CALL IN NUMBERS

April 19th

• 12:00pm Call: 866-836-4700 Passcode: 861717

• 1:00pm (Eastern) 866-836-4700 Passcode: 861721

Leapfrog Quality and Safety Hospital Survey Town Hall

Barbara Rudolph, Ph.D.Director, Leaps and Measures

April 19, 2006Call in number: 866-836-4700

12:00pm (Eastern) passcode: 861721 1:00pm(Eastern) passcode: 861717

Topics for Today

• Introductions (Dennis, Chuck, Carol, Franck, Sarah)

• Background (Barb)– Why do we ask you to complete the survey?

• First 3 Leaps (Barb)• NQF Safe Practices (TMIT)• “Mechanics” of data submission (Dennis)

– Security Codes– Re-submissions of information– Website updates

• Q & A

Why are we asking hospitals to complete the survey?

• Five years later—still need to improve safety• First estimates between 44,000-98,000

Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999)

• More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)

The Quality Chasm

• 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a)

• More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)

The Quality Chasm

• Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000)

• Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)

The Leapfrog Group’s Mission

Trigger giant leaps forward in the safety, quality and affordability of health care by: 

• Supporting informed health care decisions by those who use and pay for health care  

• Promoting high-value health care through incentives and rewards

  

Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:

Evidence-based

High impact

Understandable by Consumers

Achievable by Providers

NQF endorsed

The Leapfrog Group Strategy on Hospital Measurement and Public Reporting      

Safety ‘Leap’ Summary

1. An Rx for Rx– Computer Physician Order Entry (CPOE)

• Up to 8 in 10 serious drug errors prevented

2. Sick People Need Special Care – ICU Daytime Staffing with CCM Trained

M.D. live or via tele-monitoring, or risk-adjusted outcomes comparison• 29% mortality reduction (JAMA, 11/02)

Safety ‘Leap’ Summary

3. The Best of the Best– Evidence-based Hospital Referral (EHR) or

risk-adjusted outcomes comparison• > 30% mortality reduction for 7 complex

treatments

4. Leapfrog Safety Index– Rolled-up score of the remaining 27 of the

30 NQF-endorsed Safe Practices

Computerized Physician Order Entry (CPOE)

Each hospital fulfilling this Leap: • Assures that prescribers* enter 50% of hospital

medication orders via a computer system that includes decision support software to reduce prescribing errors;

• Requires that prescribers electronically document a reason for overriding an interception prior to doing so.

• Linked to pharmacy, admitting-discharge-transfer (ADT) information systems

* “Prescribers” used throughout this section refers to all clinicians authorized by the hospital to order pharmaceuticals for patients.

ICU Physician Staffing

• A hospital fulfilling this leap assures that all patients in its adult or pediatric general medical and/or surgical ICUs are managed or co-managed by physicians certified in critical care medicine who:

• Are ordinarily present in the ICU (on-site, or via telemedicine that meets Leapfrog specifications) during daytime hours a minimum of 8 hours per day, 7 days per week, and during this time provide clinical care exclusively in the ICU; and

• At other times . . . returns more than 95% of ICU pages within 5 minutes, based on a quantified analysis of pager response time;* and can rely on a physician or FCCS-certified non-physician “effector” who is in the hospital and able to reach ICU patients within 5 minutes in more than 95% of cases, based on a quantified hospital analysis of pager response time.*

Evidence-based Hospital Referral: Volume, Outcomes, and Process

Treatments(See specifications below)

Favorable Hospital Volume Characteristic*

Coronary artery bypass graft** 450 or more procedures/year

Percutaneous coronary intervention*** 400 or more procedures/year

Abdominal aortic aneurysm repair 50 or more procedures/year

Pancreatic resection 11 or more procedures/year

Esophagectomy 13 or more procedures/year

NICU average daily census > 15

Outcomes: CABG and PCI

• State reported risk-adjusted mortality for CABG in NY, NJ, CA, and PA (Top Quartile)

• State reported risk-adjusted mortality for PCI in NY (Top Quartile)

• Risk-adjusted CABG mortality from STS (at or above average performance)

• Risk-adjusted PCI mortality from ACC (at or above average performance)

Process Measures-developed by Zynx

80% or greater adherence to at least 2 of the measures in each high risk procedure or condition.

• CABG (Process measure examples)– All patients undergoing CABG should receive aspirin

upon hospital discharge.– All patients undergoing CABG without contraindications

should receive a beta-blocker within 24 hours after surgery.

• PCI (example)– Patients without contraindications who have undergone

PCI should receive aspirin • AAA• High Risk Infants (neo-natal steroids)

Scoring Algorithm for EHREHR Credit based on Volume Thresholds

Full Credit(full circle)

¾ Circle ½ Circle ¼ Circle No Credit(empty circle)

CABGsee Notes 1-3 below

450+ <450 Did not disclose

PCIsee Notes 1-2 below

400+ <400 Did not disclose

AAA Repairsee Note 4 below

50+ 17-49 <17 Did not disclose

Esophagectomy

13+ 8-12 5-7 <5 Did not disclose

Pancreatic resection

11+ 6-10 3-5 <3 Did not disclose

High Risk Deliveriessee Note 4 below

Average daily NICU

census >15

NICU with average daily census <15orHigh-risk deliveries but no NICU

Did not disclose

Safe Practices Section (TMIT)

• Commitments—lapse after one year

• Need to review and update all questions that have a specified time period…e.g., within the last 12 months…

• Review FAQs for changes

• Review Implementation Strategies

Timelines for Submission

• Hospitals participating in LHRP must submit by May 31st

• First report on hospital submission (June 30th) available on web by first week of July

• Updates can be done monthly

• Last survey submissions March 2007

Submission Issues (Dennis)

• Security Codes and CEO Delegation

• Maintaining survey records of answers

• How to refresh the data—must re-affirm each section

• Helpdesk services

• Website resources

Question and Answer Period

• Helpdesk access—leapfrog.medstat@thomson.com

Leapfrog’s Hospital Quality and Safety Survey Display

Quality and Safety Hospital Survey: The 2006 Refresh

Barbara Rudolph, Ph.D.Director, Leaps and Measures

April 19, 2006

Topics for Today• Introductions (Dennis, Chuck, Carol, Franck, Sarah)• Background (Barb)

– Why are we still doing this?• Cover the changes to the survey

– Survey questions (Barb)– Scoring (Barb)– Timeline (Barb)– FAQs (Chuck)

• Cover the “mechanics” of the refresh (Dennis)– Security Codes– Re-submissions of information– Website updates

• Q & A

Why are we still doing this? • Five years later—still need to improve safety• First estimates between 44,000-98,000

Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999)

• More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)

The Quality Chasm

• 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a)

• More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)

The Quality Chasm

• Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000)

• Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)

The Leapfrog Group’s Mission

Trigger giant leaps forward in the safety, quality and affordability of health care by: 

• Supporting informed health care decisions by those who use and pay for health care  

• Promoting high-value health care through incentives and rewards

  

Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:

Evidence-based

High impact

Understandable by Consumers

Achievable by Providers

NQF endorsed

The Leapfrog Group Strategy on Hospital Measurement and Public Reporting      

Safety ‘Leap’ Summary (Barb)

• An Rx for Rx– Computer Physician Order Entry (CPOE)– Up to 8 in 10 serious drug errors prevented

• Sick People Need Special Care – ICU Daytime Staffing with CCM Trained M.D. live or via tele-

monitoring, or risk-adjusted outcomes comparison– 29% mortality reduction (JAMA, 11/02)

• The Best of the Best– Evidence-based Hospital Referral (EHR) or risk-adjusted

outcomes comparison– > 30% mortality reduction for 7 complex treatments

• Overall Safety– Rolled-up score of the remaining 27 of the 30 NQF Safe Practices

(CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)

Survey Refresh (Barb)

• See Page 1—What’s New in the 2006 Survey– No substantive content changes to survey wording– Changes to Section 3, EHR process measures—

questions changed from yes/no to percent adherence (hospitals won’t need to collect additional information to answer this..

– Responses needed for time-sensitive items—see items with clock in survey (many of the NQF questions have a 12 month timeframe—need for updates—no clock on survey)

– Authorization and release to share hospital data for the LFHRP

Scoring and Timeline Changes (Barb)• Scoring – related to lapsed/failed commitments

– Assess whether met the self-imposed commitments—hospitals can achieve partial credit for committing to fully implementing the Leap by 3/31/2007.

– For CPOE, if fail two years of commitments—no credit for commitment

• But can get to “Good Progress” credit if in last 12 months—hospital brought up EMR hospital-wide or results reporting in hospital-wide

• Can only achieve good early stage credit– For IPS, if fail two years of commitments—will not be eligible for

Good Progress credit in 2007

• Timeline changes– Review, update and re-affirm by June 30th

– LHRP submitters must submit by May 31, 2006– First Public Report July 2006– In 2007, all surveys will be due on May 31

Safe Practices Section (Chuck)

• Commitments—lapse after one year

• Need to review and update all questions that have a specified time period…e.g., within the last 12 months…

• Review FAQs for changes

• Review Implementation Strategies

Submission Issues (Dennis)

• Security Codes and CEO Delegation

• Maintaining survey records of answers

• How to refresh the data—must re-affirm each section

• Helpdesk services

• Website resources

Question and Answer Period

• Helpdesk access—leapfrog.medstat@thomson.com

Leapfrog’s Hospital Quality and Safety Survey Display