CALL IN NUMBERS
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Transcript of CALL IN NUMBERS
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CALL IN NUMBERS
April 19th
• 12:00pm Call: 866-836-4700 Passcode: 861717
• 1:00pm (Eastern) 866-836-4700 Passcode: 861721
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Leapfrog Quality and Safety Hospital Survey Town Hall
Barbara Rudolph, Ph.D.Director, Leaps and Measures
April 19, 2006Call in number: 866-836-4700
12:00pm (Eastern) passcode: 861721 1:00pm(Eastern) passcode: 861717
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Topics for Today
• Introductions (Dennis, Chuck, Carol, Franck, Sarah)
• Background (Barb)– Why do we ask you to complete the survey?
• First 3 Leaps (Barb)• NQF Safe Practices (TMIT)• “Mechanics” of data submission (Dennis)
– Security Codes– Re-submissions of information– Website updates
• Q & A
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Why are we asking hospitals to complete the survey?
• Five years later—still need to improve safety• First estimates between 44,000-98,000
Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999)
• More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)
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The Quality Chasm
• 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a)
• More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)
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The Quality Chasm
• Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000)
• Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)
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The Leapfrog Group’s Mission
Trigger giant leaps forward in the safety, quality and affordability of health care by:
• Supporting informed health care decisions by those who use and pay for health care
• Promoting high-value health care through incentives and rewards
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Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:
Evidence-based
High impact
Understandable by Consumers
Achievable by Providers
NQF endorsed
The Leapfrog Group Strategy on Hospital Measurement and Public Reporting
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Safety ‘Leap’ Summary
1. An Rx for Rx– Computer Physician Order Entry (CPOE)
• Up to 8 in 10 serious drug errors prevented
2. Sick People Need Special Care – ICU Daytime Staffing with CCM Trained
M.D. live or via tele-monitoring, or risk-adjusted outcomes comparison• 29% mortality reduction (JAMA, 11/02)
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Safety ‘Leap’ Summary
3. The Best of the Best– Evidence-based Hospital Referral (EHR) or
risk-adjusted outcomes comparison• > 30% mortality reduction for 7 complex
treatments
4. Leapfrog Safety Index– Rolled-up score of the remaining 27 of the
30 NQF-endorsed Safe Practices
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Computerized Physician Order Entry (CPOE)
Each hospital fulfilling this Leap: • Assures that prescribers* enter 50% of hospital
medication orders via a computer system that includes decision support software to reduce prescribing errors;
• Requires that prescribers electronically document a reason for overriding an interception prior to doing so.
• Linked to pharmacy, admitting-discharge-transfer (ADT) information systems
* “Prescribers” used throughout this section refers to all clinicians authorized by the hospital to order pharmaceuticals for patients.
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ICU Physician Staffing
• A hospital fulfilling this leap assures that all patients in its adult or pediatric general medical and/or surgical ICUs are managed or co-managed by physicians certified in critical care medicine who:
• Are ordinarily present in the ICU (on-site, or via telemedicine that meets Leapfrog specifications) during daytime hours a minimum of 8 hours per day, 7 days per week, and during this time provide clinical care exclusively in the ICU; and
• At other times . . . returns more than 95% of ICU pages within 5 minutes, based on a quantified analysis of pager response time;* and can rely on a physician or FCCS-certified non-physician “effector” who is in the hospital and able to reach ICU patients within 5 minutes in more than 95% of cases, based on a quantified hospital analysis of pager response time.*
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Evidence-based Hospital Referral: Volume, Outcomes, and Process
Treatments(See specifications below)
Favorable Hospital Volume Characteristic*
Coronary artery bypass graft** 450 or more procedures/year
Percutaneous coronary intervention*** 400 or more procedures/year
Abdominal aortic aneurysm repair 50 or more procedures/year
Pancreatic resection 11 or more procedures/year
Esophagectomy 13 or more procedures/year
NICU average daily census > 15
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Outcomes: CABG and PCI
• State reported risk-adjusted mortality for CABG in NY, NJ, CA, and PA (Top Quartile)
• State reported risk-adjusted mortality for PCI in NY (Top Quartile)
• Risk-adjusted CABG mortality from STS (at or above average performance)
• Risk-adjusted PCI mortality from ACC (at or above average performance)
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Process Measures-developed by Zynx
80% or greater adherence to at least 2 of the measures in each high risk procedure or condition.
• CABG (Process measure examples)– All patients undergoing CABG should receive aspirin
upon hospital discharge.– All patients undergoing CABG without contraindications
should receive a beta-blocker within 24 hours after surgery.
• PCI (example)– Patients without contraindications who have undergone
PCI should receive aspirin • AAA• High Risk Infants (neo-natal steroids)
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Scoring Algorithm for EHREHR Credit based on Volume Thresholds
Full Credit(full circle)
¾ Circle ½ Circle ¼ Circle No Credit(empty circle)
CABGsee Notes 1-3 below
450+ <450 Did not disclose
PCIsee Notes 1-2 below
400+ <400 Did not disclose
AAA Repairsee Note 4 below
50+ 17-49 <17 Did not disclose
Esophagectomy
13+ 8-12 5-7 <5 Did not disclose
Pancreatic resection
11+ 6-10 3-5 <3 Did not disclose
High Risk Deliveriessee Note 4 below
Average daily NICU
census >15
NICU with average daily census <15orHigh-risk deliveries but no NICU
Did not disclose
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Safe Practices Section (TMIT)
• Commitments—lapse after one year
• Need to review and update all questions that have a specified time period…e.g., within the last 12 months…
• Review FAQs for changes
• Review Implementation Strategies
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Timelines for Submission
• Hospitals participating in LHRP must submit by May 31st
• First report on hospital submission (June 30th) available on web by first week of July
• Updates can be done monthly
• Last survey submissions March 2007
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Submission Issues (Dennis)
• Security Codes and CEO Delegation
• Maintaining survey records of answers
• How to refresh the data—must re-affirm each section
• Helpdesk services
• Website resources
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Leapfrog’s Hospital Quality and Safety Survey Display
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Quality and Safety Hospital Survey: The 2006 Refresh
Barbara Rudolph, Ph.D.Director, Leaps and Measures
April 19, 2006
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Topics for Today• Introductions (Dennis, Chuck, Carol, Franck, Sarah)• Background (Barb)
– Why are we still doing this?• Cover the changes to the survey
– Survey questions (Barb)– Scoring (Barb)– Timeline (Barb)– FAQs (Chuck)
• Cover the “mechanics” of the refresh (Dennis)– Security Codes– Re-submissions of information– Website updates
• Q & A
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Why are we still doing this? • Five years later—still need to improve safety• First estimates between 44,000-98,000
Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999)
• More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)
![Page 25: CALL IN NUMBERS](https://reader036.fdocuments.us/reader036/viewer/2022062423/56814533550346895db1fe09/html5/thumbnails/25.jpg)
The Quality Chasm
• 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a)
• More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)
![Page 26: CALL IN NUMBERS](https://reader036.fdocuments.us/reader036/viewer/2022062423/56814533550346895db1fe09/html5/thumbnails/26.jpg)
The Quality Chasm
• Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000)
• Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)
![Page 27: CALL IN NUMBERS](https://reader036.fdocuments.us/reader036/viewer/2022062423/56814533550346895db1fe09/html5/thumbnails/27.jpg)
The Leapfrog Group’s Mission
Trigger giant leaps forward in the safety, quality and affordability of health care by:
• Supporting informed health care decisions by those who use and pay for health care
• Promoting high-value health care through incentives and rewards
![Page 28: CALL IN NUMBERS](https://reader036.fdocuments.us/reader036/viewer/2022062423/56814533550346895db1fe09/html5/thumbnails/28.jpg)
Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:
Evidence-based
High impact
Understandable by Consumers
Achievable by Providers
NQF endorsed
The Leapfrog Group Strategy on Hospital Measurement and Public Reporting
![Page 29: CALL IN NUMBERS](https://reader036.fdocuments.us/reader036/viewer/2022062423/56814533550346895db1fe09/html5/thumbnails/29.jpg)
Safety ‘Leap’ Summary (Barb)
• An Rx for Rx– Computer Physician Order Entry (CPOE)– Up to 8 in 10 serious drug errors prevented
• Sick People Need Special Care – ICU Daytime Staffing with CCM Trained M.D. live or via tele-
monitoring, or risk-adjusted outcomes comparison– 29% mortality reduction (JAMA, 11/02)
• The Best of the Best– Evidence-based Hospital Referral (EHR) or risk-adjusted
outcomes comparison– > 30% mortality reduction for 7 complex treatments
• Overall Safety– Rolled-up score of the remaining 27 of the 30 NQF Safe Practices
(CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)
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Survey Refresh (Barb)
• See Page 1—What’s New in the 2006 Survey– No substantive content changes to survey wording– Changes to Section 3, EHR process measures—
questions changed from yes/no to percent adherence (hospitals won’t need to collect additional information to answer this..
– Responses needed for time-sensitive items—see items with clock in survey (many of the NQF questions have a 12 month timeframe—need for updates—no clock on survey)
– Authorization and release to share hospital data for the LFHRP
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Scoring and Timeline Changes (Barb)• Scoring – related to lapsed/failed commitments
– Assess whether met the self-imposed commitments—hospitals can achieve partial credit for committing to fully implementing the Leap by 3/31/2007.
– For CPOE, if fail two years of commitments—no credit for commitment
• But can get to “Good Progress” credit if in last 12 months—hospital brought up EMR hospital-wide or results reporting in hospital-wide
• Can only achieve good early stage credit– For IPS, if fail two years of commitments—will not be eligible for
Good Progress credit in 2007
• Timeline changes– Review, update and re-affirm by June 30th
– LHRP submitters must submit by May 31, 2006– First Public Report July 2006– In 2007, all surveys will be due on May 31
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Safe Practices Section (Chuck)
• Commitments—lapse after one year
• Need to review and update all questions that have a specified time period…e.g., within the last 12 months…
• Review FAQs for changes
• Review Implementation Strategies
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Submission Issues (Dennis)
• Security Codes and CEO Delegation
• Maintaining survey records of answers
• How to refresh the data—must re-affirm each section
• Helpdesk services
• Website resources
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Leapfrog’s Hospital Quality and Safety Survey Display