1. Implications of Public and Private Reporting of Quality Data: Mechanisms for Driving Quality Improvement Deirdre E. Mylod, Ph.D. dmylod@pressganey.com Vice President, Public Policy Press Ganey Associates, Inc. June 27, 2006 dmylod@pressganey.com

2. Overview  Relationship between publicly benchmarked and private benchmark reports for measures of quality –Clinical, Safety, HCAHPS  Normative Rates of Change Year 1 to Year 2 for privately reported patient evaluations  Relationship between hospital characteristics and successful quality improvement using private reports  Relationship between hospital activities and quality improvement related to private measures of patient evaluations –Public Reporting of Leapfrog Data –Participation in IHI –Access and Use of Data

3. Private vs. Public Reporting Are the two related? Private patient surveys are related to public clinical measures at the hospital-level. Gesell, S.B., Clark, P.A., Mylod, D.E., Wolosin, R.J., Drain, M., Lanser, P., & Hall, M.F. (2005). Hospital-level correlation between clinical and service quality performance for heart failure treatment. Journal for Healthcare Quality, 27(6), 33-44.

4. Hospital-level correlation between heart failure patients’ overall satisfaction and percent of heart failure patients given assessment of left ventricular function. 100959085807570 Percent of Patients Given Assessment of Left Ventricular Function 90 85 80 75 70 Overall Patient Satisfaction N=31 r =.5 p <.01

5. Hospital-level correlation between heart failure patients’ overall satisfaction and percent of heart failure patients given discharge instructions. 100806040200 Percent of Patients Given Discharge Instructions 90 85 80 75 70 Overall Patient Satisfaction N=26 r =.6 p <.01

6. Private vs. Public Reporting Are the two related? Private patient surveys are related to public safety measures at the hospital-level.

7. Hospitals willing to publicly report to Leapfrog have significantly higher patient satisfaction in private patient reports. 82.7 84.0

8. Private vs. Public Reporting Are the two related? Private patient surveys are related to public patient surveys at the patient- and hospital-level. Mylod, D.E., & McCaffrey, K. (2006, March). Assessment of Convergent Validity of HCAHPS® Using the Press Ganey Inpatient Survey. Poster presented at the 10 th National CAHPS User Group Meeting, Baltimore, MD.

9. Private vs. Public Reporting

10. Hospital-level correlation between private patient surveys and public patient surveys N=67 1009590858075 Press Ganey Question Mean Score 10 9 8 7 HCAHPS Average Rating (0-10) Overall Rating of Care r =.9 p <.01

11. Normative Rates of Change- Five Year Outlook

12. Proportion of Hospitals Getting Better/Worse

13. Proportion of Hospitals Significant Change

15. How Much Change Do Hospitals See Quartile with greatest decline Quartile with biggest increase

16. Facility Characteristics Not Systematically Related to Change  No consistent relationships between propensity to change and: –Bed size –Teaching status –Region of the country

17. Facility Characteristics Related to Change  Starting Performance –Hospitals with lower patient satisfaction are more likely to improve.  Patient Safety Journey –Hospitals that are wiling to submit data to Leapfrog are more likely to improve. –Hospitals active in their quality improvement journey toward safer care (IHI 100k).  Active Use of Patient Survey Data –Hospitals that analyze access online data more frequently, generate more reports and give more users permission to use data improve more over a year.

18. With private patient surveys, the lower a hospital scored in 2004, the more likely it was to improve by 2005. 4321 2004 Quartile 0.75 0.50 0.25 0.00 -0.25 -0.50 Mean Difference Error bars: 95% CI

19. Willing to Submit Data to Leapfrog

20. Hospitals identified by Leapfrog as showing Good Early Stage Effort achieve more positive change, and almost no negative change, in private patient surveys (2004-2005). Fully ImplementedGood ProgressGood Early StageWilling to ReportDid Not Disclose 1.0 0.8 0.6 0.4 0.2 0.0 -0.2 Mean Difference Error bars: 95% CI

21. In the presence of not being the best in patient satisfaction, willingness to report to Leapfrog is associated with more positive change in patient satisfaction.

22. 100k Hospitals More likely to have significant improvement and less likely to have significant decline

23. Hospitals that access their private patient survey data via an online analysis tool more, improve more over one year. 1151+551-1150201-5500-200 Total Number of Logins 0.6 0.4 0.2 0.0 -0.2 Mean Difference

24. Hospitals that generate more custom reports of their private patient survey data, improve more over one year. 1001+451-1000201-4500-200 Number of Custom Reports 0.4 0.3 0.2 0.1 0.0 Mean Difference

25. Hospitals that give permission to more staff members to access to the private patient survey data, improve more over one year. 76+51-7521-500-20 Number of Users 0.6 0.4 0.2 0.0 -0.2 Mean Difference

26. Next Steps: Prospective Study of Characteristics of Culture and Activities Linked To Change  Overarching Framework –Culture-wide concern/commitment about performance –Culture of transparency –Ongoing, in-depth analysis of data (not just collection) –Behaviorist assessment of uses of feedback –Infrastructure for quality improvement –Activities of quality improvement