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REDUCING PREVENTATIVE HARM
THROUGH TRANSPARENCY:
KEY QUALITY INITIATIVES TO IMPROVE
HOSPITAL PATIENT SAFETY RATINGS
Presented By Roshni Bag
B.S. Healthcare Management and Policy
Class of 2017
Thesis Presentation Outline
•  Patient Safety Overview
•  Measuring Patient Safety
•  Transparency + Patient Safety Information
•  CMS* Quality Initiative: Hospital Compare
•  Analyzing the relative importance of certain
measures
•  Interpret findings
•  Discuss significance of results
•  Take-aways
*Centers for Medicare and Medicaid Services
Overview
•  What is patient safety?
•  My motivation
Patient
Safety
Mortality
Readmission
Patient
Experience
Safety of
Care
Measuring Harm
Understanding
Causes
Identifying
Solutions
Evaluating
Impact
Translating
Evidence Into
Safer Care
The Importance of Patient Safety
• “To Err is Human”
•  ~98,000 people die in any given year from medical errors occurring in
hospitals
• Hospital care associated with medical errors
in 2009 was $4.4 billion
• Focusing on quality increases the likelihood of
desired health outcomes
Measuring and Sharing Patient Safety Data
•  Quantification of Patient Safety
•  Agency for Healthcare Research and Quality (AHRQ) and Centers of
Medicare and Medicaid Services (CMS)
• Structure: Ratio of providers/patients
• Process: % of people receiving preventative services
• Outcome: Surgical mortality rate
•  Government-mandated reporting
•  Transition to “Value-Based Payments”
•  Hospital Report Cards
•  Promotes transparency
•  Consumer power
•  Increases accountability of providers
CMS Quality Initiative: Hospital Compare
•  Reports data for over 100 quality measures for over
4,000 hospitals across the country
•  July 2016- “5-star rating” system introduced
Readmissions/Mortality
Safety of Care (Complications)
Patient Experience
*Obtained using HCAHPS
(Hospital Consumer Assessment
of Healthcare Providers and
Systems)
Hospitals in the United States
Obtained using “Target Map”
Medicare’s Hospital Compare Methodology
1.  Measures selected
2.  Measurements assigned to one of 7 groups
3.  “Group score” attained
4.  Hospital summary score calculated
5.  Summary scores à star rankings
Criticism
Criticism from major hospital groups
Objective
[Thesis objective]
[Research implications]
Patient
Safety
Mortality
Readmiss
ion
Patient
Experien
ce
Safety of
Care
Thesis Analysis
Analysis Methodology
Examine ~4,000 hospitals with overall CMS star rating
Compare individual measurement in each group for each of the ~4,000
hospital
Correlate all hospital scores from each measurement with overall
performance score
Find correlation coefficient for each measurement
Evaluate individual measurement versus group measurements
Evaluate “outlier” measurements [Grubbs’ test]
Results: Magnitude of Correlation Coefficients for All Measures
Patient Experience Measures
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
AcuteMyocardial
CoronaryArteryBypass
ChronicObstructive
HeartFailure(HF)30-Day
Pneumonia(PN)30-Day
AcuteIschemicStroke
AcuteMyocardial
CoronaryArteryBypass
ChronicObstructive
HeartFailure(HF)30-Day
Hospital-Level30-DayAll-
HWRHospital-WideAll-
Pneumonia(PN)30-Day
Stroke(STK)30-Day
Central-LineAssociated
Catheter-Associated
SurgicalSiteInfection
SurgicalSiteInfection
NurseCommunication
DoctorCommunication
Responsivenessof
Painmanagement
CommunicationAbout
CleanlinessofHospital
DischargeInformation
OverallRatingof
CorrelationCoefficients
Results: Average Correlation Magnitude of Each Group
Patient Experience measures as a whole had ~3x higher correlation
coefficients than mortality or readmission measures
Results: Measures plotted against correlation coefficients
Significant Measure in Group
Limitations
•  Limitations in original CMS methodology
•  Discrepancy in hospital reporting
•  Not all measures evaluated in analysis
•  Correlation does not equal causation
•  Extrapolating ratings to overall hospital quality
Take-aways
•  Greater attention to Acute Myocardial Infarction
Readmissions and Catheter-Associated Urinary Tract
Infections
•  HCAHP* Scores have high correlation with overall
ranking
•  Mortality and Readmission have much lower
correlation; indicative of risk adjustment efforts?
•  BUT this measurement category has reporting discrepancies
*HCAHPS (Hospital Consumer Assessment of Healthcare Providers & Systems), used to evaluate “Patient Experience”
Recommendations
•  Emphasis on hospital culture and patient experience
•  Higher HCAHPS response rates
•  Fully share methodology to allow performance scores to
be replicated
•  Comparisons between different hospital types /
adjustments to lessen scoring bias towards more complex
hospital
•  Proliferation of ranking systems might dilute intended
impact- standardize
Acknowledgements
Faculty Mentor: Professor Mark Norrell

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Roshni Bag Thesis Presentation

  • 1. REDUCING PREVENTATIVE HARM THROUGH TRANSPARENCY: KEY QUALITY INITIATIVES TO IMPROVE HOSPITAL PATIENT SAFETY RATINGS Presented By Roshni Bag B.S. Healthcare Management and Policy Class of 2017
  • 2. Thesis Presentation Outline •  Patient Safety Overview •  Measuring Patient Safety •  Transparency + Patient Safety Information •  CMS* Quality Initiative: Hospital Compare •  Analyzing the relative importance of certain measures •  Interpret findings •  Discuss significance of results •  Take-aways *Centers for Medicare and Medicaid Services
  • 3. Overview •  What is patient safety? •  My motivation Patient Safety Mortality Readmission Patient Experience Safety of Care Measuring Harm Understanding Causes Identifying Solutions Evaluating Impact Translating Evidence Into Safer Care
  • 4. The Importance of Patient Safety • “To Err is Human” •  ~98,000 people die in any given year from medical errors occurring in hospitals • Hospital care associated with medical errors in 2009 was $4.4 billion • Focusing on quality increases the likelihood of desired health outcomes
  • 5. Measuring and Sharing Patient Safety Data •  Quantification of Patient Safety •  Agency for Healthcare Research and Quality (AHRQ) and Centers of Medicare and Medicaid Services (CMS) • Structure: Ratio of providers/patients • Process: % of people receiving preventative services • Outcome: Surgical mortality rate •  Government-mandated reporting •  Transition to “Value-Based Payments” •  Hospital Report Cards •  Promotes transparency •  Consumer power •  Increases accountability of providers
  • 6. CMS Quality Initiative: Hospital Compare •  Reports data for over 100 quality measures for over 4,000 hospitals across the country •  July 2016- “5-star rating” system introduced
  • 8. Safety of Care (Complications)
  • 9. Patient Experience *Obtained using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
  • 10. Hospitals in the United States Obtained using “Target Map”
  • 11. Medicare’s Hospital Compare Methodology 1.  Measures selected 2.  Measurements assigned to one of 7 groups 3.  “Group score” attained 4.  Hospital summary score calculated 5.  Summary scores à star rankings
  • 13. Criticism from major hospital groups
  • 17. Analysis Methodology Examine ~4,000 hospitals with overall CMS star rating Compare individual measurement in each group for each of the ~4,000 hospital Correlate all hospital scores from each measurement with overall performance score Find correlation coefficient for each measurement Evaluate individual measurement versus group measurements Evaluate “outlier” measurements [Grubbs’ test]
  • 18. Results: Magnitude of Correlation Coefficients for All Measures Patient Experience Measures 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 AcuteMyocardial CoronaryArteryBypass ChronicObstructive HeartFailure(HF)30-Day Pneumonia(PN)30-Day AcuteIschemicStroke AcuteMyocardial CoronaryArteryBypass ChronicObstructive HeartFailure(HF)30-Day Hospital-Level30-DayAll- HWRHospital-WideAll- Pneumonia(PN)30-Day Stroke(STK)30-Day Central-LineAssociated Catheter-Associated SurgicalSiteInfection SurgicalSiteInfection NurseCommunication DoctorCommunication Responsivenessof Painmanagement CommunicationAbout CleanlinessofHospital DischargeInformation OverallRatingof CorrelationCoefficients
  • 19. Results: Average Correlation Magnitude of Each Group Patient Experience measures as a whole had ~3x higher correlation coefficients than mortality or readmission measures
  • 20. Results: Measures plotted against correlation coefficients Significant Measure in Group
  • 21. Limitations •  Limitations in original CMS methodology •  Discrepancy in hospital reporting •  Not all measures evaluated in analysis •  Correlation does not equal causation •  Extrapolating ratings to overall hospital quality
  • 22. Take-aways •  Greater attention to Acute Myocardial Infarction Readmissions and Catheter-Associated Urinary Tract Infections •  HCAHP* Scores have high correlation with overall ranking •  Mortality and Readmission have much lower correlation; indicative of risk adjustment efforts? •  BUT this measurement category has reporting discrepancies *HCAHPS (Hospital Consumer Assessment of Healthcare Providers & Systems), used to evaluate “Patient Experience”
  • 23. Recommendations •  Emphasis on hospital culture and patient experience •  Higher HCAHPS response rates •  Fully share methodology to allow performance scores to be replicated •  Comparisons between different hospital types / adjustments to lessen scoring bias towards more complex hospital •  Proliferation of ranking systems might dilute intended impact- standardize