1. NJ Quality Reporting Initiatives State Coverage Initiatives Robert Wood Johnson Foundation February 8, 2008

2. New Jersey Quality Reporting Context Major focus for the state Major focus for the state Grew out of Department role in public health and as regulator Grew out of Department role in public health and as regulator Some legislation Some legislation Support from press and advocates Support from press and advocates Build on national efforts Build on national efforts

3. Objectives for Today Context for these projects Context for these projects Broad overview of these projects Broad overview of these projects Data sources/general methodology Data sources/general methodology Describe several projects Describe several projects Issues for future Issues for future

4. Public Reporting Efforts: Current HMO Performance 1997 HMO Performance 1997 CABG Mortality 1997 CABG Mortality 1997 Hospital Performances 2004 Hospital Performances 2004 Bariatric Surgery 2006 Bariatric Surgery 2006 Patient Safety 2006 Patient Safety 2006 AHRQ Quality Indicators 2007 AHRQ Quality Indicators 2007

5. Public Reporting Efforts: In Development Hospital Associated Infections Hospital Associated Infections Stroke Stroke Other Cardiac Other Cardiac

6. Context for Reporting Grew out of DHSS recognition of need Grew out of DHSS recognition of need HMO reporting grew out of revisions in regulations HMO reporting grew out of revisions in regulations CABG grew out of press questions and DHSS commitment CABG grew out of press questions and DHSS commitment Other reports developed from this beginning Other reports developed from this beginning

7. NJ Context Legislative requirements for CABG, medical errors, stroke Legislative requirements for CABG, medical errors, stroke Advisory Groups for hospital performance, CABG, stroke Advisory Groups for hospital performance, CABG, stroke DHSS initiation of other efforts within context of public reporting DHSS initiation of other efforts within context of public reporting Started early and grew Started early and grew

8. Data Sources: Various Administrative discharge data: Administrative discharge data: Additional clinical information: Additional clinical information: National data collection: National data collection: AHRQ QIs, bariatric surgery CABG, medical errors, stroke Hospital quality, infections

9. Hospital Performance Report: In General Collect CMS/Joint Commission data Collect CMS/Joint Commission data Heart attacks, CHF, pneumonia, surgical improvement Heart attacks, CHF, pneumonia, surgical improvement Collect quarterly data from hospitals Collect quarterly data from hospitals Specific patient level data allows research Specific patient level data allows research

10. Hospital Performance Report: Web Site Interactive web site allows sorting on county, individual hospitals Interactive web site allows sorting on county, individual hospitals Provides consumer resources and information Provides consumer resources and information Basis for other quality reports Basis for other quality reports www.nj.gov/health/hpr www.nj.gov/health/hpr www.nj.gov/health/hpr

11. Give visibility to public reports-press coverage Give visibility to public reports-press coverage Outreach to get visibility for web site Outreach to get visibility for web site Several grants to work with hospitals on quality improvement initiatives Several grants to work with hospitals on quality improvement initiatives Presentation at SHIP meetings Presentation at SHIP meetings Hospital Performance Report: Use of Information

12. Patient Safety Initiative Legislative requirements: Legislative requirements: –Mandatory reporting –Voluntary reporting –All licensed facilities Implemented for hospitals in 2005 Implemented for hospitals in 2005 Hospital submit events and RCAs Hospital submit events and RCAs

13. Patient Safety Initiative: Data Use NQF List for events Use NQF List for events Work with hospitals on performance Work with hospitals on performance Training and Newsletters Training and Newsletters Annual reports-aggregate Annual reports-aggregate www.nj.gov/health/ps www.nj.gov/health/ps

14. Hospital Associated Infections Reporting Based on broad legislative requirements Based on broad legislative requirements Strategy-quick regulatory process Strategy-quick regulatory process Begin data collection in 2009 Begin data collection in 2009 Begin public reporting in 2010 Begin public reporting in 2010

15. Infections Reporting: Changing Context Following national model-more consumer involvement Following national model-more consumer involvement Tension between hospital resources and pubic demand for information Tension between hospital resources and pubic demand for information Tentative solution Tentative solution

16. Infections Reporting: Technical Issues Use CDC’s NHSN national data warehouse Use CDC’s NHSN national data warehouse Gives states access to individual hospital data Gives states access to individual hospital data Work on hospital enrollment, training and validation issues Work on hospital enrollment, training and validation issues Resource issues Resource issues

17. Impact of NJ Reports Improvement in hospital performance scores and national ranking based on Jencks articles Improvement in hospital performance scores and national ranking based on Jencks articles Basis for work with hospitals on quality Basis for work with hospitals on quality CABG mortality decreases 54% between 1994 and 2004 CABG mortality decreases 54% between 1994 and 2004

18. On NJ Agenda Build mandated public reporting Build mandated public reporting Add quality reports to interactive site Add quality reports to interactive site Add measures/costs to interactive site Add measures/costs to interactive site Build awareness of information Build awareness of information Use for hospitals in financial distress Use for hospitals in financial distress

19. Issues to Consider Increasing acceptance of public reporting Increasing acceptance of public reporting Still not sure what consumers use Still not sure what consumers use Comprehensibility an issue Comprehensibility an issue Obvious that providers use Obvious that providers use Consider pay for performance Consider pay for performance

20. Additional Information Health Care Quality Assessment Office Health Care Quality Assessment Office www.nj.gov/health/healthcarequality www.nj.gov/health/healthcarequality