BATTELLE WayFinder - ohio.hcwayfinder.com · The Battelle WayFinderTM Q.I. Dashboard (WayFinder) is...

BATTELLE WayFinder™ USER GUIDE

User Guide Version 2.6.1 | Software Version 2.6.1

Battelle Memorial Institute

505 King Avenue Columbus, Ohio 43201

June, 2018

Table of Contents Overview ....................................................................................................................... 1

Getting Started ....................................................................................................................... 2

Sign In with Local Account ...................................................................................................... 2

WayFinder Concepts.................................................................................................................. 4

WayFinder Modules ................................................................................................................... 7

AHRQ Quality & Patient Safety Indicators .............................................................................. 7

Reoccurring Opportunities Tab ........................................................................................... 8

Hospital Data Tab ..............................................................................................................11

Modeled Data Tab .............................................................................................................13

Indicator Information ..........................................................................................................14

Composite Measures .............................................................................................................16

Composite Measure Detail Page ........................................................................................17

Indicator Information Page .................................................................................................18

Readmission Measures .........................................................................................................19

Hospital Data Tab ..............................................................................................................20

Modeled Data Tab .............................................................................................................22


NHSN & ACS Measures ........................................................................................................26

Hospital Data .....................................................................................................................26


Hospital HIIN Reported Measures .........................................................................................29

Hospital Data .....................................................................................................................29


Reports ......................................................................................................................31

Quality Reports ......................................................................................................................31

Priority Reports ......................................................................................................................32

Table of Figures

Figure 1. Sign In ......................................................................................................................... 2

Figure 2. License Agreement ..................................................................................................... 3

Figure 3. Home Page ................................................................................................................. 6

Figure 4. AHRQ Quality & Patient Safety Page .......................................................................... 7

Figure 5. Proportion of Adverse Events that were Problematic ................................................... 8

Figure 6. Benchmark Value ........................................................................................................ 9

Figure 7. Problematic Score, Associated Costs, Days of Care ................................................... 9

Figure 8. Top Five .....................................................................................................................10

Figure 9. AHRQ Hospital Data Page .........................................................................................11

Figure 10. AHRQ Modeled Data Tab ........................................................................................13

Figure 11. AHRQ Indicator Specific Information .......................................................................15

Figure 12. Composite Measures Page ......................................................................................16

Figure 13. Composite Measure Detail Page ..............................................................................17

Figure 14. Readmission Hospital Data Page ............................................................................20

Figure 15. Readmission Modeled Data Page ............................................................................22

Figure 16. Readmission Individual Indicator Page .....................................................................25

Figure 17. NHSN & ACS Hospital Data Page ............................................................................26

Figure 18. NHSN or ACS Observed Rate ..................................................................................28

Figure 19. HIIN Hospital Data Page ..........................................................................................29

Figure 20. HIIN Observed Rate .................................................................................................30

Figure 21. Quality Report Selection ...........................................................................................31

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Overview

The Battelle WayFinderTM Q.I. Dashboard (WayFinder) is a cloud-based, quality analytics tool that guides hospital quality improvement staff with the identification of problematic adverse events. WayFinder presents available hospital performance data, comparative benchmark metrics and details on which adverse events had a lower probability of occurrence.

Leveraging WayFinder, hospitals can now manage their health care safety and quality performance measures. WayFinder presents safety, quality, and performance data over time and provides indicator specific comparisons to respective peer groups and benchmark groups. WayFinder contains hospital data and modeled data which was derived from AHRQ's hospital specific measures including the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI) and Pediatric Quality Indicators (PDI) as well as CMS, ASC-CDC, NHSN-CDC measures, and various hospital-reported measures.

WayFinder data are organized in measure specific modules which present charts, tables and tools that can be further filtered by the quarter or year and benchmark. These modules include: AHRQ Quality and Patient Safety Indicators, Composite Measures, Readmission Measures, NHSN and ACS Measures, and Hospital HIIN Reported Measures. WayFinder additionally provides access to patient specific data through its Priority Report ordering system. In the Priority Reports, patient specific encounters are grouped by hospital, indicator, and date, providing a list of adverse events that impacted the quality measures, and affect the overall quality score.

The use of these modules, tools, and charts can help identify patterns and trends among the hospital’s patients and their treatment, providing the opportunity to improve the management of these types of events in the future.

The platform currently includes the majority of the AHRQ IQI, NQI, PDI and PSI quality measures; AHRQ composite measures; CMS readmission measures (including cohort-specific and composite all-cause readmission); NHSN measures; and NDNQI measures.

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Getting Started

Account information is managed in WayFinder using role-based accounts according to the level of access required.

Figure 1. Sign In

Sign In with Local Account

To sign in using a local account, follow the https://ohio.hcwayfinder.com/Account/LocalLogin URL and enter the provided WayFinder Username and Password, as shown in Figure 1. Once authenticated the user will be logged in and redirected to the WayFinder Modules Home page.

If logging into WayFinder for the first time, a user must accept the End User License Agreement (EULA). The EULA presents the Terms of Use between the user and Battelle.

Please read and indicate that you accept the terms of the agreement by checking the box (if the user does not agree to the terms of the EULA they will be redirected to the Sign In page). If accepted, select the hospital that you represent and then select "I Accept", as shown in Figure 2. The user then will be redirected to the WayFinder Home page.

https://ohioqa.hcwayfinder.com/Account/LocalLogin

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Figure 2. License Agreement

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WayFinder Concepts The WayFinder Platform has several key concepts that are used throughout. A description of each is described below.

Benchmarks A benchmark is a level of performance used for comparison. Information is combined across hospitals to create several comparison benchmarks on the WayFinder platform. A user will only see the benchmarks that are associated with their hospital or hospital system. Some examples of the benchmarks available include:

• Ohio: All hospitals in Ohio • OHA: All hospitals in the Ohio Hospital Association (nearly the same as the Ohio

benchmark with the possible addition of some out-of-state hospitals)

• Hospital Types: Short term acute care, children’s, teaching and critical access hospitals

• Regional Collaboratives: Northeast, Northwest and Central Ohio collaborative hospitals

• Market Areas: Akron/Canton/Youngstown, Cincinnati, Cleveland, Columbus, Dayton and Toledo

• Districts: Central, Southwest, Southeast, Northwest and Northeast

• Hospital Bedsize: 0-100, 101-300 and 300+

• Hospital Size and Location: Large urban, small urban, and rural hospitals

• HIIN: All hospitals in the Hospital Improvement Innovation Network

• Hospital Systems: All hospitals in your system

• National: An estimate of national performance based on State Inpatient Databases (SID), National (Nationwide) Inpatient Sample (NIS) and OHA data

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Measures The WayFinder Platform displays measures in tabular format generated directly from hospital data as well as from modeled data (hospital data that has been smoothed to reduce the effects of statistical noise or random error which provides a more reliable assessment of hospital performance). All modules include measures that were calculated with the hospital data. The AHRQ and Readmission modules additionally include measures using modeled data. The AHRQ module also includes information on Recurring Opportunities that are summaries of hospital data. Measures displayed on the Platform were calculated or obtained from the following programs:

• AHRQ QI Software: Developed by AHRQ, includes measures on AHRQ Measures module as well as composite measures on Composite Module.

• CMS Readmission programs: Developed by Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation for CMS. See measures on Readmission Module

• CDC NHSN: Measures pulled from the CDC National Healthcare Safety Network (NHSN) database. See measures on NHSN and ACS Measures Module

• ASP: For a small number of hospitals that do not report to NHSN, measures are pulled from the Associated Systems Professionals (ASP) web portal. Additionally, other hospital-reported measures are obtained from the ASP portal. See measures on NHSN & ACS Measures Module and Hospital HIIN Reported Measures Module.

Help Content Throughout the platform hovering over the help icon will provide information about an element on the page. When finished reviewing the information, click anywhere on the page to close the information dialog.

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WayFinder Home Page

Once logged in, the WayFinder Home Page will appear as presented in Figure 3. The WayFinder Home page provides access to Information and Administration support, System Settings and the main functionality access to each of the modules currently available in the platform.

Figure 3. Home Page

The Information menu dropdown provides useful links to learn more on the quality indicators and measures that are the drivers of the platform, information about OHA and Battelle, information on how to contact OHA, and Release Notes. The Administration menu dropdown allows administrators to manage their users. Only Administrators will see information under this dropdown.

The System Setting Icon allows users to set the Time Aggregation and Time Span that will be used throughout the platform. Time Aggregation can be Quarterly or Annual for all modules and Monthly, Quarterly or Annual for the NHSN, ACS, and Hospital HIIN Measures. For graphs and tables that are displayed based on a time series this option allows the user to specify if it should be displayed by year or quarter. The Time Span option allows users to narrow the temporal range to a more limited view of the data.

Navigation to a specific module is performed by clicking on the desired WayFinder Module icon or by selecting the module from the OHA WayFinder Modules dropdown on the menu bar at the top of the Home Page.

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WayFinder Modules

As displayed in Figure 4 above, the WayFinder Platform includes the following modules: AHRQ Quality and Patient Safety Indicators, Composite Measures, Readmission Measures, NHSN and ACS Measures, and Hospital HIIN Reported Measures. All modules begin with a hospital system level listing that shows the member hospitals listed under the hospital system. This view will vary based on the user's role in the system. A hospital association level user, for example, would see all member hospital systems, while a hospital level user on the other hand will only see a single hospital system with a single hospital's data. In all modules, selecting a hospital on the hospital system overview page will launch the user into the data for the selected hospital.

AHRQ Quality & Patient Safety Indicators

Figure 4, the AHRQ Quality & Patient Safety Indicators Module, provides a view of a hospital's performance data over time based on the AHRQ measures and comparisons to different benchmark groups.

Figure 4. AHRQ Quality & Patient Safety Page

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The module includes three tabs: Reoccurring Opportunities, Hospital Data and Modeled Data. The Reoccurring Opportunities tab provides Hospital summary level data. The Hospital Data tab provides the hospital data directly from the hospitals, and the Modeled Data tab provides the hospital data that has been smoothed to reduce the effects of statistical noise or random error which provides a more reliable assessment of hospital performance.

Reoccurring Opportunities Tab

The data on the Reoccurring Opportunities tab contains Hospital Summary level data that is compared against a selected benchmark.

Proportion of Adverse Events that were Problematic

Figure 5, the Proportion of Adverse Events that were Problematic, presents hospital summary level data (quarterly or annual) against the National benchmark group. Specifically, the graph presents the sum of problematic events across all indicators divided by the sum of all modeled adverse events across all indicators for each time-period.

Figure 5. Proportion of Adverse Events that were Problematic

Problematic is defined as the estimated number of adverse events that would not have occurred if this hospital performed at a level of the 80th percentile (or top 20%) of the hospitals in the National benchmark. Modeled is defined as the estimated number of adverse events accounting for statistical noise or random error.

The gray dotted lines on the chart represent the ICD-10 conversion.

To view hospital or benchmark specific values for a specific time, hover over the point of interest on the chart and the popup will display the data (see Figure 6). To change the benchmark group select the drop-down menu located in the upper right of the chart. In Figure 6 the benchmark selected is National.

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Figure 6. Benchmark Value

Problematic Score, Associated Costs, and Days of Care

In the center of the page are a series of charts, as in

Figure 7, that presents where a hospital falls within the selected benchmark for Problematic Score, Associated Costs, and Days of Care.

Each of these graphs represents the distribution of the respective value for hospitals in the selected benchmark. The black dashed line indicates the value for this hospital. Hovering over the black line will show the percentile of this hospital with respect to the hospitals in the selected benchmark. The graphs are based on data from most recent quarter or an estimate for the most recent year depending on the time aggregation selected (see the Getting Started Section).

Figure 7. Problematic Score, Associated Costs, Days of Care

Problematic Score:

The Problematic score from the most recent plotted value in Figure 5 is multiplied by 1000. Lower values of this score are better.

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Associated Costs:

The Associated Costs is the costs among discharges with an adverse event minus costs among discharges without an adverse event, accounting for case-mix. The ”per patient” value is this value divided by the total at risk across all indicators.

Days of Care

Days of care is the total number of days of care associated with adverse events across all indicators. It represents the days of care among discharges with an adverse event minus days of care among discharges without an adverse event, accounting for case-mix. The ”per patient” value is this value divided by the total at risk across all indicators. Three tables at the bottom of the page show the Top Five Events, Costs, and Days of Care that the hospital may want to focus on (see Figure 8). Each table has three columns: Quality Indicator, Problematic and Total. ”Problematic” indicates the number, associated costs, or days of care associated with problematic events, and “Total” is the total number of adverse events, the total cost of adverse events, or the total number of days of care due to adverse events. This table can help to focus your attention on the measures that are having the largest impact on the hospital.

Figure 8. Top Five

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Hospital Data Tab

The Hospital Data tab shows hospital data for each measure individually (see Figure 9). To quickly monitor hospital specific data, the quality indicators available for the selected hospital are displayed.

Figure 9. AHRQ Hospital Data Page

The filter options above the table allow the user to filter the information by Data Type (Adverse Events, Days of Care or Associated Costs), Year, Quarter, and Benchmark. Note that the Quarter option will not be present if the user has selected the time aggregation of “Year” under the Account Settings. By selecting a Quality Measure from the Hospital Data or Modeled Data Page, graphs of the individual measure will appear (see Figure 11). Details on this display will be described in the “Indicator Information” section below.

If a user has access to more than a single hospital in their hospital system, they can also change the selected hospital from the upper left drop-down list by the hospital name.

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Rank In the Rank column, the top number (numerator) indicates the hospital's position in a low-to-high ranking of all hospitals in the selected benchmark group by the modeled rate (modeled/patients at risk). A lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. The same Rank values are displayed on the Hospital Data and Modeled Data tabs. The modeled rate is the estimated rate adjusted to account for statistical noise or random error. Note that there is no ranking for the National Benchmark.

Percentile The hospital's percentile in the ranking relative to the selected benchmark is displayed in this column. Higher is better. The same Percentiles are displayed on the Hospital Data and Modeled Data tabs.

Observed Adverse Events, Associated Costs, Days of Care The actual number of adverse events, associated costs, or days of care for the time-period selected is shown in this column.

Case Mix Benchmark Adverse Events, Associated Costs, Days of Care The estimated value that would occur at an average hospital within the National benchmark if it had the same case-mix as this hospital is shown in this column.

Risk Adjusted Adverse Events, Associated Costs, Days of Care The estimated value that would occur at this hospital if it had the same case-mix as the National benchmark is shown in this column.

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Modeled Data Tab

The modeled data page (Figure 10) displays the hospital data that has been smoothed to reduce the effects of statistical noise or random error which provides a more reliable assessment of hospital performance. The modeled data display is very similar to the Hospital Data display. See the Hospital Data section for information on navigating the page.

Figure 10. AHRQ Modeled Data Tab

Rank

In the Rank column, the top number (numerator) indicates the hospital's position in a low-to-high ranking of all hospitals in the selected benchmark group by the modeled rate (modeled/patients at risk). A lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. The same Rank values are displayed on the Hospital Data and Modeled Data tabs.

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The modeled rate is the estimated rate adjusted to account for statistical noise or random error. Note that there is no ranking for the National Benchmark.

Percentile

The hospital's percentile in the ranking relative to the selected benchmark is displayed in this column. Higher is better. The same Percentiles are displayed on the Hospital Data and Modeled Data tabs.

Modeled Adverse Events, Associated Costs, Days of Care

The estimated value accounting for statistical noise or random error of adverse events, associated costs, or days of care for the time period selected is shown in this column.

Problematic Adverse Events, Associated Costs, Days of Care

The estimated value that would not have occurred if the hospital performed at the level of the 80th percentile (or top 20%) of the hospitals in the selected benchmark is shown in this column.

Proportion Problematic Adverse Events, Associated Costs, Days of Care

The proportion problematic is the Problematic Events, Costs or Days of Care divided by the Modeled number of events, costs or days of care.

CMS Dollars at Risk

The estimated change in Medicare payment over the previous 12-month period attributable to the Medicare Hospital Value Based Purchasing (HVBP) program for relevant measures is shown here.

Indicator Information

Selecting one of the measures on the Hospital Data page or the Modeled Data page will display graphs with individual indicator information (see Figure 11). The top of the Indicator Page allows users to easily change the hospital (if they have access to more than one hospital) or the measure for which the graphs represent. Each graph displayed is explained below.

Observed Rate vs. Case Mix Benchmark Rate Graph Observed is the reported rate and the Case Mix Benchmark is the estimated rate that would occur at an average hospital if it had the same case-mix as the selected hospital.

Modeled Rate Graph This is a graph of the estimated rate accounting for statistical noise or random error. The graph can be customized by adding benchmarks and other hospitals (with authorization). Confidence intervals can also be added and are indicated with blue shading.

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Figure 11. AHRQ Indicator Specific Information

Trend Data Graph Users can change the Data Type (Adverse Events, Days of Care, Associated Costs) graphed by selecting a different value from the drop down in the bottom left corner. By default, Adverse Events are displayed. This graph contains several plots:

• Observed Cases, Costs or Days: the value reported by the selected hospital

• Modeled Cases, Costs or Days: the estimated value adjusted to account for statistical noise or random error

• Problematic Cases, Costs or Days: the estimated cases, costs or days that would not have occurred if the given hospital performed at a level of the 80th percentile (or top 20%) of the hospitals in the National benchmark.

• Patients at Risk: The grey bars represent the number of patients at risk for the selected measure

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Composite Measures

The Composite Measures module (see Figure 12), contains summary information across multiple indicators giving the user an opportunity to identify domains and drivers of quality and prioritize quality initiatives. The hospital composite data reflects composite rates calculated from current data provided by the health institutions relative to the National benchmark. The filter options above the table allow the users to filter the year and quarter.

Figure 12. Composite Measures Page

Weight This column indicates the weight of each component of the composite. Each composite expands to a list of all components of the composite when the arrow to the left of the composite measure is selected.

Count This column shows the number of patients at risk for the individual indicators. For the composite, the weighted average number of patients at risk is displayed.

Lower The lower bound of the 95% confidence interval for the score is shown in this column.

Score For individual indicators, the score is calculated by dividing the modeled rate for this hospital by the rate of the National benchmark. For the composite, it is a weighted average of the score of each of the indicators. Lower values are better. Values less

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than 1 represent performance better than the benchmark, values greater than 1 reflect performance worse than the benchmark.

Upper The upper bound of a 95% confidence interval for the score is shown in this column.

Composite Measure Detail Page

Selecting a composite measure will display the Composite Measure Detail page (see Figure 13). Figure 13. Composite Measure Detail Page

Composite and Components The top graph includes the composite and individual components that make up the composite. The composite line represents the score or weighted average across the components. Lower values are better. Values less than 1 represent performance better than the benchmark, values great than 1 reflect performance worse than the benchmark. The component lines represent the score which is the ratio of the modeled

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rate for the selected hospital to the rate of the National benchmark. The individual components can be toggled on and off by selecting the indicators in the legend of the graph. The wheel chart in the upper left corner represents the relative weights of the components.

Composite Benchmark The Composite Benchmark chart provides the user the ability to compare the Composite Measure to relevant benchmarks. Multiple benchmarks can be added by selecting them in the Select Benchmark drop-down list. Once selected click the "Add Benchmark" button to add them to the chart. There is no limit to the number of benchmarks that can be compared. The chart lines can be toggled on and off by selecting the indicator in the legend. To remove all benchmarks except the composite click the "Reset" button.

Indicator Information Page

Selecting a component will display the same Indicator Information page that is displayed when

selecting an indicator in the “AHRQ Measures” or “Readmissions Measures” Modules (see

Figure 11and Figure 16). Information about this page can be found in those sections.

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Readmission Measures

The Readmissions Module contains CMS readmission measures (including cohort-specific and composite all-cause readmission) data. Readmission measures will allow providers to better understand their 7-day and 30-day readmission rates, giving them the information needed to reduce readmission rates and increase reimbursement rates from CMS.

The OHA administrative claims data includes total charges for each hospital stay. This charge information represents the amount that hospitals billed for services but does not reflect how much hospital services actually cost or the specific amounts that hospitals received in payment. However, to determine cost savings for HIIN activities the hospital charges must be translated into actual costs. Cost-to-Charge ratios enable this conversion. Charge information is obtained by summing total charges across hospital stays for each hospital. Cost information is obtained from the hospital accounting reports collected by the Centers for Medicare and Medicaid Services (CMS). Some imputation for missing values is necessary (a weighted average for a peer group within the state). Converting the discharge-level charge data to cost estimates involves simply multiplying total charges with the appropriate hospital-level cost-to-charge ratio.

The Readmission Measures module includes a metric of associated inpatient days calculated using a similar methodology to access the potential and actual reduction in days of care resulting from improved performance. For readmission measures WayFinder includes yet other metrics for “readmission” costs, “readmission” days, “index” costs and “index” days. These metrics calculate the mean and total costs and mean and total inpatient days for the readmission discharge and the index discharge for each readmission measure. The readmission discharge might be at the same hospital as the index discharge, or it might be at a different hospital. Together these metrics may tell a dynamic story of the impact of some quality improvement interventions intended to reduce readmissions. For example, preventing a readmission by increasing the length of stay will result in lower readmission costs, but also lower associated costs (because the “control” costs are higher), mitigating the business case for subsequent quality improvement efforts.

The module includes two tabs: Hospital Data and Modeled Data. The Hospital Data tab provides the hospital data directly from the hospitals, and the Modeled Data tab provides the hospital data that has been smoothed to reduce the effects of statistical noise or random error which provides a more reliable assessment of hospital performance.

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Hospital Data Tab

The Readmission Hospital Data tab shows the readmission measure outcomes individually for the selected hospital (see Figure 14).

Figure 14. Readmission Hospital Data Page

The filter options above the table allow the user to filter the information by Data Type (Adverse Events, Days of Care, Associated Costs, Readmission Costs, or Readmission Days), Year, Quarter, and Benchmark. Note that the Quarter option will not be present if the user has selected the time aggregation of “Year” under the Account Settings. By selecting a Readmission Measure from the Hospital Data or Modeled Data Page, graphs of the individual measure will appear (see Figure 16). Details on this display will be described in the “Indicator Information” section below.

If a user has access to more than a single hospital in their hospital system, they can also change the selected hospital from the upper left drop-down list by the hospital name.

Rank In the Rank column, the top number (numerator) indicates the hospital's position in a low-to-high ranking of all hospitals in the selected benchmark group by the modeled rate (modeled/patients at risk). A lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. The same Rank values are displayed on the Hospital Data and Modeled Data tabs.

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The modeled rate is the estimated rate adjusted to account for statistical noise or random error. Note that there is no ranking for the National Benchmark.

Observed Adverse Events, Associated Costs, Days of Care, Readmission Cost, Readmission Days The actual number of adverse events, associated costs, or days of care for the time-period selected is shown in this column.

Case Mix Benchmark Adverse Events, Associated Costs, Days of Care, Readmission Cost, Readmission Days The estimated value that would occur at an average hospital within the National benchmark if it had the same case-mix as this hospital is shown in this column.

Risk Adjusted Adverse Events, Associated Costs, Days of Care, Readmission Cost, Readmission Days The estimated value that would occur at this hospital if it had the same case-mix as the National benchmark is shown in this column.

Difference The difference column is simply the Observed value minus the Case Mix Benchmark value.

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Modeled Data Tab

The modeled data page (Figure 15) displays the hospital data that has been smoothed to reduce the effects of statistical noise or random error which provides a more reliable assessment of hospital performance. The modeled data display is very similar to the Hospital Data display. See the Hospital Data section for information on navigating the page.

Figure 15. Readmission Modeled Data Page

Rank In the Rank column, the top number (numerator) indicates the hospital's position in a low-to-high ranking of all hospitals in the selected benchmark group by the modeled rate (modeled/patients at risk). A lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. The same Rank values are displayed on the Hospital Data and Modeled Data tabs. The modeled rate is the estimated rate adjusted to account for statistical noise or random error. Note that there is no ranking for the National Benchmark.

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Modeled Adverse Events, Associated Costs, Days of Care, Readmission Cost, Readmission Days The estimated value accounting for statistical noise or random error of adverse events, associated costs, or days of care for the time period selected is shown in this column.

Problematic Adverse Events, Associated Costs, Days of Care, Readmission Cost, Readmission Days The estimated value that would not have occurred if the hospital performed at the level of the 80th percentile (or top 20%) of the hospitals in the selected benchmark is shown in this column.

Proportion Problematic Adverse Events, Associated Costs, Days of Care, Readmission Costs, Readmission Days The proportion problematic is the Problematic Events, Associated Costs, Days of Care, Readmission Costs or Readmission Days divided by the modeled number of Events, Associated Costs, Days of Care, Readmission Costs or Readmission Days.


Selecting one of the measures on the Hospital Data page or the Modeled Data page will display graphs with individual indicator information (see Figure 11Figure 16). The top of the Indicator Page allows users to easily change the hospital (if they have access to more than one hospital) or the measure for which the graphs represent. Each graph displayed is explained below.

Observed Rate vs. Case Mix Benchmark Rate Graph Observed is the reported rate and the Case Mix Benchmark is the estimated rate that would occur at an average hospital if it had the same case-mix as the selected hospital.

Modeled Rate Graph This is a graph of the estimated rate accounting for statistical noise or random error. The graph can be customized by adding benchmarks and other hospitals (with authorization). Confidence intervals can also be added and are indicated with blue shading.

CMS Dollars at Risk Graph This is a graph of the estimated change in Medicare payments attributable to the Medicare Hospital Value Based Purchasing (HVBP) program.

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Trend Data Graph Users can change the Data Type (Adverse Events, Days of Care, Associated Costs, Readmission Costs or Readmission Days) graphed by selecting a different value from the drop down in the bottom left corner. By default, Adverse Events are displayed. This graph contains several plots:

• Observed Cases, Costs, Days, Readmission Costs, or Readmission Days: the value reported by the selected hospital

• Modeled Cases, Costs, Days, Readmission Costs, or Readmission Days: the estimated value adjusted to account for statistical noise or random error

• Problematic Cases, Costs, Days, Readmission Costs, or Readmission Days: the estimated cases, costs, days, readmission costs, or readmission days that would not have occurred if the given hospital performed at a level of the 80th percentile (or top 20%) of the hospitals in the National benchmark.

• Patients at Risk: The grey bars represent the number of patients at risk for the selected measure

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Figure 16. Readmission Individual Indicator Page

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NHSN & ACS Measures

The NHSN & ACS Measures module contains measures developed by the Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). The majority of the data are reported from the NHSN database. However, a small number of hospitals do not report directly to NHSN. In these cases, data if available, are reported from the web portal managed by Associated Systems Professionals (ASP). Depending on the measure, the rate numerator represents the observed number of cases of infection or the number of days on an associated device. The rate denominator represents the number of days on an associated device, the total number of procedures, the number of days as a patient, or the predicted number of cases.

Hospital Data

The Hospital Data tab as shown in Figure 17 provides rates for the NHSN measures CAUTI, CLABSI, CDIFF, MRSA, VAE, and several sub-measures as well as ACS-CDC SSI rates. Choosing a benchmark group from the drop-down menu will show a hospital’s observed rank and percentile among other hospitals in the benchmark group.

Figure 17. NHSN & ACS Hospital Data Page

Rank In the Rank column, the top number (numerator) indicates the hospital's position in a low-to-high ranking of all hospitals in the selected benchmark group by the observed

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rate. A lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. Note that there is no ranking for the National Benchmark. Depending on current OHA membership, the OHA, Ohio, and HIIN Benchmarks will often be very similar or identical. This is because most or all hospitals in OHA are also in Ohio (hospitals in bordering states have sometimes been included, in which case the OHA and Ohio Benchmarks would differ slightly), and the data in this module are currently available for HIIN hospitals only. (If these data ever became available for non-HIIN hospitals, the HIIN Benchmark would differ from the OHA and Ohio Benchmarks.)

Percentile This hospital’s percentile in the ranking relative to the selected benchmark is displayed in this column. Higher is better.

Denominator The denominator is measure dependent. Examples are: number of days on an associated device, the total number of procedures, the number of days as a patient, or the predicted number of cases.

Numerator The numerator is also measure dependent. Examples are: observed number of cases of infection or the number of days on an associated device.

Observed Rate This is the value in the numerator column divided by the value in the denominator column.

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Selecting one of the NHSN or ACS measures will display the Observed rate graph (see Figure 18). The chart features a line plot of the observed rates. With authorization additional hospitals can be added to the plot. The denominator value is indicated by the grey bars.

Figure 18. NHSN or ACS Observed Rate

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Hospital HIIN Reported Measures

The Hospital HIIN Reported Measures module contains data self-reported by hospitals through the ASP (Associated Systems Professionals) web portal. Because of the wide variety of measures included in this module, rates represent a similarly wide variety of metrics.

Hospital Data

The Hospital Data tab as shown in Figure 19 provides rates for the ASP-collected measures including ADE, DELIRIUM, FALLS, HAND_HYGIENE, PRU, SEPSIS, VTE, and various sub-measures. Choosing a benchmark group from the drop-down menu will show a hospital’s observed rank and percentile among other hospitals in the benchmark group.

Figure 19. HIIN Hospital Data Page

Rank In the Rank column, the top number (numerator) indicates the hospital's position in a ranking of all hospitals in the selected benchmark group by the observed rate. ADE measures, FALL_INJURY, PrU_NQF0201, and VTE_6 are ranked low to high (a lower rate is better), whereas all other measures in this module are ranked high to low (a higher rate is better). In both cases, a lower rank is better. The lower number (denominator) indicates the number of hospitals in the selected benchmark group with data for this indicator. Note that there is no ranking for the National Benchmark. Depending on current OHA membership, the OHA, Ohio, and HIIN Benchmarks will often be very similar or identical. This is because most or all hospitals in OHA are also

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in Ohio (hospitals in bordering states have sometimes been included, in which case the OHA and Ohio Benchmarks would differ slightly), and the data in this module are currently available for HIIN hospitals only. (If these data ever became available for non-HIIN hospitals, the HIIN Benchmark would differ from the OHA and Ohio Benchmarks.

Percentile This hospital’s percentile in the ranking relative to the selected benchmark is displayed in this column. Higher is better.

Denominator The denominator is measure dependent. Examples are: patients at risk for an event, or the number of opportunities.

Numerator The numerator is the actual number of events for the time-period selected.

Observed Rate This is the value in the numerator column divided by the value in the denominator column.


Selecting a HIIN measure will display the observed rate graph (see Figure 20). The chart features a line plot of the observed rates. With authorization additional hospitals can be added to the plot. The denominator value is indicated by the grey bars.

Figure 20. HIIN Observed Rate

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Reports

Quality Reports

The Quality reports are derived from the data provided to the OHA Data Portal using WayFinder analytics. The reports were designed to help identify areas of prioritization for hospitals. A Quality report for each quarter starting with 2017 Quarter 4 will be available from the main menu option title bar as displayed in Figure 21. Quality Report Selection. Figure 21. Quality Report Selection

The Quality reports are based on the most recent 3 years of data and contain the following sections:

• High Impact Domains: A score is assigned to each of three domains (Quality, Patient Safety, and Readmissions) based on performance relative to other similar hospitals.

• High Impact Areas: Areas (such as Medical, Surgical, etc.) where quality indicators have been persistently problematic and represent a high number of opportunities for improvement.

• Indicator Analysis: An assessment of characteristics of patients who experienced adverse events for indicators in the identified High Impact areas.

For more details on the content of the Quality report, please see an individual report.

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Priority Reports

Priority reports provide detailed information that links hospital performance on quality measures to patient records. This detailed information readily provides data that can help your hospital to target quality problems and mitigate them. Since the information in these reports contain personally identifiable information (PII), special security requirements are needed to view these reports. If you would like to know who at your facility receives these reports, please ask your primary WayFinder contact at your hospital or contact [email protected] to request the information.

The priority report is in the form of an excel file and contains the following fields:

• Medical Record number • Patient Account number • Discharge year • Discharge quarter • Indicator (that is, the quality measure associated with this record) • Condition (Readmission only) • Days until readmission (Readmission only) • Length of stay (Readmission only) • Disposition (Readmission only) • Risk index • Risk index decile • Present on admission • Treatment effect index • Treatment effect index decile • Group • Risk Level

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