1. Reporting hospital quality Ben Yandell, PhD, CQE System Associate Vice President Clinical Information Analysis (CIA) Norton Healthcare

2. KHC Reporting Workgroup Use existing, externally-defined indicators Hospital Compare website by CMS* Select indicators used in – value-based purchasing – readmission reduction program Update quarterly * CMS is the Centers for Medicare & Medicaid Services; a federal agency

3. 5 scores 1.Outcomes 2.Ratings by patients 3.Clinical process 4.Efficiency 5.Readmissions With component details available

4. Outcomes 30-day survival after hospitalization - heart attack - heart failure - pneumonia Hospital-acquired infections - bloodstream - urinary tract infection - surgical-site Complications - Pressure Ulcer (“bed sore”) - Blood clot - Bloodstream infections - Pneumothorax (“collapsed lung”) - Sepsis (a severe reaction caused by infection) - Surgical incision problems - Unintended puncture or cut during surgery - Postoperative Hip Fracture (usually due to a fall)

5. Death rate for heart attack patients (CMS Hospital Compare. Medicare patients; risk-adjusted 30-day) Outcomes

6. Ratings by patients Overall rating of hospital Communication with nurses Communication with doctors Responsiveness of hospital staff Pain management Communication about medications Cleanliness and quietness Discharge information “Consistency” – based on the lowest-scoring item

7. Overall hospital rating (CMS Hospital Compare. All inpatients; % rating 9 or 10 out of 10) Ratings by patients

8. Efficiency Medicare expenses from 3 days before through 30 days after hospitalization. Average annual spending per Medicare beneficiary for all Medicare-reimbursed care: hospital, physician, rehabilitation, durable medical equipment, etc.

9. Efficiency 3% more efficient – Kentucky average 2% more efficient – U.S. average; Baptist As predicted – Jewish & St. Mary’s 1% less efficient – Norton Hospitals, Floyd Memorial, Clark Memorial, Indiana average 2% less efficient – U of L Hospital Compare 1/11/14; calendar year 2012 data

10. Clinical process Heart attack patients receiving medication to dissolve blood clots received it within 30 minutes of arrival Pneumonia patients received recommended initial antibiotic Surgical patients received recommended antibiotic Antibiotic discontinued as recommended after surgery Urinary catheter removed on postop day 1 or 2 Beta-blocker continued postop Surgical patients received recommended blood-clot prevention Hospitalized patients received influenza immunization

11. Urinary catheter removed after surgery (CMS Hospital Compare. All inpatients; urinary catheter removed within day or two.) Clinical process Footnote 2. Data based on sample.

12. Readmissions Heart Attack Heart Failure Pneumonia Chronic Obstructive Pulmonary Disease Total Hip and Total Knee Replacement

13. Readmission after hip or knee replacement (CMS Hospital Compare. Medicare patients ; risk-adjusted 30-day) Readmissions

14. 5 scores 1.Outcomes 2.Ratings by patients 3.Clinical process 4.Efficiency 5.Readmissions With component details available