Mortality Measurement: Slide Presentation (Text Version)

Next Steps and Potential Research Studies to Accelerate Adoption of a National Mortality Measure (Text Version)

On November 3, 2008, Evan Benjamin and Eugene Nelson made this presentation at the 2008 Annual Conference. Select to access the slide presentation (PDF File, 3.1 MB).

Slide 1

Research Questions to Accelerate Adoption

Evan Benjamin, M.D.
Vice President, Healthcare Quality, Baystate Medical Center
Associate Professor, Tufts University

Eugene Nelson, D.Sc., M.P.H.
Director of Quality Administration
Dartmouth Hitchcock Medical Center
Professor, Clinical Leadership Improvement
The Dartmouth Institute

Slide 2

Topics

• National Quality Forum's (NQF) Framework for Metric Evaluation
• Some Research Questions
• Improvement Equation
• Your Ideas for Research Questions

Slide 3g

NQF Framework for Metric Evaluation

1. Importance:
   • Variation in quality
   • Low levels of performance
   • Key leverage point in improving quality
2. Scientific Acceptability:
   • Well defined
   • Reliable
   • Valid
   • Precise
   • Adaptable
   • Risk adjusted
   • Process linked to outcome

Slide 4

NQF Framework for Metric Evaluation

3. Usability:
   • Can be used to make decisions
   • Statistically meaningful
   • Clinically meaningful
   • Dissemination strategy in place
   • Fosters Improvement
4. Feasibility:
   • Cost of measurement
   • Timing, frequency specified
   • Auditing strategy
   • Confidentiality

Slide 5

NQF Framework for Metric Evaluation

1. Importance:
   • Variation in quality
   • Low levels of performance
   • Key leverage point in improving quality

4. Feasibility:
   • Cost of measurement
   • Timing, frequency specified
   • Auditing strategy
   • Confidentiality

Slide 6

Research Questions to Accelerate Adoption Using NQF Framework

2. Scientific Acceptability:
   • Validity:
     • Is mortality data a marker of other meaningful aspects of care?
       • Adverse events?
       • Errors?
       • Processes of care? (Hospital Quality Alliance [HQA], Hand hygiene, ventilator-associated pneumonia [VAP])
       • Complications? (Patient Safety Indicators [PSIs], Healthcare Associated Infections [HAIs])

Slide 7

Research Questions to Accelerate Adoption Using NQF Framework

2. Scientific Acceptability:
   • Precision:
     • Can mortality data discriminate real differences in performance? (positive predictive value of poor performer identification)
     • Can mortality data reflect more than random variation?
     • What is the concordance between the models?

Slide 8

Research Questions to Accelerate Adoption Using NQF Framework

2. Scientific Acceptability:
   • Reliability:
     • Are the data reliable within an organization? (accurately distinguish complications from comorbidities)
     • Are the data reliable across organizations? (documentation and coding consistency)

Slide 9

Research Questions to Accelerate Adoption Using NQF Framework

3. Scientific Acceptability:
   • Risk Adjustment: Can we...
     • Understand the issue of differences in coding for palliative care?
     • Improve the capture of severity with more clinical data?

Slide10

Research Questions to Accelerate Adoption Using NQF Framework

3. Usability:
   • Are differences in performance clinically meaningful?
   • Are differences in performance statistically meaningful?

Slide 11

Research Questions to Accelerate Adoption Using NQF Framework

3. Usability:
   • Fosters Improvement:
     • Can providers use the data to make decisions?
     • How can the data be converted into actionable improvement?
     • Can the data be used to engage staff in improvement?
     • How can drill down capability be used for improvement?
   • Unintended Consequences:
     • What are the unintended consequences of a national mortality measure?

Slide 12

Improvement Equation

Generalizable Medical Evidence plus Specific Context leads to Measured Improvement

Examples of generalizable medical evidence include E-B interventions: clinical, safety, reliability. An example of a specific context is a hospital. An example of measured improvement is a mortality metric.

A complementary framework for developing research questions.

Slide 13

A Research Agenda…More Ideas?

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