1. Hospital Measures Reporting in Ohio Michele Shipp, MD, DrPH AHRQ QUALITY INDICATORS USERS MEETING Wednesday September 9, 2008 AHRQ ANNUAL CONFERENCE 2008 Selecting Indicators for Public Reporting: The Ohio Experience

2. Hospital Performance Measures Selection Ohio Department of Health Alvin Jackson, MD Madelyn Dile, JD Jodi Govern, JD Kaliyah Shaheen, MPH

3. BACKGROUND

4. HOUSEBILL 197  HB 197 became law in November 2006 Requires Ohio hospitals to report performance measure data to the Ohio Department of Health for the purpose of public reporting

5. HOUSEBILL 197 Required Measure Sets Centers for Medicare and Medicaid Services (CMS) The Joint Commission (JC) National Quality Forum (NQF) endorsed measures Agency for Healthcare Research and Quality (AHRQ )

6. Creation of Advisory Council A Hospital Measures Advisory Council was created by statute and consisted of:  Director of Health (Council Chair)  Two members of the House of Representatives  Two members of the Senate  Superintendent of Insurance  Executive Director of the Commission on Minority Health  Representatives from several agencies

7. Creation of other Groups Mandated Groups  A Data Expert Group  An Infection Control Group Ad Hoc Groups  The Advisory Council created Pediatric and Perinatal workgroups

8. Process for Measures Selection  Data Expert Group monthly meetings  Creation of set criteria as guidelines  Examination of measure specifications  Selection of measures  Recommendations to Advisory Council on selected measures * Measures related to Adult care, Chronic Diseases, Patient Safety – Slide 9

9. Measure Selection Criteria  Importance  Do the measures reflect unequivocally important aspects of patient care?  Preventability  Can a poor score be prevented through proper care?  Is excess variation in the data accounted for by factors unrelated to hospital quality?  Genuine quality improvement  Can a hospital’s rate be improved without improving quality?

10. Measure Selection Criteria (cont.)  Data integrity  Can a hospital accurately collect the data from its records?  Does the measure adequately measure the construct it attempts to measure?  Ability to publicly report  Is the measure of use to consumers?  Is the measure comprehensible to consumers?  Do hospitals have a sufficient case load to accurately report quality?  Burden  Does calculating the measure place undue burden on hospitals?

11. Measure Selection Criteria (cont.)  Evidence-based  Is there scientific research demonstrating the accuracy and importance of the measure?  Variance  Is there sufficient variability in performance among hospitals to allow for comparison?  National Quality Forum endorsement  Is the measure endorsed by the National Quality Forum?

12. Overview of Selected Measures  All measures from 4 required sources considered  Total of 84 measures were recommended to the Advisory Council  47 CMS measures  17 AHRQ measures  10 JC measures  10 Infection measures

13. AHRQ: Patient Safety Indicators  The Data Expert Group recommended the following AHRQ Patient Safety Indicators to the Advisory Council PSI-1: Complications of Anesthesia PSI-3: Decubitus Ulcer PSI-5: Foreign Body Left During Procedure PSI-9: Postoperative Hemorrhage or Hematoma PSI-16: Transfusion Reaction PSI-17: Birth Trauma—Injury to Neonate PSI-18: Obstetric Trauma– Vaginal Delivery with Instrument PSI-19: Obstetric Trauma—Vaginal Delivery without instrument PSI-20: Obstetric Trauma—Cesarean Delivery

14. AHRQ : Inpatient Quality Indicators  The Data Expert Group recommended the following AHRQ Inpatient Quality Indicators for inclusion IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate IQI-21: Cesarean Delivery Rate IQI-22: Vaginal Birth after Cesarean Rate, Uncomplicated IQI-33: Primary Cesarean Delivery Rate IQI-34: Vaginal Birth after Cesarean Rate, All

15. AHRQ: Recommended Measures  After consideration and voting by the Advisory Council, 7 of the 17 AHRQ measures were recommended to the Director of Health for public reporting PSI -1: Complications of Anesthesia PSI-3: Decubitus Ulcer PSI-5: Foreign Body Left During Procedure IQI-5: CABG volume IQI-6: PCTA volume IQI-12: CABG mortality rate IQI-30: PCTA mortality rate  If passed through the rule making process hospitals will begin reporting these measures in late 2009

16. Current Hospital Reporting in Ohio  April 2007 Hospital reporting start date by HB 197  ODH selected 11 measures for interim reporting  2 of these measures were from AHRQ  Reporting done April and October 2007, 2008

17. Hospital Reporting Beginning April 2007 Postoperative Respiratory Failure Adult Pediatric Iatrogenic Pneumothorax Adult Pediatric Neonate

18. Current Reporting Feedback from Hospitals  Postoperative Respiratory Failure  Ohio has found the numbers are too small for Iatrogenic Pneumothorax and may not be the best measure for the purpose of public reporting Only 2 hospitals in the adult category and 1 hospital in the neonatal category had reportable data

19. Iatrogenic Pneumothorax - Pediatrics October 1, 2006 – September 30, 2007 187 hospitals

20. Other Measures Currently Being Reported  Aspirin at Arrival for Acute Myocardial Infarction  Beta Blocker at Arrival for Acute Myocardial Infraction  Pneumococcal Vaccination for Pneumonia  Blood Culture before Initial Antibiotic for Pneumonia  ACEI or ARB Left Ventricular Systolic Dysfunction for Heart Failure  Evaluation of Left Ventricular Systolic function for Heart Failure

21. Next Steps  Adopt rules reflecting recommended measures  Six to nine month process Public comment period Public hearing  Reporting of new measures to begin no earlier than October 2009  Development of the consumer website To be operational by January 2010

22. If you have any questions please contact Kaliyah Shaheen at 614-995-4982 or kaliyah.shaheen@odh.ohio.govkaliyah.shaheen@odh.ohio.gov September 2008 Thank You Questions??