIES

• Members Readily Access and Apply Data
• -- Web Enabling
• -- Increased Application Supports
• -- Education on and Demonstration of
• Data Utility

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NACHRI Benchmark Tools

• Annual Survey on Utilization and Financial
  Indicators of Childrens Hospitals
• Case Mix
• Clinical Productivity and Staffing Program (CPSP)
• Ambulatory Services Productivity System
• VPS
• FOCUS Groups

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Annual Survey on Utilization and Financial
Indicators

• 5 years of benchmark reporting on over 85
  financial, operating and utilization measures
  across135 hospitals
• Access to reports is part of NACHRI membership
• Member querying/reporting and standard reports
  available at https//benchmark.nachri.org

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Participation Fees

• The NACHRI annual membership fee does not cover
  participation in the MIS Comparative Data
  (Benchmarking) or FOCUS Group Programs
• Due to the unique needs of each member and the
  unique resources required to operate each MIS
  product offering, participation fees in these
  programs are independent of membership dues.
  This voluntary participation-based fee structure
  maximizes NACHRI membership and minimizes overall
  membership dues.

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Participation Fees by Product
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Case Mix Program-- Details --

• 77 NACHRI members currently contributing
• Stores 3 million records from 2000-2006 (Q2)
• Data warehouse vendor Solucient
• Data comes from UB-92 billing elements
• ICD-9-CM Dx and Px Codes, LOS, Charges, etc.
• Access to indicators such as
• Case Volume
• Average Length of Stay (ALOS)
• Case Mix Index (CMI) APR-DRG
• CMI and Wage Adj Charges per Case or Day
• Estimated Costs
• Mortality
• Payor (e.g. Medicaid)

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Case Mix Program -- Benefits --

• Annual Report (Released in June each year)
• Hospital-Specific Reports include Executive
  Summary and detailed reports by MDC, APR-DRG and
  APR-DRG Severity
• ORYX quality measures
• Enables members to identify quality of care and
  cost savings improvement opportunities
• Example
• Cardinal Glennon Benchmarked their pediatric
  readmissions during pursuit of the Malcolm
  Baldrige Award
• Childrens Hospital Graduate Medical Education
  (CHGME) Application CMI
• Provides custom ad-hoc reports
• Web-based access to ad-hoc reports

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Case Mix ProgramDepartmental Costs-- Benefits
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• Facilitates critical pathway design, benchmark
  development, and changes in hospital service
  delivery through identification of practice
  costs.
• Cost variances are identified from the aggregate
  of peers by APR-DRG, major diagnostic categories
  (MDC) and the entire patient population
• High or low variances from peers are identified
  by specific diagnoses at the department level.
  This data is crucial to affect key departmental
  management decisions
• Only inliers are presented to remove the
  possibility of skewing the summary level results

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Clinical Productivity and Staffing Program (CPSP)

• Inpatient Units
• Currently contains four (4) years of clinical
  staff productivity data for 22 inpatient units
  for over 50 hospitals
• Offers seven (7) executive and management-level
  productivity indicator reports containing such
  statistics as
• Budgeted hours of care, including activity based,
  worked, and paid hours by Units
• Staffing hours in relation to census, length of
  stay, and patient characteristics by Hospitals
  and Units
• Total patients treated and unit utilization by
  patient type (e.g. inpatients, observation
  patients, and other patients with a roll-up for
  all patients seen on unit for reporting period.)
• Outpatient Clinics
• Provides information at the clinic level for
  tracking, trending, managing, and benchmarking
• Direct Clinic Hours and Time by Staff Category
• Productivity by Selected Position direct clinic
  hours, total worked hours, and the ratio of
  direct to worked hours
• Clinic specific reports total visits, new
  visits, follow-up visits, average visits per hour
  and daily visits per room

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FOCUS Groups

• Since 1994, NACHRI has provided an organized
  effort to improve the quality of care provided to
  children through its FOCUS Group Initiatives. 
• FOCUS Groups are performance-measurement and
  continuous-improvement groups aligned through
  topic-specific clinical-practice/service areas.
• Interdisciplinary teams represent the hospitals
  within each of the groups (ambulatory,
  oncology/BMT, Pediatric Intensive Care Units and
  ED). 
• Generally, there are 8-20 hospitals in a FOCUS
  Group. 
• Hospitals come together for three 2-day meetings
  and multiple conference calls to accomplish their
  work over the course of one year. 

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FOCUS Groups

• The groups are designed to
• Improve quality and streamline operations
• Benchmark strategic areas of importance using
  rapid learning, implementation and evaluation
• Evaluate evidence-based practice
• Design/complete multi-institutional research
  projects evaluating prior outcomes and/or
  addressing current practice issues
• Identify key implementation strategies and
  incorporate them into the education of all
• Document their work in outcomes which are
  shared with NACHRI hospitals
• 2006 FOCUS Groups 
• Ambulatory
• Emergency
• PICU
• Oncology/BMT

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FOCUS Group Quick Facts

• 43 interdisciplinary teams participating in 4
  FOCUS Groups in 2006.
• Each FOCUS Group is facilitated by a team of
  clinical experts to assist with identification
  and evaluation of areas for strategic/operating
  importance.
• Heavy emphasis is placed on implementation and
  measurement of the hospitals performance
  improvement opportunities.

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Bridging the PICU Continuum of Research ?
Quality Improvement ? Management
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The VPS, LLC Partners

• A partnership between NACHRI, Childrens Hospital
  Los Angeles, and the Childrens Hospital of
  Wisconsin in Milwaukie
• Expanse of data elements covering the complete
  continuity of care from PICU admission through
  discharge, including severity of illness
  indicators
• Standardized comparative clinical dataset of over
  100,000 cases and 66 participating sites

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Requirements for Quality Pediatric Critical Care

• Means of managing administrative requirements of
  PICUs
• Ability to trend internal quality indicators
• Ability to benchmark quality indicators against
  both peers and national cohort of PICUs
• Tools for multi-site research
• Method of tracking physician and trainees skills
• Outcomes analysis
• Standing Research Committee for peer review of
  proposals

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Cyber Center Demos

• Please visit the NACHRI Cyber Center for more
  demonstrations and more details on each program