1. The Focus on Quality A Closer Look at a National Trend
April 2006
The Focus on Quality
A Closer Look at a National Trend
Issue Brief available at:

2. The Evolving Field of Quality Improvement in Healthcare
Institute of Medicine (IOM) report To Err Is Human heightened public discussion
Emphasis on:
data collection
measurement of treatment outcomes
implementation of clinical pathways
Trend to begin tying reimbursement to progress on quality measures
Quality improvement has long been a part of hospitals’ day-to-day operations
IOM report attempted to quantify the incidence of errors in hospitals
Clinical pathways are proven care regimens for particular illnesses or conditions

3. National Quality Initiatives Take Shape
Accrediting body
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
Core Measures
National Patient Safety Goals
Payers
Centers for Medicare & Medicaid Services (CMS)
Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU)
JCAHO’s Core Measures: Rate hospital performance on heart attack, heart failure, pneumonia, surgical infection prevention, and pregnancy and related conditions. Hospitals must submit data on several core measure sets.
JCAHO’s National Patient Safety Goals: Accredited hospitals are expected to comply with these. One example, for the goal of improving effectiveness of communication among caregivers, hospitals are to standardize a list of abbreviations, acronyms and symbols NOT to be used throughout the organization.
CMS’ RHQDAPU: Hospitals not submitting performance data for the 10 starter set measures (i.e. prescribing aspirin and beta-blockers to heart attack patients at arrival and discharge) receive a 0.4 percentage point reduction in their annual Medicare payment update for fiscal years 2005, 2006 and (Centers for Medicare & Medicaid Services. Hospital Quality Initiative.)

4. National Quality Initiatives Take Shape (cont’d)
Payers
CMS (cont’d)
Hospital Quality Alliance – Improving Care Through Information Initiative
In collaboration w/ the American Hospital Association and others
Premier Hospital Quality Incentive Demonstration
In collaboration w/ Premier, Inc.
Hospital Quality Alliance initiative aims to publish online information about 22 measures of hospitals’ standards of care for heart attack, heart failure, pneumonia and surgical infection prevention. (Centers for Medicare & Medicaid Services. Hospital Quality Initiative.)
Premier Demonstration is a Medicare pay-for-performance project. 260 hospitals providing data on a set of 34 quality measures related to five clinical conditions. Hospitals performing in the top 10% for a given diagnosis receive a 2% Medicare bonus payment for the measured condition (those in the next highest 10% receive a 1% payment). Hospitals not achieving absolute improvements above the demonstration baseline are subject to reductions in payments in the 3rd year of the demonstration. (Centers for Medicare & Medicaid Services. “Medicare Demonstration Shows Hospital Quality of Care Improves with Payments Tied to Quality.” Medicare News, November 14, 2005.)

5. National Quality Initiatives Take Shape (cont’d)
Business groups
The Leapfrog Group
Hospital Quality and Safety Survey
The Institute for Healthcare Improvement
100,000 Lives Campaign
Leapfrog is a coalition of 170 major employers. Hospitals may voluntarily submit data for their survey. (The Leapfrog Group. “Latest Survey Results.”; The Institute for Healthcare Improvement.)
IHI’s 100,000 Lives Campaign aims to get hospitals to commit to adopting six steps to improve patient care and prevent avoidable deaths (i.e. deploy rapid response teams). Goal is to save 100,000 lives by June 14, 2006.

6. Rating Systems and Report Cards Evolve to Inform Consumers
U.S. News & World Report
America’s Best Hospitals
Solucient
100 Top Hospitals
HealthGrades
HealthGrades ratings
U.S. News & World Report: Hospitals are ranked based on 17 specialties, including cancer care and pediatrics. (U.S. News & World Report. “America’s Best Hospitals 2005 Methodology.”)
Solucient annually publishes a list of the 100 top hospitals that rated based on clinical excellence, operating efficiency and financial health, and responsiveness to the community. (Solucient. “100 Top Hospitals: National Benchmarks for Success – 2004.” HealthGrades.)
HealthGrades evaluates quality of care provided to hospital patients for 28 common medical conditions, including pancreatitis and hip fracture.

7. Evaluating Quality Initiatives and Rating Systems / Report Cards
Importance of risk adjustment
Statistical process to identify and adjust for variation in patient outcomes stemming from differences in patient characteristics
Credibility dependent on measures used
Surveys of providers’ reputations vs. compliance with clinical pathways
Different hospitals treat different types of patients. For example, a large, urban medical center may treat patients who are sicker and have more complex illnesses than patients treated at smaller hospitals and thus, may have higher mortality rates.
Risk adjustment is important to ensure quality comparisons account for variations in patient outcomes stemming from differences in patient characteristics. (Joint Commission on Accreditation of Healthcare Organizations. “Risk Adjustment.”; Excellus Blue Cross Blue Shield. “Hospital Quality Reports: Glossary – Terms and Definitions.”)

8. What our Hospital Is Doing