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What’s New in 2009: The Leapfrog Hospital Survey

Survey Townhall CallsApril 15, 2009April 21, 2009May 1, 2009

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Town Hall Call Overview• Introduction

– Survey Team– Where to locate slides– Leapfrog and the Hospital Survey—why complete?– Goals for 2009 survey

• Survey Submission Logistics/Timeline/Website Resources• What’s New for 2009• Detailed review of survey questions

– Computerized Physician Order Entry (CPOE)– Safe Practices Score (SPS)– Hospital Acquired Conditions (HACs)

• Catheter-related blood stream infections– Common Acute Conditions (CACs)

• Normal Deliveries– Evidence-based Hospital Referral (EBHR)

• Q & A• Schedule for Town Hall Specialty Calls

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Why Complete Leapfrog Survey?Unique in the Milieu

• Represents employers/purchasers/consumers interests• Seeks public accountability/transparency• Rewards high performance• High impact performance measures “not the low hanging

fruit” (e.g., CPOE, IPS, EBHR, HACs, Deliveries)• Full range of measures—structural, process and outcome

(but focused on outcome)• Regional and national in scope—all payer information • Standardized measures to assure “same fruit” is sampled • Harmonized with other major national performance

measurement programs—but shows more complete picture of care delivery

• Significant hospital input on survey revisions

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Survey Review ProcessSteps in the process to revise the survey have

included: 

• (November, 2008) - Public review and comment period – hospitals were invited to share comments and feedback on the proposed changes for the 2009 Leapfrog Hospital Survey. 

• (January, 2009) - Pilot test of revised survey – 20 hospitals were asked to test a draft of the 2009 Leapfrog Hospital Survey and provide feedback to Leapfrog.

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Behind the Changes in 2009

Goals for the new survey—1. Look for opportunities to streamline survey—reduce

burden2. Update language in Safe Practices to address

maintenance by NQF3. Continue to support CMS initiatives (HACs)4. Align with other performance measurement groups 5. Provide normal delivery measures to address area

of care that is important to consumers and purchasers

6. Maintain measures included in Leapfrog’s Pay for Performance program

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How did we do?• Maintained burden below the 2007 Survey pages—

now 76 pages vs 106 pages • Language in Safe Practices updated to reflect

changes endorsed as part of Safe Practices for Better Healthcare: 2009 Update

• Added two outcome measures and two process measures addressing normal deliveries

• Added one hospital acquired condition identified by CMS and others--CLABSI

• Aligned EBHR volume measures to address new Survival Predictor for CABG, PCI, AAA, AVR. Hospitals can continue to report their results from other data collections—lowering burden—but providing full picture of care

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Survey Submission Logistics, Timeline, Website Resources

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Survey Security and Integrity

• Core principle: hospital self-certification• Executive authority . . .and accountability• Survey security and integrity are critical:

– 16-digit security code

• Authorization to access granted only to:– CEO . . . can provide code directly to any

delegate(s)– CEO-authorized delegate . . . Help Desk can email

security codes. See survey home page link, “Need security code?”

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Survey Helpdesk Available

• Survey Helpdesk—designed to respond within 1-2 business days (unless it requires an expert panel member to respond)

• Survey must be completed before CPOE Evaluation. Help Desk cannot respond in real time. Plan to complete early.

• Don’t wait until late June. If you have a problem, you likely will not make deadline.

• Link on survey homepage https://leapfrog.medstat.com/helpdesk.html

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2009 Timeline

• April 2, 2009 -- Leapfrog launched 2009 Survey

• June 30, 2009 -- RRO-targeted hospitals report or be listed on Leapfrog’s website as Did Not Respond

• July 21, 2009 -- Leapfrog website lists new results

• Top Hospitals List/Highest Value Hospitals --Recognition programs/initiatives will be done in 2009 beginning as early as mid-September

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Website Resources

To assist hospitals in completing the Survey, Leapfrog makes the following tools available: – Frequently Asked Questions– Overview of “What’s New in 2009?” – Fact sheets on Each Leap (including bibliography

information) – White Papers on Severity-adjustment for LOS, and Survival

Predictor– Scoring Algorithms– End Notes– Specifications for measuring and reporting rates of Hospital-

Acquired Conditions – Link to purchase NQF’s Safe Practices for Better

Healthcare: 2009 Update report

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Website Resources for EBHR

• Medical Coding for High-Risk Procedures and ConditionsProcedure code, diagnosis codes and other specifications for counting high-risk surgery volumes

• Publicly Reported Outcomes for CABG and PCIFor hospitals in CA, MA, NJ, NY and PA – publicly reported risk-adjusted mortality rates for responding to survey questions about PCI (MA, NY only) and CABG (all five states).

• Process Measures -- SpecificationsDetailed specifications for Leapfrog’s procedure-specific process measures of quality -- for CABG, PCI, AAA Repair, and high-risk deliveries.

• Resource Utilization Measures – SpecificationsDetailed specifications for Leapfrog’s CABG and PCI including:

– Coding for counting eligible cases– Coding and other criteria for identifying cases with risk factors – Specifications for reporting geometric mean length of stay– Criteria for identifying cases followed by readmission

• Excel Tool for Computing Geometric Mean Length of Stay

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Website Resources for Common Acute Conditions (CAC)

• Volume Standard Coding: Medical Coding for Chronic Acute ConditionsProcedure/diagnosis codes and other specifications for counting AMI and Pneumonia volume

• Process Measures - SpecificationsSpecifications for Leapfrog’s nationally-endorsed condition-specific process measures of quality -- for AMI, Pneumonia, and Normal Deliveries.

• Resource Utilization Measures – SpecificationsDetailed specifications for Leapfrog’s Common Acute Conditions (AMI and Pneumonia) – including:

– Coding for counting eligible cases– Coding and other criteria for identifying cases with risk factors – Specifications for reporting geometric mean length of stay– Criteria for identifying cases followed by readmission

• Excel Tool for Computing Geometric Mean Length of Stay

• Outcome Measures for Normal Deliveries– Coding for counting eligible cases (denominator)– Criteria for determining numerator

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What’s New for 2009

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Survey Changes: The Details1. Computerized Prescriber Order Entry (CPOE)

Evaluation Tool—instruction updates requiring completion of sample test; scoring from test incorporated into public results.

2. Updated Safe Practices

3. Hospital-Acquired Conditions – addition of Catheter-associated Blood Stream Infections

4. Common Acute Conditions – Addition of Normal Deliveries

5. Evidence Based Hospital Referral Changes

a. Survival Predictor for CABG, PCI, AAA, AVR

b. Public Reporting Additions

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Computerized Prescriber Order Entry (CPOE) Evaluation Tool

• The CPOE Evaluation Tool provides hospitals an opportunity to assess their implementation of system alerts for potential medication-related adverse events

• Test involves the hospital loading computer-generated patient profiles and medication orders into their CPOE system and reporting back on the alerts they received

• Hospitals scores on the tool will impact their overall CPOE results in 2009

• Hospitals access the tool from the survey website once they have completed the CPOE section of the online survey (i.e. CPOE Q1=YES). Failure to complete the applicable sections of the survey after submitting their test score will result in removal of CPOE score and hospital will be listed as “Declined to respond” in applicable sections.

• Same security code as survey.

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CPOE Evaluation – Impact on Overall CPOE Score

• General Overview of 2009 CPOE survey scoring algorithm:

– Fully implemented (4 bars):CPOE implemented, 75%+ IP orders, and score 50% or better on at least four test categories on appropriate test*

– Substantial progress (3 bars):CPOE implemented, 50-74% IP orders, and score of 50% or better on two test categories; or, 75%+ IP orders but score below 50% on four test categories

– Some Progress (2 bars):25-49% of IP orders and completed an evaluation.

– Willing to Report (1 bar):Completed CPOE section of survey

* Adult inpatient test for adult/general hospital (pediatric test optional); pediatric test for children’s hospital

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CPOE Evaluation – Scored Results, Sample

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CPOE Evaluation – Scored Results, Sample (cont’d)

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Feedback on CPOE Evaluation Tool

“No question—this is a valuable experience—it is very important work and it should be applauded.”

David Stockwell, Patient Safety Officer

Children’s National Medical Center

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Updated Safe Practices

• The 2009 Updated Safe Practices Report was issued in March of 2009. The report separated Safe Practice #1 - Culture of Safety - into 4 separate Safe Practices. In addition, three practices were added.

• The 2009 Safe Practices chosen for hospitals to report on are those that have the strongest supporting evidence and are not measured in other sections of the survey

• The 2009 Safe Practices section focuses on 17 of the 31 non-Leapfrog-created Safe Practices - this includes the splitting of Safe Practice 1 into 4 Practices, and the addition of the Safe Practice for Urinary Tract Infections.

• The Safe Practices have kept the 4A framework, but have been updated wording to reflect changes in the 2009 report.

• A total of 737 points are available for the Safe Practices Score.• Page number references to the 2009 Updated Safe Practices are

included in the survey to assist users in both understanding the practice and in accessing the evidence in support of the practice.

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Safe Practices 2009• Basic design of survey ( 4 A’s) remains the same

– Awareness– Accountability– Ability– Action

• Changes to the content– Updates to existing measures in alignment with new

report– Individual practice weighting remains the same as

2008, except for splitting SP 1 into four sections and UTI which now brings overall score to 737

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17 Safe Practices Safe Practice

Weighting (pts)

1 Leadership Structures and Systems 120 2 Culture Measurement for Performance 20 3 Teamwork Training and Skill Building 40 4 Identification and Mitigation of Risks and Hazards 120 5 Informed Consent 4 6 Life Sustaining Treatment 4 9 Nursing Workforce 100

12 Communication of Critical Information 84 14 Labeling of Diagnostic Studies 15 15 Discharge Systems 25 17 Medication Reconciliation 35 19 Hand Hygiene 30 21 Central Venous Catheter Related Bloodstream Infection Prevention a 30 23 Prevention of Aspiration and Ventilator Associated Pneumonia a 20 25 Catheter Associated Urinary Tract Infection Prevention b 30 28 DVT/VTE Prevention b 25 29 Anticoagulation Therapy b 35

GRAND TOTAL

737

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Hospital-Acquired Conditions--CLABSI

• New condition added to the hospital-acquired conditions • This survey cycle measures hospital-acquired pressure

ulcers and hospital-acquired injuries (burns, falls, etc.) and has added Catheter-associated Blood Stream Infections (CLABSI)

• CLABSI Results will be reported as a rate per central line days

• CLABSI endorsed measure—aligned with CDC reporting• This condition can be identified by hospitals using the

same protocol that CDC is using, but excluding the symptom only cases

• Hospitals will need to rely on laboratory confirmed cases

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Common Acute Conditions: Normal Deliveries

• New condition added to the 2008 survey’s two common acute conditions -- Acute Myocardial Infarction (AMI) and Pneumonia—new section is on Normal Deliveries

• Three of the Normal Delivery measures for these conditions are endorsed by the National Quality Forum (NQF); the fourth is still in review– Elective Deliveries between 37 completed weeks

and 39 completed weeks– Elective, low-risk C-Sections– DVT prophylaxis for Cesarean Sections– Bilirubin Screening

• Scoring thresholds for the measures are set based on historical national data and published research

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Evidence Based Hospital Referral (EBHR) 2009 Changes

• Additional statewide and regional public risk-adjusted mortality outcomes recognized– Michigan BC/BS Cardiovascular Consortium

(BMC2) for PCI

• Survival predictor released for CABG, PCI, AAA, AVR when risk-adjusted results unavailable.

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EBHR: Survival Predictors Added

• No additional questions from last year• “Survival predictor”—based on volume and non-

adjusted in-hospital deaths--a composite measure that predicts future hospital performance on mortality

• Takes into account number of cases via weights—so that reliability related to small numbers is assured

• Developers—Drs. Justin Dimick and John Birkmeyer, U.Mich Medical School, Doug Staiger from Dartmouth

• Reported as independent score on consumer pages• White paper available on LF website

http://www.leapfroggroup.org/media/file/SurvivalPredictorWhitepaper.pdf

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Questions?

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Dates of Town Hall Specialty Calls

• Check survey home page for dates and times

• CPOE Evaluation Tool

• Administrative Data: How to Use for Answering LF Hospital Survey questions