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The Importance of Public Reporting on Quality
Nancy Foster
Vice President
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“Bottom Line It for Me”
Public Reporting Drives Improvement If It Is:
• Scientifically sound
• Actionable
• Fair
• Important
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Actions From Data
• Boards examine– Link leaders compensation to performance
• Leadership team – Examines data routinely
– Share with clinical staff
– Lead efforts to improve
• Collaboratives bring together providers trying to address challenges
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Scientifically Sound
• Measure looks at: – Reasonably expected outcomes
– Processes shown to be directly linked to better outcomes
• Reliable data collection
• Relevant numerators and denominators
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Soundness Example
Vascular Catheter Associated Infections
• Outcome measure, evidence of preventability
• Data collection good for NHSN, less than sound for HAC
• HAC Rate– Numerator = patients with vascular catheter associated infections– Denominator = Medicare patients– Highest = Villa Veliciana (1 of 33 patients)– Among highest, academic medical centers
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Actionable
• Proven strategies exist that will enable change in performance
• Change is within the influence of the organization
• Regulations don’t stand in the way
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Fairness in Measurement
• Adjust for differences in patients as they present to the hospital– Risk adjustment
– Exclusions
• Adjust for other factors?– Patient preference
– Genetic information???
How might this change as we move to measures across the continuum of care?
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Fairness Example
• 30 day readmissions
• Those with high rates include:– Safety net hospitals
– Disproportionate number with low mortality rates
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Important
• Significant opportunity to improve outcomes for patients
Accountability Measures — Using Measurement to Promote
Quality ImprovementMark R. Chassin, M.D., M.P.P., M.P.H., Jerod M. Loeb, Ph.D.,
Stephen P. Schmaltz, Ph.D.,
and Robert M. Wachter, M.D.NEJM, June 30, 2010