Summary

Hospital Quality Alliance

Meeting Summary: September 18, 2007

HQA Meeting Summary 9/18/2007

Attendees AARP AFL-CIO Agency for Healthcare Research

and Quality American Hospital Association American Medical Association American Nurses Association Association of American Medical

Colleges Blue Cross/Blue Shield

Association Centers for Medicare and

Medicaid Services Consumer-Purchaser Disclosure

Project

Federation of American Hospitals The Joint Commission National Association of Children’s

Hospitals and Related Institutions National Association of Public

Hospitals and Health Systems National Business Coalition on

Health National Quality Forum Quality Alliance Steering

Committee US Chamber of Commerce Wisconsin Collaborative for

Healthcare Quality (via phone)


Meeting Agenda

Improving Usefulness of Mortality Data Update on Measurement Pipeline

Outpatient Measures Implementation of Pediatric Asthma

Measures Hospital-CAHPS


Characteristics of Mortality Measures Risk-Standardized Mortality Rates for AMI and Heart

Failure Risk-adjusted Use hierarchical generalized linear model Presented with 95% “interval estimate”

Aligned with American Heart Association/American College of Cardiology

Endorsed by National Quality Forum; Adopted by HQA Hospital performance is categorized:

No different than U.S. national rate Better than U.S. national rate Worse than U.S. national rate

Assesses hospital performances as a whole and drives national distribution toward lower mortality rates


AMI Underlying Risk Standardized Mortality Rates:(RSMRs): 2005 - 2006

05

000

1.0

e+04

1.5

e+04

Hos

pita

ls

.1 .15 .2 .25Risk-standardized mortality rate

US National Rate

Range of RSMR

Total # Patients

Total # Deaths

Total # Hospitals

16.4% 10.8%-24.0% 222,171 36,477 4,477

Select Percentiles and Corresponding

RSMR Values

25th to 75th percentile

15.0%-17.2%


14.0%-18.2%


13.4%-18.8%

There is variation; about 13% from Low to High


HF Underlying Risk Standardized Mortality Rates:(RSMRs): 2005 - 2006

US National Rate

Range of RSMR

Total # Patients

Total # Deaths

Total # Hospitals

11.1% 6.7%-17.3% 423,294 47,170 4,807

01

.0e+

042

.0e+

043

.0e+

044

.0e+

04H

osp

itals

.05 .1 .15 .2Risk-standardized mortality rate

Select Percentiles and Corresponding

RSMR Values


10.0%-11.8%


9.3%-12.8%


8.9%-13.4%

There is variation; more than 10% from Low to High


Next Steps: Mortality Measures

Pneumonia 30-day mortality will be added to Hospital Compare in Summer 2008

Improving the display of mortality information will be explored

The HQA will offer potential options to enhance display for consideration at the December 2007 meeting


Hospital Outpatient Reporting Program The measure workgroup recommends the Hospital Quality Alliance adopt the

following ten measures Emergency Department (ED) AMI Transfer Measures

1) ED Aspirin at Arrival 2) ED Median Time to Fibrinolysis 3) ED Fibrinolytic Therapy Received Within 30 Minutes of Arrival 4) ED Median Time to ECG 5) ED Median Time to Transfer for Primary PCI

Heart Failure 6) ACE or ARB for LVSD

Perioperative Care 7) Timing of Antibiotic Prophylaxis 8) Selection of Prophylactic Antibiotic – First or Second Generation Cephalosporin

Pneumonia 9) Empiric Antibiotic for Community Acquired Pneumonia

Diabetes 10) Hemoglobin A1c Poor Control in type 1 or 2 Diabetes Mellitus

Contingent on: NQF endorsement further field testing and establishment of adequate infrastructure to support data collection

If any of these conditions are not resolved, the HQA reserves the ability to withdraw its support of any of these measures


Pediatric Asthma Measures 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

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

For the moment and using this approach, only Joint Commission-accredited hospitals will be reported on Hospital Compare


Next Steps: Pediatric Asthma Measures Better understand the financial resources and

the time required to make accomplish the following: Posting pediatric asthma measures (Joint Commission

data only) on Hospital Compare Adapting the CART tool Enabling the capacity of the Iowa data warehouse to

accept the data CMS will provide resources estimates as soon as

possible HQA partners will encourage hospitals to report

pediatric asthma measures


Hospital-CAHPS (HCAHPS)®

27 question survey of patient experience with hospital care Six Composite Measures

Nurse Communication Doctor Communication Responsiveness of Hospital Staff Pain Control Communication about Medication Discharge Information

Four individual items Cleanliness of Hospital Environment Quietness of Hospital Environment Overall Rating of Hospital Recommend Hospital

Adjusted for patient characteristic and mode of administration HCAHPS data collection and reporting is linked to annual payment

update Information will be posted on Hospital Compare in March 2008


HCAHPS – Display (DRAFT)


Next Steps: HCAHPS®

Resolve some of the remaining display challenges, including: How to help consumers navigate the website Quickly distinguish between data from patients and data

about clinical conditions How to display results for easy comparison How to allow for easy drill down to details

Determine at what level will the data be available for download from Hospital Compare

Develop “rules” or guidelines for secondary uses of the data

Develop comprehensive communication and media strategy for March 2008 roll out.


Public Comment

Remarks centered on the following issues:Janet Heinrich ~ Health Policy R&D

Measures of medication safety should be a priority

Ellen Kurtzman ~ George Washington University

Measurement and reporting of nursing quality is critically important

Karen Linscott ~ Leapfrog Group Expedited movement of measures through the

endorsement and HQA adoption process


Other Meeting Decisions & Outcomes

The HQA Principals: Empowered Rich Umbdenstock to represent the HQA

on the National Quality Forum’s Priority Partners Tasked staff to develop potential priorities for

measurement and reported to be considered at the December meeting

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

Approved the recommendations of the Membership Sub-committee


Principal Organizations


For Additional Information

Katherine [email protected]

Hospital Quality Alliance: www.hospitalqualityalliance.org

Hospital Compare: www.hospitalcompare.hhs.gov

Summary

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