1 © 2004 TMIT IHI National Quality Forum Charles Denham, MD Franck Guilloteau Carol Ferguson, RN...

1© 2004 TMIT

IHI National Quality Forum

Charles Denham, MDFranck Guilloteau

Carol Ferguson, RN

Leapfrog NQF Safe Practices Survey:A Road Map to Patient Safety and Market Success

2© 2004 TMIT

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Leapfrog NQF Safe Practices Survey

• The Present – P-4-P Tsunami

• Leapfrog NQF Leaps

• NQF Survey Early Results

• Submitter’s Toolbox & Research Test Bed

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The Facts: Where are we?

Facts Regarding Harm and Adverse Events:

• From 98,000 to 195,000 deaths – little progress in 5 yrs1

• From 1 out of 4 admissions have an ADE2

Facts Regarding JCAHO:

• Extremely Negative GAO Report on JCAHO3

• Federal Bills Moving Power From JCAHO to CMS4-5

Sources:1.HealthGrades Quality Study: Patient Safety in American Hospitals. July, 2004.2.Rozich JD, Haraden CR, Resar RK. Adverse Drug Event Trigger Tool: A Practical Methodology for

Measuring Medication Related Harm. Quality and Safety in Healthcare. 2003;12:194-200.3.U.S. Government Accountability Office. CMS Need Additional Authority to Adequately Oversee Patient

Safety in Hospitals. Washington, D.C. July, 2004.4.H.R. 4877, Sponsored by Fortney Pete Stark (D-CA), Introduced 07/20/04.5.S. 2698, Sponsored by Charles E. Grassley (R-IA), Introduced 07/20/04.

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U.S. News & World Report

November 8, 2004How to Be a Smart

Patient

Modern HealthcareNovember 1, 2004

Patient Safety Proves Elusive

Wall Street JournalNovember 5, 2004FDA Plans Major

Review of Procedures

Modern HealthcareNovember 1, 2004

Rurals May Lose in Quality Quest

Institute of MedicineNovember 1, 2004Quality Through

Collaboration: The Future of Rural Health Care

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Modern PhysicianNovember 15, 2004Quality Group Calls

Meeting on Establishing Benchmarks

Kaiser Family Foundation, AHRQ, Harvard School of

Public HealthNovember 17, 2004

Five Years After IOM Report, Half of Consumers

Worry About Safety of Health Care

New England Journal of MedicineNovember 11, 2004Improving Patient

Safety – Five Years after the IOM Report

Wall Street JournalNovember 17, 2004

Hospitals Make Fewer Errors, But all

Short on Safety Goals

Leapfrog GroupNovember 16,

2004Survey Results

Published

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Facts Regarding Personal Adverse Event Experience:

• 4 out of 10 consumers experienced harm or death.

• More than 1 out of 3 physicians have a family member who experienced harm or death.

• Little progress since first IOM Report in 1999.

Source: Blendon RJ, DesRoches CM, et al. Views of Practicing Physicians and the Public on Medical Errors. NEJM 2002;347:1933-40.

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Physician and Consumers Family Experience: Breakdown of Adverse Events

42%

35%

24%

28%

13%

10%

5%

7%

Physicians

Public

TotalTotal

Serious Health Serious Health ConsequencesConsequences

Minor Health Minor Health ConsequencesConsequences

No Health No Health ConsequencesConsequences


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Significant loss of time at work, school, or other important life

activities17%

12%

16%

11%

12%

8%

11%

6%

10%7%

Severe pain

Temporary disability

Long-term disability

Death

Physicians

Public

Physician and Consumers Family Experience: Breakdown of Adverse Events with “Serious Consequences”


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Facts Regarding Evidence-Based Medicine:

• Less than 25% of care by physicians is substantiated by evidence in the literature.1

• Even when best practices are established in the literature, less than 55% of U.S. care is delivered using such best practices2

Sources1.Research on the delivery of medical care using hospital firms. Proceedings

of a workshop. April 30 and May 1, 1990, Bethesda, MD. Med Care, 1991;29(7 Suppl):JS1-70.

2.McGlynn EA, et al. Quality of Health Care Delivered to Adults in the United States. NEJM, 2003;348(26):2635-45.

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Facts Regarding Innovation Adoption:

• 17-year average adoption rate when evidence is established in the literature1

• Reimbursement single most important accelerator


Source1.Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer, 2000:65-70.

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Original researchOriginal research

PublicationPublication

AcceptanceAcceptance

SubmissionSubmission

Bibliographic databasesBibliographic databases

Reviews, guidelines, textbookReviews, guidelines, textbook

ImplementationImplementation

48%48%

46%46%

35%35%

50%50%

Negative Negative resultsresults

Negative Negative resultsresults

Lack of Lack of numbersnumbers

Inconsistent Inconsistent indexingindexing

variablevariable

0.5 year0.5 year

0.6 year0.6 year

0.3 year0.3 year

6-13 years6-13 years

9.3 years9.3 years

Kumar, 1992Kumar, 1992

Kumar, 1992Kumar, 1992

Poyer, 1982Poyer, 1982

Antman, 1992Antman, 1992

Dickersin, 1987Dickersin, 1987

Koren, 1989Koren, 1989

Balas, 1995Balas, 1995

Poynard, 1985Poynard, 1985

It takes 17 years to implement 14% of original It takes 17 years to implement 14% of original research as evidence-based medicineresearch as evidence-based medicine

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Overall Perceptions

55%

44%

2004 2000*

Percent who say they are dissatisfiedwith the quality of health care in this country…

4%

40%

38%

17%

Gottenworse

Gottenbetter

Stayedabout the same

Don’tKnow

* Gallup Poll conducted September 11-13, 2000 with 1,008 U.S. adults.

Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2004)

Has the quality of health care in this country…

25© 2003 TMIT

Which comes closer to your view…

19962004 2002

27%

69%

27%

67%

36%

59%

Friends and familydon’t have enough

knowledge andexperience to provide

good information abouthealth plans

The opinions of friendsand family are a goodsource of information

about health plans

Employers are a goodsource of information about

the quality of differenthealth plans because they

examine plans closely whendeciding which ones to

offer

Employers are NOT a goodsource of information

about the quality of healthplans because their main

concern is saving thecompany money

58%

36%

61%

29%

69%

25%

Note: “Don’t know” responses not shown


Sources Of Information On Quality

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• Leapfrog NQF Leap



27© 2004 TMIT

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Safe Practice Background

• “National Quality Forum Safe Practices for Better Healthcare: A Consensus Report” was developed to help standardize evidence-based safe practices of care.

• The Leapfrog NQF Safe Practices ‘Leap’ is using these safe practices to survey hospital performance

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NQF Safe Practices for Better Healthcare: A Consensus Report

• 30 Safe Practices

Criteria for Inclusion• Specificity• Benefit• Evidence of

Effectiveness• Generalization• Readiness

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The Leapfrog NQF Safe Practices ‘Leap #4’

• NQF endorsed 30 high-priority Safe Practices to be universally applied in relevant clinical care settings

• Includes Leapfrog’s initial 3 safe practices

• Leapfrog will now assess hospitals’ progress on the remaining 27 safe practices

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Development of this New Survey

• Survey Tool developed by Texas Medical Institute of Technology (TMIT)

• 27 practices weighted according to patient safety impact, combined into a single score (1,000)

• Relative ranking compared to other hospitals - placed into quartiles

• First Public Results to be released in mid-July 2004

© 2003 TMIT Leapfrog Survey 1.0. 31 11.17.03 1600 CT

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Enterprise-wide System

# Practice Final Weighting out of 1,000 points

1 Create Safety Culture 263

3 Ensure Adequate Nursing Workforce 119

SUBTOTAL 382

Enterprise-wide Process

6 Verbal Order Readback 36

7 Standardized Abbrev./Doses 17

8 No Pt Care Summaries from Memory 17

9 Pt Care Info/Orders to all Providers 84

SUBTOTAL 154

TOTAL ENTERPRISE-WIDE 536

Clinical Care Setting or Function Specific

5 Pharmacist Active in Med Use 32

10 Pt Readback of Informed Consent 9

11 Document Resusc./End of Life/ Directives 12

13 Prevention of Mislabeled Radiographs 16

14 Wrong-site/Wrong-patient Prevention 30

15 Prophylactic Beta Blockers for Elective Surgery 23

16 Pressure Ulcer Prevention 28

17 DVT/VTE- Risk Assessment & Prevention 27

18 Anticoagulation Services 39

19 Aspiration Prevention 24

20 Central Venous Line Sepsis Prevention 33

21 Surgical Site Infection/AB Prophylaxis 37

22 Contrast-induced Renal Failure Protocol 12

23 Malnutrition Prevention 12

24 Tourniquet—Ischemia/Thrombosis Prevention 9

25 Hand Washing 33

26 Flu Vaccination for HC Workers 11

27 Optimize Medication Workspaces 7

28 Optimize Med. Storage/Pkg/Labeling 22

29 I.D. High Alert Medications 21

30 Med. Unit Dosing/Unit-of-Use Dispensing 29

SUBTOTAL 465

27 NQF Safe Practices Weighting Results

1,000 Points Applied to27 Practices

Weighted IndividuallyHospitals Nationally

Ranked


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Enterprise-wide System

# Practice Final Weighting out of 1,000 points

1 Create Safety Culture 263

3 Ensure Adequate Nursing Workforce 119

SUBTOTAL 382

Enterprise-wide Process 6 Verbal Order Readback 36

7 Standardized Abbrev./Doses 17

8 No Pt Care Summaries from Memory 17

9 Pt Care Info/Orders to all Providers 84

SUBTOTAL 154

TOTAL ENTERPRISE-WIDE 536



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Clinical Care Setting or Function Specific5 Pharmacist Active in Med Use 32

10 Pt Readback of Informed Consent 9

11 Document Resusc./End of Life/ Directives 12

13 Prevention of Mislabeled Radiographs 16

14 Wrong-site/Wrong-patient Prevention 30

15 Prophylactic Beta Blockers for Elective Surgery 23

16 Pressure Ulcer Prevention 28

17 DVT/VTE- Risk Assessment & Prevention 27

18 Anticoagulation Services 39

19 Aspiration Prevention 24

20 Central Venous Line Sepsis Prevention 33



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Clinical Care Setting or Function Specific21 Surgical Site Infection/AB Prophylaxis 37

22 Contrast-induced Renal Failure Protocol 12

23 Malnutrition Prevention 12

24 Tourniquet—Ischemia/Thrombosis Prevention 9

25 Hand Washing 33

26 Flu Vaccination for HC Workers 11

27 Optimize Medication Workspaces 7

28 Optimize Med. Storage/Pkg/Labeling 22

29 I.D. High Alert Medications 21

30 Med. Unit Dosing/Unit-of-Use Dispensing 29

SUBTOTAL 465


© 2003 TMIT Leapfrog Survey 1.0 11.17.03 1600 CT

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1. Compliment the NQF Safe Practices Report (May 2003): The survey, weighting system, and ranking system designs are explicitly tied to the problem areas and practices defined by the NQF report. Recognizing the challenges of tying standards, measures, or practices to a report that is written at a snapshot in time, the survey, weighting, and ranking systems take into account that new evidence and refinement of performance improvement methods are being generated all the time. Patient safety is an emerging science and is constantly evolving. Therefore, the guiding principles included focus on the excellent list of safety problems being targeted by NQF practices and apply the “4 A Framework” below. The “4 A Framework” provides real flexibility of interpretation and provides a means of providing partial credit for partial progress and partial credit for commitment to progress. Although the survey will undergo refinement through public review and optimization by our subject matter experts, the design will be kept intact in order to make the survey fair and reasonable. The goal is to neutralize the challenges of explicitly tying questions to specific language of practices that are evolving while staying well within the scope of the NQF report.

2. Partial Credit for Partial Progress: The questions were designed using a “select any that apply” response giving hospitals numerous opportunities for partial credit. Once significant public input is provided, a set of FAQs will be provided for each question to assure that respondents will have clarity regarding what will qualify for credit on a question specific basis.

3. Partial Credit for Commitment: Many of the questions provide partial credit to organizations that make substantial commitment to get started. This will help those that may be “behind the safety curve”. The intent is to provide a clear roadmap to organizations that have heretofore not prioritized safety. These questions are also intended to provide fairness in areas where patient safety issues have not been well publicized.

4. Systematic Application of 4A Framework : The 4A framework recognizes the sequential and interdependent nature of awareness of our performance opportunities, accountability of leadership, the ability to employ practices, and measurable action towards closing performance gaps. This “4A Framework” (updated from a 3 A framework published by C. Denham in 2001) was used as an organizational structure to allow systematic customization of survey questions.

Awareness: Clearly, the leaders of an organization must be aware of performance problems before they can make any impact on them. The concept of THE problem or performance opportunity addresses the awareness by hospitals that there is evidence to support a common problem across all hospitals. The concept of OUR problem addresses awareness of the frequency and severity of adverse events to our patient population within our organization and recognition of the impact that practices or performance improvement methods can have on those adverse events. Awareness of THE performance opportunities and OUR performance opportunities are addressed in a relatively standardized manner in each survey question, however they were customized to each problem depending on the current state of awareness in the community.

Accountability: A critical success factor to patient safety is accountability of the leadership to performance. Whether the mechanisms of personal performance reviews or performance compensation incentives are used, sustained gains in patient safety frequently do not occur without personal accountability of the leaders. This issue was addressed in a relatively standardized way throughout the survey, however the questions were fine tuned to the scope or care setting addressed by the practice.

Ability: An organization may be aware of THE problem – a performance gap common to most hospitals. In fact they may be aware of OUR problem (their own) with clear evidence of frequency and severity of adverse events in their own patient population. They may even have awareness of the impact of a given practice, however if they do not invest in education or skill development and more importantly allocate real protected staff time and dollars to a given problem, the impact on safety is modest at best. Adding a patient safety responsibility to an already overloaded employee without carving out the time and providing them the necessary financial resources to make an impact sends a clear message to the organization. The “ability” related survey questions employ a graduated set of investment levels ranging from investment in education, skill development (training regarding the application of practices or performance improvement methods), dedicated HR, and dedicated line item budget allocations.

Actions: Action activities were tied to the NQF cited best practices language as appropriate. Where there have been great strides in best practices, the survey questions provide latitude for activities deserving credit. A set of FAQs will be tied to each survey question that will provide guidance as to what activities may qualify for credit, especially if certain developments in patient safety have been substantiated in the literature after publication of the NQF report. Performance Improvement programs and project actions were given high emphasis, as such, these programs will require thorough literature reviews and examination of readily available practices be undertaken. Such initiatives would include but not limited to the NQF practices especially if there were new high impact actions that target the problems listed in the NQF report. Far more important than attestations of compliance to procedures, policies, and protocols are ongoing programs that have regular measurement and process improvement elements.

5. Sensitivity to use of the word “Problem”: Risk managers at hospital organizations have expressed concern over the use of the word “problem”, therefore wherever possible the term “performance opportunity” was used in the survey in place of the word “problem”. That is not to say the word problem is not used appropriately in the NQF report. It is.

What Guiding Principles were used to design the 1.0 Survey Questions?

1. Compliment the NQF Safe Practices Report (May 2003): • The survey, weighting system, and ranking system designs are

explicitly tied to the problem areas and practices defined by the NQF report.

• Recognizing the challenges of tying standards, measures, or practices to a report that is written at a snapshot in time, the survey, weighting, and ranking systems take into account that new evidence and refinement of performance improvement methods are being generated all the time.

• Patient safety is an emerging science and is constantly evolving. The goal is to neutralize the challenges of explicitly tying questions to specific language of practices that are evolving while staying well within the scope of the NQF report.


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2. Partial Credit for Partial Progress:• The questions were designed using a “select any that apply”

response giving hospitals numerous opportunities for partial credit. Once significant public input is provided, a set of FAQs will be provided for each question to assure that respondents will have clarity regarding what will qualify for credit on a question specific basis.

3. Partial Credit for Commitment: • Many of the questions provide partial credit to organizations

that make substantial commitment to get started. This will help those that may be “behind the safety curve”. The intent is to provide a clear roadmap to organizations that have heretofore not prioritized safety. These questions are also intended to provide fairness in areas where patient safety issues have not been well publicized.


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4. Systematic Application of 4 A Framework:

• The 4A framework recognizes the sequential and interdependent nature of awareness of our performance opportunities, accountability of leadership, the ability to employ practices, and measurable action towards closing performance gaps. This “4A Framework” (updated from a 3 A framework published by C. Denham in 2001) was used as an organizational structure to allow systematic customization of survey questions.

© 2003 HCC Corporation

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hccarchive\fdtncomp\communication\tools\

template\topdown.pot

OUR PROBLEM

AWARENESS

THE PROBLEM

EvidenceOf Education

Commitmentto Educate

Commitment To Measure and Report To Admin

Measured Events with Opportunity

Report To Admin

In Strategic/Ops Plan

Commit To Strategic/Ops Plan

ABILITY

Commit to Invest in Education

Commit to Invest in Skills

Commit to Dedicated HR

Commit to Budget

Invest in Education

Invest in Skills

Dedicated HR

Line Item Budget

ACTION

Commit to Performance Improvement Program


Commit to Clinical Functional Unit wide, Department-wide Service Line wide PI Program

Commit to Enterprise-wide PI Program OR Rigorous Practice Implementation

Basic Level of Practice Actions

Intermediate Level of Practice Actions

Enterprise-wide PI Program OR Rigorous Practice Implementation

Clinical Functional Unit wide, Department-wide Service Line wide PI Program

BOARD

DEPT HEAD

SR. EXECs

CEO

ACCOUNTABILITY

Commitment toDept. Head Accountability

Commitment toExec.s Accountability

Commitment toCEO Accountability

Commitment toReport Board

• The 4 A Framework provides a graduated scale of options for to Awareness, Accountability, Ability, and Action.

• The survey design was intended to deliver partial credit for partial progress in each of the 4 A categories.

• Partial credit for commitment is provided not only to help stratify the respondents but to create a Hawthorne effect: to encourage commitment through participation in the survey and recognition that a hospital organization could increase its score by making a commitment at the time of survey response.

• The Rural Hospital Task Force will apply the 4 A Framework to the first 3 Leapfrog Leaps. The objective is to create a fair and reasonable set of survey questions to address the unique characteristics of rural hospitals.

4 A Framework

Confidential – Not to be distributed


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OUR PROBLEM

THE PROBLEM

ABILITY




Commit to Budget

Invest in Education

Invest in Skills

Dedicated HR

Line Item Budget

ACTION









BOARD

DEPT HEAD

SR. EXECs

CEO

ACCOUNTABILITY





AWARENESS





Report To Admin




AWARENESS




Measured Events with Opportunity Report To Admin



OUR PROBLEM

THE PROBLEM


40

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OUR PROBLEM

THE PROBLEM

ABILITY




Commit to Budget

Invest in Education

Invest in Skills

Dedicated HR

Line Item Budget

ACTION









AWARENESS





Report To Admin




BOARD

DEPT HEAD

SR. EXECs

CEO


ACCOUNTABILITY

Commitment toDept. Head

Accountability

Commitment toCEO

Accountability



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OUR PROBLEM

THE PROBLEM

ACTION









AWARENESS





Report To Admin




ACCOUNTABILITY





ABILITY




Commit to Budget

Invest in Education

Invest in Skills

Dedicated HR

Line Item Budget


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ABILITY




Commit to Budget

Invest in Education

Invest in Skills

Dedicated HR

Line Item Budget

OUR PROBLEM

THE PROBLEM

AWARENESS





Report To Admin




ACCOUNTABILITY





ACTION









43© 2004 TMIT

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44© 2003 TMIT

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45© 2004 TMIT

NQF Survey Preliminary ResultsNQF Survey Preliminary ResultsNQF Survey Preliminary ResultsNQF Survey Preliminary Results

• Overall number of survey respondents: 1,019

• Number of NQF Survey Respondents: 893

• NQF Survey Respondent Percentage: 88%

• 75% Non Profit – 25% For Profit

• Report to be Published 2nd Quarter of 2005

• Overall number of survey respondents: 1,019

• Number of NQF Survey Respondents: 893

• NQF Survey Respondent Percentage: 88%

• 75% Non Profit – 25% For Profit

• Report to be Published 2nd Quarter of 2005

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46© 2004 TMIT


0

50

100

150

200

250

300

350

400

<100 100-299 300-499 500<

Bed Size

47

47© 2004 TMIT


• 7 in 10 hospitals require a pharmacist to review all medication orders before medication is given to patients.

• 8 in 10 hospitals have implemented procedures to avoid wrong-site surgeries

• 7 in 10 report they do not have an explicit protocol to ensure adequate nursing staff,

• 7 in 10 do not have policy to check with patients to make sure they understand the risks of their procedures

• 7 in 10 hospitals require a pharmacist to review all medication orders before medication is given to patients.

• 8 in 10 hospitals have implemented procedures to avoid wrong-site surgeries

• 7 in 10 report they do not have an explicit protocol to ensure adequate nursing staff,

• 7 in 10 do not have policy to check with patients to make sure they understand the risks of their procedures

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48© 2004 TMIT


• 6 in 10 lack procedures for preventing malnutrition in patients

• 5 in 10 report they do not have procedures in place to prevent bed sores (pressure ulcers)

• 4 in 10 hospitals lack policies requiring workers to wash their hands with disinfectant before and after seeing a patient.

• 6 in 10 lack procedures for preventing malnutrition in patients

• 5 in 10 report they do not have procedures in place to prevent bed sores (pressure ulcers)

• 4 in 10 hospitals lack policies requiring workers to wash their hands with disinfectant before and after seeing a patient.

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49© 2004 TMIT

Are we moving the “Needle”Are we moving the “Needle”Are we moving the “Needle”Are we moving the “Needle”

• Overall Commitment Ratio: 9.6%

• For Profit Commitment slightly higher

• Commitment Ratio by Quartile:- Quartile 1: 7.1%- Quartile 2: 9.2%- Quartile 3: 12.4%- Quartile 4: 13.3%

• Overall Commitment Ratio: 9.6%

• For Profit Commitment slightly higher

• Commitment Ratio by Quartile:- Quartile 1: 7.1%- Quartile 2: 9.2%- Quartile 3: 12.4%- Quartile 4: 13.3%

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50© 2004 TMIT


• Commitment Ratios for Key Safe Practices:

- SP 1 (Create Safety Culture): 5.4%- SP 3 (Ensure Adequate Nursing Workforce): 5.4%- SP 9 (Pt Care Info/Orders to all Providers): 8.4%- SP 18 (Anticoagulation Services): 6.5%

• Commitment Ratios for Key Safe Practices:

- SP 1 (Create Safety Culture): 5.4%- SP 3 (Ensure Adequate Nursing Workforce): 5.4%- SP 9 (Pt Care Info/Orders to all Providers): 8.4%- SP 18 (Anticoagulation Services): 6.5%

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51© 2004 TMIT

NQF Survey Preliminary ResultsNQF Survey Preliminary Results

• Safe Practices with High Commitment Ratios:

- SP 15 (Prophylactic Beta Blockers for Elective Surgery): 56.5%

- SP 17 (DVT/VTE - Risk Assessment & Prevention): 45.7%

- SP 19 (Aspiration Prevention): 26.3%- SP 24 (Tourniquet - Ischemia/Thrombosis

Prevention): 23.8%- SP 23 (Malnutrition Prevention): 21.1%

• Safe Practices with High Commitment Ratios:

- SP 15 (Prophylactic Beta Blockers for Elective Surgery): 56.5%

- SP 17 (DVT/VTE - Risk Assessment & Prevention): 45.7%

- SP 19 (Aspiration Prevention): 26.3%- SP 24 (Tourniquet - Ischemia/Thrombosis

Prevention): 23.8%- SP 23 (Malnutrition Prevention): 21.1%

53© 2003 TMIT

19%

12%

27%

15%

23%

35%

11%

22%

28%

9%

20002004

Hospitals

Health InsurancePlans

Doctors

Percent who say they saw information inThe past year comparing quality among…

Percent who say they saw informationOn ANY of the above…

Percent who say they saw qualityinformation in the past year and usedthis information to make health caredecisions…


Exposure To And Use Of Quality Information

54© 2003 TMIT

Percent of Americans who say they would prefer a…

2004 2000 1996

48% 46%50%

38%

76%

20%

Surgeon whohas treated

friends/family

Surgeon that israted higher

Planrecommended

by friends

Plan highlyrated byexperts

Hospital thatIs familiar

Hospital that israted higher

61%

33%

62%

32%

72%

25%

45%49%47% 45%

52%

43%


Note: “Don’t know” responses not shown

Relative Importance Of Quality Ratings

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Purchaser Initiatives

Founded by the Business Roundtable with support from the Robert Wood Johnson Foundation

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Incentive & Reward Programs Growing

78 programs in Leapfrog Compendium – http://www.leapfroggroup.org/ircompendium.htm

Search & sort by state, target & program structure

– 16 programs include Leapfrog measures

– 42 programs target physicians

– 22 programs target hospitals

– 6 programs target consumers

Funded by Commonwealth Fund

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Rewards Principles

Top performers get increased market share through patient shift (co-pay/co-insurance differentials) and/or bonuses

Other groups will get bonuses when they improve performance by moving up a group

Rewards for top performers at baseline will kick in after second reporting period if they are still in the top cohort

Rewards for all others will kick in after second consecutive reporting of sustained improvement or continued improvement

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Incentives & Rewards Include Both Direct Financial Rewards and Market-Share Shift

% of Contracted Payment

Top Performance Bonus 2.00%

Improvement BonusCohort 3 to Cohort 2 1.25%Cohort 4 to Cohort 3 0.50%

% of Contracted Payment

3.00%

Hospital Incentive Patient Incentive*(Co-insurance reduction)

+

62© 2004 TMIT TMIT

AssessCollect SubmitPlanPrepare

Stage 1: Prepare

• Obtain hard copy or digital PDF version of the NQF Safe Practices for Better Health Care: A Consensus Report

• Print a hard copy of the Leapfrog survey and Frequently Asked Questions (FAQs)

• Organize Survey Submission team

63© 2004 TMIT TMIT

AssessCollect SubmitPrepare

Stage 2: Plan

• Pull a team of “internal experts” together to help answer the survey Including:

1. Nursing2. Pharmacy3. Infection Control4. Surgical Services5. Administration

• Assign team member responsibilities for individual survey questions

• Develop Survey Submission Plan

Plan

64© 2004 TMIT TMIT

Assess SubmitPrepare

Stage 3: Collect

• Each team member collects source documents to support survey question answers

• Inventory source documents to each Safe Practice; establish a filing system as resource for gap analysis and future survey submissions

• Perform gap analysis to determine what documents are missing that need to support remaining survey questions

Plan Collect

65© 2004 TMIT TMIT

SubmitPrepare

Stage 4: Assess

• Create a draft survey to determine baseline score

• Identify pre-submission actions that can be immediately implemented to finalize an answer to any survey questions.

• Identify Commitment answers to survey questions to optimize survey score

• Prepare potential Commitment Scenarios (see example)

Plan Collect Assess

66© 2004 TMIT TMIT

Prepare

Stage 5: Submit

Final CEO Briefing

• Review baseline survey score

• Make decisions regarding immediate pre-submission actions

• Present optimized score with commitments

• Give recommendations for Performance Improvement Projects

Plan Collect Assess Submit

67© 2004 TMIT TMIT

Prepare

Stage 5: Submit (Continued)

Submit to Leapfrog Web Site: www.leapfrog.medstat.com

• Obtain CEO agreement to certify submission

• Acquire a Security Code from the Leapfrog Web Site

Create Follow-up Action Plan

Plan Collect Assess Submit

1 © 2004 TMIT IHI National Quality Forum Charles Denham, MD Franck Guilloteau Carol Ferguson, RN...

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