Selecting Indicators for Public Reporting: The Ohio Experience (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Michele Shipp, M.D., Dr.P.H., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1 MB).

Slide 1

Selecting Indicators for Public Reporting: The Ohio Experience

• AHRQ Annual Conference 2008
  AHRQ Quality Indicators (QI) Users Meeting
  Wednesday, September 9, 2008

• Hospital Measures Reporting in Ohio
  Michele Shipp, M.D., Dr.P.H.

Slide 2

Ohio Department of Health Hospital Performance Measures Selection

• Alvin Jackson, M.D.
  • Dr. Jackson, the Director of the Health Department, served as the Chair of the Hospital Measures Advisory Council
• Madelyn Dile, J.D.
  • Madelyn Dile—Assistant Chief for the Division of Quality Assurance—facilitated the meetings
• Jodi Govern, J.D.
  • Jodi Govern J.D., also at the Division of Quality Assurance, filled in in case of Madelyn's absence and facilitated the Infection Control Group meeting
• Kaliyah Shaheen, M.P.H.
  • Kaliyah Shaheen, Data Manager for the Division of Quality Assurance, was appointed by Dr. Jackson as his Data Expert and served as a member on the Data Expert Group along with serving as a member of the Infection Control Group and has been the contact for Council members. Also, Ms. Shaheen has been the main data person involved in the process at ODH; she also will be managing the reporting Web site

Slide 3

Background

No text

Slide 4

House Bill (HB) 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
  • The intent of the Bill has always been to assist with consumer decision-making through public reporting, and to promote transparency among hospitals.

Slide 5

HB 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)

Slide 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

Slide 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

Slide 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

Slide 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?

Slide 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?

Slide 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?

Slide 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

Slide 13

AHRQ: Patient Safety Indicators (PSIs)

• 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

Slide 14

AHRQ: Inpatient Quality Indicators

• The Data Expert Group recommended the following AHRQ Inpatient Quality Indicators for inclusion:
  • IQI-5: Coronary artery bypass graft (CABG) volume
  • IQI-6: Percutaneous transluminal angioplasty (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

Slide 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.

Slide 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

Slide 17

Hospital Reporting Beginning April 2007

• Postoperative Respiratory Failure:
  • Adult
  • Pediatric
• Iatrogenic Pneumothorax:
  • Adult
  • Pediatric
  • Neonate

Slide 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

Slide 19

Iatrogenic Pneumothorax—Pediatrics

• Pie chart representing 187 hospitals between October 1, 2006-September 30, 2007, indicates:
  • 0%—about two-thirds
  • No Cases—about one-sixth
  • Not Enough Cases—about one-sixth

Slide 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

Slide 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 Web site:
  • To be operational by January 2010

Slide 22

Thank You

• If you have any questions please contact Kaliyah Shaheen at 614-995-4982 or kaliyah.shaheen@odh.ohio.gov
• September 2008