Quality Health Indicators
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Transcript of Quality Health Indicators
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Quality Health Indicators
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• About QHi• The PiHQ Portal• Defining your facility• Selecting Measures• Entering Data• Dashboards• Reports• How we use the data
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Quality Health Indicators
The Quality Health Indicator (QHi) web site was developed through the Kansas Hospital Association (KHA) and the Kansas Rural Health Options Project (KRHOP) to facilitate a benchmarking project for rural Kansas hospitals.
The goal of QHi is to provide hospitals an economical instrument to evaluate internal processes of care and to seek ways to improve practices by comparing specific measures of quality with like hospitals.
Using QHi as a tool, regional networks of hospitals and individual facilities can select from a library of indicators to determine which measures meet their unique needs.
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Quality Health Indicators
More than 900 users in over 250 Critical Access and other small rural hospitals in Alaska, Arizona, California, Colorado, Illinois, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Mexico, Oklahoma, Oregon and Wyoming use QHi as a data collection and benchmarking tool.
As a user-driven multi-state project, QHi is well-positioned to serve as a significant repository of information on quality of care and performance in rural hospitals nationwide.
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Four Pillars Of Measurement
Quality Health Indicators
Clinical
Quality
Employee
Contribution
Patient
Satisfaction
Financial
Operational
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QHi Core Measures Set
Clinical Quality• Healthcare Associated Infections per 100 inpatient days• Unassisted Patient Falls per 100 inpatient days• Pneumococcal Immunization (PPV23) – Age 65 and Older (CMS IMM-1b)• Discharge Instruction (CMS HF-1)
Employee Contribution• Benefits as a Percentage of Salary• Staff Turnover
All participating hospitals are asked to collect and report the 8 QHi Core Measures:
Financial Operational• Days Cash on Hand • Gross Days in AR
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Clinical Quality Measures Inpatients Screened for Pneumonia Vaccine Status (not a CMS measure) Medication Omissions Resulting in Medication Errors Medication Errors Resulting from Transcription Errors ER Provider Response Times Return ER Visits within 72 hours with same/similar diagnosis Readmissions Within 30 Days with Same or Similar Diagnosis Healthcare Associated Infections per 100 inpatient days* Unassisted Patient Falls per 100 inpatient days* Long Term Care Patient Falls per 100 Long Term Care patient days
CMS Pneumonia Measures Inpatients Receiving O2 Assessment within 24 hours of admission - CMS PN-1 (retired) Inpatients Receiving Pneumonia Immunization - CMS PN-2 (retired) Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital - CMS PN-3b Adult Smoking Cessation Advice/Counseling - CMS PN-4 (retired) Pneumonia Patients Receiving Initial Antibiotic Within 6 Hours of Hospital Arrival - CMS PN-5c (retired) Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients - CMS-PN6 Influenza Vaccination - CMS PN-7 (retired)
*Part of the 8 Core Measure Set
Additionally, facilities can select from over 90 measures
in the QHi library of indicators:
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Clinical Quality Measures (continued)
CMS OP Transfer Measures Median Time to Fibrinolysis in the Emergency Department - CMS OP-1 Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival in the Emergency Department - CMS OP-2 Median Time to Transfer to Another Facility for Acute Coronary Intervention in the Emergency Department - CMS
OP-3 Aspirin at Arrival in the Emergency Department - CMS OP-4 Median Time to ECG in the Emergency Department - CMS OP-5 Timing of Antibiotic Prophylaxis in Hospital Outpatient Surgery - CMS OP-6 Prophylactic Antibiotic Selection for Surgical Patients in Hospital Outpatient Surgery - CMS OP-7
CMS Immunization Measures Pneumococcal Immunization (PPV23) – Overall Rate - CMS IMM-1a Pneumococcal Immunization (PPV23) – Age 65 and Older* - CMS IMM-1b Pneumococcal Immunization (PPV23) – High Risk Populations (Age 6 through 64 years) - CMS IMM-1c Influenza Immunization - CMS IMM-2
*Part of the 8 Core Measure Set8
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Clinical Quality Measures (continued) CMS HF Measures Discharge Instructions* – CMS HF-1 Evaluation of LVS Function – CMS HF-2 ACEI or ARB for LVSD – CMS HF-3 Adult Smoking Cessation Advice/Counseling – CMS HF-4 (retired)
CMS SCIP Measures Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision – CMS SCIP-Inf-1a Prophylactic Antibiotic Selection for Surgical Patients – CMS SCIP-Inf-2a Prophylactic Antibiotics Discontinued Within 24 Hours after Surgery End Time – CMS SCIP-Inf-3a Surgery Patients with Appropriate Hair Removal – CMS SCIP-Inf-6 Urinary Catheter Removed on Postop Day 1 or Postop Day 2 with Day of Surgery being Day 0 – CMS SCIP-Inf-9 Surgery Patients with Periop Temperature Management – CMS SCIP-Inf-10 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Periop Period –
CMS SCIP-Card-2 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered – CMS SCIP-VTE-1 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery
to 24 Hours After Surgery – CMS SCIP-VTE-2
*Part of the 8 Core Measure Set 9
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Employee Contribution Measures Non-Nursing Staff Turnover Average Time to Hire (All Staff) Nursing Staff Turnover Average Time to Hire (Nursing) Average Time to Hire (Non-Nursing) Salary to Operating Expenses Comparison Benefits as a Percentage of Salary* Staff Turnover*
Patient Satisfaction Measures
How well staff worked together to care for the patient (QHi1) The extent to which the patient felt ready for discharge (QHi2)
In addition to these two original QHi patient satisfaction measures, 22 HCAHPS measures are now in the library of indicators.
*Part of the 8 Core Measure Set
Hospital Characteristics Measures Average Inpatient Days
Monthly Inpatient Census
ALOS (in hours) Comparison
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Financial
Bad Debt Expense
Charity Care
Cost per Patient Day
Labor Hours per Patient Day
Operating Profit Margin
Current Ratio
Net Patient Revenue per Patient Days
Payer Mix – Commercial
Payer Mix – Medicaid
Payer Mix – Medicare
Payer Mix – Other
Payer Mix – Other Government
Payer Mix – Self/Private Pay
Days Cash on Hand*
Gross Days in AR*
Financial & Operational Measures
Operational
Physical Therapy Labor Hours per Unit of Service
Laboratory Labor Hours per Unit of Service
X-ray Labor Hours per Unit of Service
Mammogram Labor Hours per Unit of Service
Ultrasound Labor Hours per Unit of Service
CT Labor Hours per Unit of Service
MRI Labor Hours per Unit of Service
Pharmacy Labor Hours per Unit of Service
Nursing Hours per Patient Day
Rural Health Clinic Encounters per FTE
Long Term Care Hours per LTC Patient Day
Laboratory Hours per Billed Service
*Part of the 8 Core Measure Set
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Web Site AccessAn email address and password are required to enter this secure web site.
The level of access is determined by the User type:
System Administrator – maintains the site – KHA/KHERF
State Administrator –provides support to Hospital Contacts in their State
Network Administrator – maintains Network profiles & provides support
Hospital Contact – maintains Hospital profiles , adds users & enters data
Hospital User – enters data and runs reports
View Only – views data and runs reports
Report Recipient – no access to QHi, only receives reports
Quality Health Indicators
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Defining
Your
HospitalReturn to Main Menu
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Users navigate through the suite of resources in the PiHQ Portal by clicking
on the blue-lettered links in the whitemenu bar
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Hover text provides a briefdescription of each resource
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All QHi, HSI and SQSS users have access to the
PiHQ search engine.
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Users type in search topic here
…or on any page throughout the portal
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Results are pulled from all Portal resources.
Future enhancements will allow users to pull from resources outside of PiHQ as well.
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The Resource Library holds all resource materials developed for PiHQ.
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All users have access to the Resource Library
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Results are pulled from all Portal resources.
Icons identify the source of the information.
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All users have access to the Calendar
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The Calendar provides registration information for upcoming Quality Training Sessions
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Users with access to this application are directed to the home page,
without additional log in.
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All HCAHPS measures can be automatically pulled from HSI and uploaded directly into QHi, eliminating duplicate entry.
Future enhancements will allow any HSI measure to be uploaded into QHi.
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Users with access to this application are directed to their customized home page, without additional log in.
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Partners in Healthcare Quality are working with two notable Risk Management vendors to pull aggregate data directly into QHi, further reducing data entry, and enhancing comparative analysis and benchmarking opportunities.
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Defining
Your
HospitalReturn to Main Menu
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Users navigate through QHi by selecting options from
the red main-menu bar andthe blue sub-menu bar
Click Administration to viewHospital Profile page
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Hospital Contacts are responsible forcompleting and maintaining the
Hospital Profile page for their facility
All fields with a redasterisk are required
fields
Hospital Characteristicsdefine each facility for
creation of peer groupswhen running reports
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Click drop-down to select Level of
Measurement . This applies only to
Financial/Operational measures
Question mark icons provide pop-up
definitions throughout the QHi site
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Selecting
Measures
Return to Main Menu
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Click here to go toMeasure Selection
page
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In Collected Measure Sets, users can select the
default measures predetermined by their
state or network
The QHi Core Measure Set is pre-
selected as it is required for all
hospitals
Additional measure sets are available here
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Collected Measures lists the
measures within the measure sets
currently collected by the hospital
Individual measures are displayed and can be selected
under Additional Measures
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Additional Measures lists:(1) individual measures currently collecting (2) other measures that are available to collect
Indicates the numberof hospitals in QHi
collecting themeasureClick the plus icon to
add measure toCurrently Collecting
Click the minus icon to remove measure
fromCurrently Collecting
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Click the question mark icon todisplay the calculation for
each measure
Click show elements todisplay the elementsrequired to calculate
the measure
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Entering
Data
Return to Main Menu
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Click Data Submissions to accessthe Data Submission page
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Click Go to: drop-down arrow to selectprior months’
data submissions
To create a new data submissionspage, select correct month and
year from Month to add: drop-down arrows
IMPORTANT: You must check Activate datafor reporting box and then Save All and Stayin order for the data entered this month to be
displayed on dashboards or in reports
Click Save All and Stay tosave data entered
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If data for the month is entered and saved,but not activated, this message will appear
to remind the user to activate the datafor reporting
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Prior months’data is displayed
for easy reference
Click to automatically calculatemeasures and immediately
display results
Data elements automatically populate this pagebased on the measures selected by the user in
the Measure Selection page
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The
Dashboard
Return to Main Menu
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The Core Measures Dashboarddisplays comparison data for the
eight Core Measures
Roll mouse over anyDashboard graph to
view the pop-up calculationfor that measure
The Dashboard can bedisplayed in graph,table, or graph/table
views
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Table View
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Graph and Table View
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Dashboard data is calculated using aconsecutive three-month summing average
State Avg values reflect data fromhospitals in the same state asMy Hospital and reported in
the same time interval
QHi Avg values reflect data from allhospitals in QHi reporting the samemeasure in the same time interval
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Financial measures on the Dashboard default to peer groups
based on the hospital’s level of reporting (Hospital Only or Entire
Enterprise)
A hospital must have activated data for at least one of the three
months in the Date Range in order for the measure to be
displayed on the Dashboard
My Hospital data for some clinical measures will not
display on the Dashboard if the hospital had no
occurrences during the Date Range period
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The three months in the Date Range canbe changed by clicking the drop-down to
select the start month for the desiredthree-month period
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Click here to view theDashboard as a PDF
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PDF view
The PDF format allows the user to save, print
or email the Dashboard in graph, table or
graph/table views
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Users can email the Dashboard in PDF tothemselves by clicking To Myself
…or choose another recipient
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User selects from a list ofexisting registered users
…or choose to add a new recipient
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Enter the name and Emailaddress of the new recipient
…and click Add New
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Click Create Schedule to establish apre-determined schedule for mailing
Dashboard reports to selected recipients
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1. Select run date by clicking on calendar2. Select frequency (monthly, quarterly, annually)
3. Select recipients4. Click on Save Schedule
5. Report is sent through email as a PDF attachment
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Click View My Dashboard tocreate a customized Dashboard
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Only those measures being collected by the
hospital will be available in the list
Click drop-down to select a measure to display on
Dashboard
Selected measures are retained and are
user specific
Notes section available to add comments or
additional information
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Click At A Glance Dashboard toview a twelve-month trending
graph/table view of each of theeight Dashboard measures
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At A Glance twelve-monthtrending graphs for each
Core measure withtimeline and view options
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Reports
Return to Main Menu
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Reports is still available tousers to create peer reports.
However, its function hasbeen replaced by the
enhanced and upgradedNew Reports
Click New Reports to view measures andcreate peer reports
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Select report start and end dates
Select peer groups
Select data grouping
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Users can select up to five additional peer groups
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Available criteria selections for each peer group
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Users can only create a reporton measures that are being
collected by their hospital
Click on the blue measurescategory bar to display the
list of measures (beingcollected by that hospital)
in that category
Users can select more thanone measure from more
than one category
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Select output format
Select how wish to view report
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Webpage At A Glance view
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Webpage Line Graph view
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Webpage Bar Graph view
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Webpage Table view
The user’s facility isidentified as Hospital
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Webpage Table with detail view
Note that peer hospitals arenot identified by name but
have been assignedrandom numbers
Click on the envelope icon tocontact a peer hospital forbest practice information
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The Hospital Contact at theselected peer hospital will receive the email message
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Export format applies toTable and Table with detail
views
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From the Excel reportusers can create
customized graphs to meet their needs
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Gray Scale format displaysgraphs in black and white
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Click on Best Practice Reportto view and create reports that
list the top five performersfor any measure in QHi
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Hospitals can create a customized BestPractice report by selecting:
1. Comparison quarter2. Sorting and display option
3. Criteria4. Measures
5. Clicking on Run Report
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Reports the summed average of themost recent or selected quarter’s data
Top performers are defined by themost recent or selected quarter’s data
Previous two quarters are displayedfor reference purposes only
Click on the envelope icon tocontact a top performer hospital
for best practice information
If your hospital is not in the top 5 performers, it will be shown at the end of the list with
the ranking identified
If your hospital is in the top 5 performers of aCore measure, it will be identified on the
Dashboard with green stars and themessage: “Best Practice Top Performer”
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Training, educational materialsand QHi documents are availablefor download on the Help page
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How we use the data
Return to Main Menu
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I print a copy of the graphs and take it to the board for discussion. They appreciate seeing in color how we compare to other CAHs in KS as well as others in the USA.
On a quarterly basis I am giving a copy of the bar graphs to our Board Members at their meeting.
I give the Quality Committee a copy of the quality reports on a quarterly basis.
We track and present our indicators monthly and are usually above the norm. On the occasions when we fall below, it prompts us to review processes to seek improvements.
If we fall below expectations, we look for ways to improve and then report back to the board in the next quarter.
We like the Days in AR report. This is our only source for comparative information on this measure.
Quality Health Indicators
What do we do with the data? A few comments from our hospitals…
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Thank you for viewing this demonstration.
If you have any questions or would like additional information on the QHi project, please contact:
Sally Perkins, QHi System Administrator [email protected]
785-276-3118or
Stuart Moore, QHi [email protected]
785-276-3104
Quality Health Indicators