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Hospital Measures Reporting in OhioMichele Shipp, MD, DrPH
AHRQ QUALITY INDICATORS USERS MEETINGWednesday September 9, 2008
AHRQ ANNUAL CONFERENCE 2008
Selecting Indicators for Public Reporting:The Ohio Experience
Hospital Performance Measures Selection
Ohio Department of Health
Alvin Jackson, MD
Madelyn Dile, JD
Jodi Govern, JD
Kaliyah Shaheen, MPH
BACKGROUND
HOUSEBILL 197
HB 197 became law in November 2006Requires Ohio hospitals to report performance measure data to the Ohio Department of Health for the purpose of public reporting
HOUSEBILL 197
Required Measure Sets Centers for Medicare and Medicaid Services
(CMS) The Joint Commission (JC) National Quality Forum (NQF) endorsed
measures Agency for Healthcare Research and Quality
(AHRQ)
Creation of Advisory Council
A Hospital Measures Advisory Council was created by statute and consisted of: Director of Health (Council Chair) Two members of the House of
Representatives Two members of the Senate Superintendent of Insurance Executive Director of the Commission on
Minority Health Representatives from several agencies
Creation of other Groups
Mandated Groups A Data Expert Group An Infection Control Group
Ad Hoc Groups The Advisory Council created Pediatric
and Perinatal workgroups
Process for Measures Selection Data Expert Group monthly
meetings Creation of set criteria as guidelines Examination of measure
specifications Selection of measures Recommendations to Advisory
Council on selected measures* Measures related to Adult care, Chronic Diseases, Patient Safety – Slide 9
Measure Selection Criteria
Importance Do the measures reflect unequivocally important
aspects of patient care?
Preventability Can a poor score be prevented through proper
care?
Is excess variation in the data accounted for by factors unrelated to hospital quality?
Genuine quality improvement Can a hospital’s rate be improved without
improving quality?
Measure Selection Criteria (cont.)
Data integrity Can a hospital accurately collect the data from its
records?
Does the measure adequately measure the construct it attempts to measure?
Ability to publicly report Is the measure of use to consumers? Is the measure comprehensible to consumers? Do hospitals have a sufficient case load to
accurately report quality? Burden
Does calculating the measure place undue burden on hospitals?
Measure Selection Criteria (cont.)
Evidence-based Is there scientific research demonstrating the
accuracy and importance of the measure?
Variance Is there sufficient variability in performance
among hospitals to allow for comparison?
National Quality Forum endorsement Is the measure endorsed by the National
Quality Forum?
Overview of Selected Measures
All measures from 4 required sources considered
Total of 84 measures were recommended to the Advisory Council
47 CMS measures 17 AHRQ measures 10 JC measures 10 Infection measures
AHRQ: Patient Safety Indicators
The Data Expert Group recommended the following AHRQ Patient Safety Indicators to the Advisory Council
PSI-1: Complications of AnesthesiaPSI-3: Decubitus UlcerPSI-5: Foreign Body Left During ProcedurePSI-9: Postoperative Hemorrhage or HematomaPSI-16: Transfusion ReactionPSI-17: Birth Trauma—Injury to Neonate PSI-18: Obstetric Trauma– Vaginal Delivery with Instrument
PSI-19: Obstetric Trauma—Vaginal Delivery without instrument
PSI-20: Obstetric Trauma—Cesarean Delivery
AHRQ : Inpatient Quality Indicators
The Data Expert Group recommended the following AHRQ Inpatient Quality Indicators for inclusion
IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate IQI-21: Cesarean Delivery Rate IQI-22: Vaginal Birth after Cesarean Rate,
Uncomplicated IQI-33: Primary Cesarean Delivery Rate IQI-34: Vaginal Birth after Cesarean Rate, All
AHRQ: Recommended Measures After consideration and voting by the Advisory
Council, 7 of the 17 AHRQ measures were recommended to the Director of Health for public reporting
PSI -1: Complications of Anesthesia PSI-3: Decubitus Ulcer PSI-5: Foreign Body Left During Procedure IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate
If passed through the rule making process hospitals will begin reporting these measures in late 2009
Current Hospital Reporting in Ohio
April 2007 Hospital reporting start date by HB 197
ODH selected 11 measures for interim reporting
2 of these measures were from AHRQ
Reporting done April and October 2007, 2008
Hospital Reporting Beginning April 2007
Postoperative Respiratory FailureAdultPediatric
Iatrogenic PneumothoraxAdultPediatricNeonate
Current ReportingFeedback from Hospitals Postoperative Respiratory Failure Ohio has found the numbers are too
small for Iatrogenic Pneumothorax and may not be the best measure for the purpose of public reportingOnly 2 hospitals in the adult category and 1
hospital in the neonatal category had reportable data
Iatrogenic Pneumothorax - Pediatrics
October 1, 2006 – September 30, 2007
187 hospitals
Other Measures Currently Being Reported
Aspirin at Arrival for Acute Myocardial Infarction
Beta Blocker at Arrival for Acute Myocardial Infraction
Pneumococcal Vaccination for Pneumonia Blood Culture before Initial Antibiotic for
Pneumonia ACEI or ARB Left Ventricular Systolic
Dysfunction for Heart Failure Evaluation of Left Ventricular Systolic
function for Heart Failure
Next Steps
Adopt rules reflecting recommended measures Six to nine month process
Public comment periodPublic hearing
Reporting of new measures to begin no earlier than October 2009
Development of the consumer website To be operational by January 2010
If you have any questions please contact Kaliyah Shaheen at 614-995-4982 or [email protected] 2008
Thank You
Questions??