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  1. 1. Hospital Quality Alliance Meeting Summary: September 18, 2007
  2. 2. Attendees <ul><li>AARP </li></ul><ul><li>AFL-CIO </li></ul><ul><li>Agency for Healthcare Research and Quality </li></ul><ul><li>American Hospital Association </li></ul><ul><li>American Medical Association </li></ul><ul><li>American Nurses Association </li></ul><ul><li>Association of American Medical Colleges </li></ul><ul><li>Blue Cross/Blue Shield Association </li></ul><ul><li>Centers for Medicare and Medicaid Services </li></ul><ul><li>Consumer-Purchaser Disclosure Project </li></ul><ul><li>Federation of American Hospitals </li></ul><ul><li>The Joint Commission </li></ul><ul><li>National Association of Children’s Hospitals and Related Institutions </li></ul><ul><li>National Association of Public Hospitals and Health Systems </li></ul><ul><li>National Business Coalition on Health </li></ul><ul><li>National Quality Forum </li></ul><ul><li>Quality Alliance Steering Committee </li></ul><ul><li>US Chamber of Commerce </li></ul><ul><li>Wisconsin Collaborative for Healthcare Quality (via phone) </li></ul>
  3. 3. Meeting Agenda <ul><li>Improving Usefulness of Mortality Data </li></ul><ul><li>Update on Measurement Pipeline </li></ul><ul><ul><li>Outpatient Measures </li></ul></ul><ul><li>Implementation of Pediatric Asthma Measures </li></ul><ul><li>Hospital-CAHPS </li></ul>
  4. 4. Characteristics of Mortality Measures <ul><li>Risk-Standardized Mortality Rates for AMI and Heart Failure </li></ul><ul><ul><li>Risk-adjusted </li></ul></ul><ul><ul><li>Use hierarchical generalized linear model </li></ul></ul><ul><ul><li>Presented with 95% “interval estimate” </li></ul></ul><ul><li>Aligned with American Heart Association/American College of Cardiology </li></ul><ul><li>Endorsed by National Quality Forum; Adopted by HQA </li></ul><ul><li>Hospital performance is categorized: </li></ul><ul><ul><li>No different than U.S. national rate </li></ul></ul><ul><ul><li>Better than U.S. national rate </li></ul></ul><ul><ul><li>Worse than U.S. national rate </li></ul></ul><ul><li>Assesses hospital performances as a whole and drives national distribution toward lower mortality rates </li></ul>
  5. 5. AMI Underlying Risk Standardized Mortality Rates: (RSMRs): 2005 - 2006 <ul><li>There is variation; about 13% from Low to High </li></ul>4,477 36,477 222,171 10.8%-24.0% 16.4% Total # Hospitals Total # Deaths Total # Patients Range of RSMR US National Rate Select Percentiles and Corresponding RSMR Values 13.4%-18.8% 5 th to 95 th percentile 14.0%-18.2% 10 th to 90 th percentile 15.0%-17.2% 25 th to 75 th percentile
  6. 6. HF Underlying Risk Standardized Mortality Rates: (RSMRs): 2005 - 2006 <ul><li>There is variation; more than 10% from Low to High </li></ul>4,807 47,170 423,294 6.7%-17.3% 11.1% Total # Hospitals Total # Deaths Total # Patients Range of RSMR US National Rate Select Percentiles and Corresponding RSMR Values 8.9%-13.4% 5 th to 95 th percentile 9.3%-12.8% 10 th to 90 th percentile 10.0%-11.8% 25 th to 75 th percentile
  7. 7. Next Steps: Mortality Measures <ul><li>Pneumonia 30-day mortality will be added to Hospital Compare in Summer 2008 </li></ul><ul><li>Improving the display of mortality information will be explored </li></ul><ul><li>The HQA will offer potential options to enhance display for consideration at the December 2007 meeting </li></ul>
  8. 8. Hospital Outpatient Reporting Program <ul><li>The measure workgroup recommends the Hospital Quality Alliance adopt the following ten measures </li></ul><ul><ul><li>Emergency Department (ED) AMI Transfer Measures </li></ul></ul><ul><ul><ul><li>1) ED Aspirin at Arrival </li></ul></ul></ul><ul><ul><ul><li>2) ED Median Time to Fibrinolysis </li></ul></ul></ul><ul><ul><ul><li>3) ED Fibrinolytic Therapy Received Within 30 Minutes of Arrival </li></ul></ul></ul><ul><ul><ul><li>4) ED Median Time to ECG </li></ul></ul></ul><ul><ul><ul><li>5) ED Median Time to Transfer for Primary PCI </li></ul></ul></ul><ul><ul><li>Heart Failure </li></ul></ul><ul><ul><ul><li>6) ACE or ARB for LVSD </li></ul></ul></ul><ul><ul><li>Perioperative Care </li></ul></ul><ul><ul><ul><li>7) Timing of Antibiotic Prophylaxis </li></ul></ul></ul><ul><ul><ul><li>8) Selection of Prophylactic Antibiotic – First or Second Generation Cephalosporin </li></ul></ul></ul><ul><ul><li>Pneumonia </li></ul></ul><ul><ul><ul><li>9) Empiric Antibiotic for Community Acquired Pneumonia </li></ul></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><ul><li>10) Hemoglobin A1c Poor Control in type 1 or 2 Diabetes Mellitus </li></ul></ul></ul><ul><li>Contingent on: </li></ul><ul><ul><li>NQF endorsement </li></ul></ul><ul><ul><li>further field testing and </li></ul></ul><ul><ul><li>establishment of adequate infrastructure to support data collection </li></ul></ul><ul><li>If any of these conditions are not resolved, the HQA reserves the ability to withdraw its support of any of these measures </li></ul>
  9. 9. Pediatric Asthma Measures <ul><li>Because CMS could pay for pediatric services under Medicare, it is allowable for CMS, through the QIO program, to engage in activities that promote quality improvement in pediatric medicine by means of public reporting </li></ul><ul><li>The Joint Commission has indicated preliminary willingness to send to CMS a hospital-level file that includes Medicare Provider Number, measure rate, denominator and any relevant footnotes or other data that are necessary in order for the Children’s Asthma Care (CAC) measures to be posted on Hospital Compare </li></ul><ul><li>For the moment and using this approach, only Joint Commission-accredited hospitals will be reported on Hospital Compare </li></ul>
  10. 10. Next Steps: Pediatric Asthma Measures <ul><li>Better understand the financial resources and the time required to make accomplish the following: </li></ul><ul><ul><li>Posting pediatric asthma measures (Joint Commission data only) on Hospital Compare </li></ul></ul><ul><ul><li>Adapting the CART tool </li></ul></ul><ul><ul><li>Enabling the capacity of the Iowa data warehouse to accept the data </li></ul></ul><ul><li>CMS will provide resources estimates as soon as possible </li></ul><ul><li>HQA partners will encourage hospitals to report pediatric asthma measures </li></ul>
  11. 11. Hospital-CAHPS (HCAHPS) ® <ul><li>27 question survey of patient experience with hospital care </li></ul><ul><li>Six Composite Measures </li></ul><ul><ul><li>Nurse Communication </li></ul></ul><ul><ul><li>Doctor Communication </li></ul></ul><ul><ul><li>Responsiveness of Hospital Staff </li></ul></ul><ul><ul><li>Pain Control </li></ul></ul><ul><ul><li>Communication about Medication </li></ul></ul><ul><ul><li>Discharge Information </li></ul></ul><ul><li>Four individual items </li></ul><ul><ul><li>Cleanliness of Hospital Environment </li></ul></ul><ul><ul><li>Quietness of Hospital Environment </li></ul></ul><ul><ul><li>Overall Rating of Hospital </li></ul></ul><ul><ul><li>Recommend Hospital </li></ul></ul><ul><li>Adjusted for patient characteristic and mode of administration </li></ul><ul><li>HCAHPS data collection and reporting is linked to annual payment update </li></ul><ul><li>Information will be posted on Hospital Compare in March 2008 </li></ul>
  12. 12. HCAHPS – Display (DRAFT)
  13. 13. Next Steps: HCAHPS ® <ul><li>Resolve some of the remaining display challenges, including: </li></ul><ul><ul><li>How to help consumers navigate the website </li></ul></ul><ul><ul><li>Quickly distinguish between data from patients and data about clinical conditions </li></ul></ul><ul><ul><li>How to display results for easy comparison </li></ul></ul><ul><ul><li>How to allow for easy drill down to details </li></ul></ul><ul><li>Determine at what level will the data be available for download from Hospital Compare </li></ul><ul><li>Develop “rules” or guidelines for secondary uses of the data </li></ul><ul><li>Develop comprehensive communication and media strategy for March 2008 roll out. </li></ul>
  14. 14. Public Comment <ul><li>Remarks centered on the following issues: </li></ul><ul><ul><li>Janet Heinrich ~ Health Policy R&D </li></ul></ul><ul><ul><ul><li>Measures of medication safety should be a priority </li></ul></ul></ul><ul><ul><li>Ellen Kurtzman ~ George Washington University </li></ul></ul><ul><ul><ul><li>Measurement and reporting of nursing quality is critically important </li></ul></ul></ul><ul><ul><li>Karen Linscott ~ Leapfrog Group </li></ul></ul><ul><ul><ul><li>Expedited movement of measures through the endorsement and HQA adoption process </li></ul></ul></ul>
  15. 15. Other Meeting Decisions & Outcomes <ul><li>The HQA Principals: </li></ul><ul><ul><li>Empowered Rich Umbdenstock to represent the HQA on the National Quality Forum’s Priority Partners </li></ul></ul><ul><ul><li>Tasked staff to develop potential priorities for measurement and reported to be considered at the December meeting </li></ul></ul><ul><ul><li>Directed the staff workgroup to monitor new developments and explore possible mechanisms that could enable all-payer, claims-based measures to be implemented on a national basis </li></ul></ul><ul><ul><li>Approved the recommendations of the Membership Sub-committee </li></ul></ul>
  16. 16. Principal Organizations
  17. 17. For Additional Information <ul><li>Katherine Browne </li></ul><ul><li>202.828.0549 </li></ul><ul><li>[email_address] </li></ul><ul><li>Hospital Quality Alliance: </li></ul><ul><li>Hospital Compare: </li></ul>