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The Relationship Between Organizational Factors and Performance Among Pay-for- Performance Hospitals Vina ER, Rhew DC, Weingarten SR, Weingarten JB, Chang JT.
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Background Pay for Performance (P4P) Hospital Quality Incentive Demonstration (HQID) Project Rewarding high performance hospitals with 2% bonus on Medicare payments
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Objective To identify the key quality improvement (QI) factors associated with higher performance in hospitals in a P4P program
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Sampling frame Hospitals participating in the HQID project across 5 clinical conditions or procedures: –Acute myocardial infarction (AMI) –Heart failure (HF) –Pneumonia (PN) –Total hip or total knee replacement (THR/TKR) –Coronary artery bypass graft (CABG)
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Study sample
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Overall Composite Quality Score (O-CQS) –Calculated by Premier, Inc. –Utilized O-CQS from year 2 (October 1, 2004 - September 30, 2005) –Combines composite process score (CPS) and composite outcome score (COS)
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Structured telephone interview Telephone interviews were conducted by Zynx Health investigators (blinded to each hospital’s performance ranking): July, 2007 - October, 2007 Average interview: ~35 minutes Respondents were asked to focus on their QI activities during the past year
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QI domains 1.Quality improvement (QI) interventions 2.Data feedback systems (quality compliance) 3.Physician leadership 4.Organizational support for QI 5.Organizational culture
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Results 92 hospitals were eligible for the study 84 (91%) completed the interview –45 were in the top 2 deciles –39 were in the bottom 2 deciles
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Hospital characteristics
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QI interventions *P <.01
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QI interventions *P <.01
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QI interventions: Electronic capabilities
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Data feedback
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Physician leadership Among hospital CMOs with the general role of improving quality, –Percentage who recruited “physician champions” (82.1% vs 69.4%, P<.05).
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Organizational support
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Organizational culture
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Limitations Voluntary participants in a P4P program Participants not blinded own performance rankings Unable to evaluate association of QI efforts to future performance
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Conclusions Main factors associated with high performance: –Organizational structure –Organizational support for QI –Organizational culture
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Policy implications Strategies should encourage development of improved organizational structure, support and culture for quality Develop and strengthen resources to support QI activities
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Acknowledgements Zynx Health, Inc. Premier, Inc. Centers for Medicare & Medicaid Services
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Questions?
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References (1) Centers for Medicare and Medicaid Services (CMS) / Premier Hospital Quality Incentive Demonstration Project. Internet 2008 January 3;Available at: URL: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/hqi-whitepaper041306.pdf http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/hqi-whitepaper041306.pdf (2) Centers for Medicare and Medicaid Services (CMS) / Premier Hospital Quality Incentive Demonstration Project. Internet 2008 January 3;Available at: URL: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/resources/hqi-whitepaper-year2.pdf http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/resources/hqi-whitepaper-year2.pdf (3) Lindenauer PK, Remus D, Roman S et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med 2007 February 1;356(5):486-96. (4) Bradley EH, Herrin J, Mattera JA et al. Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction. Med Care 2005 March;43(3):282-92. (5) Bradley EH, Herrin J, Mattera JA et al. Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction. Med Care 2005 March;43(3):282-92. (6) Marciniak TA, Ellerbeck EF, Radford MJ et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA 1998 May 6;279(17):1351-7. (7) Metersky ML, Galusha DH, Meehan TP. Improving the care of patients with community-acquired pneumonia: a multihospital collaborative QI project. Jt Comm J Qual Improv 1999 April;25(4):182- 90.
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References (8) Ferguson TB, Jr., Peterson ED, Coombs LP et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA 2003 July 2;290(1):49-56 (9) Fonarow GC, Abraham WT, Albert NM et al. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med 2007 July 23;167(14):1493-502. (10) Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008 January 15;148(2):111-23. (11) Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Medical Care 2003;41(1):I30-8.
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BACK-UP SLIDES
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QI Interventions
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*P <.05; ‡P <.01.
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Results, Summary
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