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

What’s New in 2009: The Leapfrog
Hospital Survey
Survey Townhall Calls
April 15, 2009
April 21, 2009
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May 1, 2009
Town Hall Call Overview
• Introduction
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Survey Team
Where to locate slides
Leapfrog and the Hospital Survey—why complete?
Goals for 2009 survey
• Survey Submission Logistics/Timeline/Website Resources
• What’s 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
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Why Complete Leapfrog Survey?
Unique in the Milieu
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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 measures—structural, process and outcome
(but focused on outcome)
Regional and national in scope—all payer information
Standardized measures to assure “same fruit” is sampled
Harmonized with other major national performance
measurement programs—but shows more complete picture
of care delivery
Significant hospital input on survey revisions
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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.
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Behind the Changes in 2009
Goals for the new survey—
1. Look for opportunities to streamline survey—
reduce burden
2. Update language in Safe Practices to address
maintenance by NQF
3. Continue to support CMS initiatives (HACs)
4. Align with other performance measurement groups
5. Provide normal delivery measures to address area
of care that is important to consumers and
purchasers
6. Maintain measures included in Leapfrog’s Pay for
Performance program
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How did we do?
• Maintained burden below the 2007 Survey pages—
now 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 collections—lowering burden—but
providing full picture of care
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Survey Submission Logistics, Timeline,
Website Resources
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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?”
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Survey Helpdesk Available
• Survey Helpdesk—designed 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.
• Don’t 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
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2009 Timeline
• April 2, 2009 -- Leapfrog launched 2009
Survey
• June 30, 2009 -- RRO-targeted hospitals
report or be listed on Leapfrog’s 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 midSeptember
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Website Resources
To assist hospitals in completing the Survey, Leapfrog
makes the following tools available:
– Frequently Asked Questions
– Overview of “What’s 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 HospitalAcquired Conditions
– Link to purchase NQF’s Safe Practices for Better Healthcare:
2009 Update report
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Website Resources for EBHR
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Medical Coding for High-Risk Procedures and Conditions
Procedure code, diagnosis codes and other specifications for counting high-risk surgery
volumes
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Publicly Reported Outcomes for CABG and PCI
For 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).
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Process Measures -- Specifications
Detailed specifications for Leapfrog’s procedure-specific process measures of quality -- for
CABG, PCI, AAA Repair, and high-risk deliveries.
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Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s 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
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Excel Tool for Computing Geometric Mean Length of Stay
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Website Resources for Common Acute
Conditions (CAC)
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Volume Standard Coding: Medical Coding for Chronic Acute Conditions
Procedure/diagnosis codes and other specifications for counting AMI and Pneumonia
volume
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Process Measures - Specifications
Specifications for Leapfrog’s nationally-endorsed condition-specific process measures of
quality -- for AMI, Pneumonia, and Normal Deliveries.
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Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s Common Acute Conditions (AMI and Pneumonia) –
including:
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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
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Excel Tool for Computing Geometric Mean Length of Stay
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Outcome Measures for Normal Deliveries
– Coding for counting eligible cases (denominator)
– Criteria for determining numerator
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What’s New for 2009
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Survey Changes: The Details
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Computerized Prescriber Order Entry (CPOE)
Evaluation Tool—instruction updates requiring
completion of sample test; scoring from test
incorporated into public results.
Updated Safe Practices
Hospital-Acquired Conditions – addition of Catheterassociated Blood Stream Infections
Common Acute Conditions – Addition of Normal
Deliveries
Evidence Based Hospital Referral Changes
a. Survival Predictor for CABG, PCI, AAA, AVR
b. Public Reporting Additions
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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 Q1=YES). 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.
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• Same security code as survey.
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);
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pediatric test for children’s hospital
CPOE Evaluation – Scored Results, Sample
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CPOE Evaluation – Scored Results,
Sample (cont’d)
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Feedback on CPOE Evaluation Tool
“No question—this is a valuable
experience—it is very important work
and it should be applauded.”
David Stockwell, Patient Safety Officer
Children’s National Medical Center
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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 nonLeapfrog-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.
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Safe Practices 2009
• Basic design of survey ( 4 A’s) 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
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17 Safe Practices
Weighting
(pts)
Safe Practice
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12
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25
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Leadership Structures and Systems
Culture Measurement for Performance
Teamwork Training and Skill Building
Identification and Mitigation of Risks and Hazards
Informed Consent
Life Sustaining Treatment
Nursing Workforce
Communication of Critical Information
Labeling of Diagnostic Studies
Discharge Systems
Medication Reconciliation
Hand Hygiene
a
Central Venous Catheter Related Bloodstream Infection Prevention
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Prevention of Aspiration and Ventilator Associated Pneumonia
b
Catheter Associated Urinary Tract Infection Prevention
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DVT/VTE Prevention
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Anticoagulation Therapy
GRAND TOTAL
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120
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120
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100
84
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30
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737
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 measure—aligned 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
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Common Acute Conditions: Normal
Deliveries
• New condition added to the 2008 survey’s two
common acute conditions -- Acute Myocardial
Infarction (AMI) and Pneumonia—new 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
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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.
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EBHR: Survival Predictors Added
• No additional questions from last year
• “Survival predictor”—based on volume and nonadjusted in-hospital deaths--a composite measure
that predicts future hospital performance on mortality
• Takes into account number of cases via weights—so
that reliability related to small numbers is assured
• Developers—Drs. 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/SurvivalPredictorWhitepaper.pdf
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Questions?
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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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