Methodology

Performance Data

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Compare Performance by Groups and Regions

Top Performers

Benchmarks

Interactive Map

Differences from CMS Hospital Compare


This site includes data on the performance of most U.S. hospitals. It does not include data on the following types of hospitals: Rehabilitation, Children's or Psychiatric. Unregistered users can compare up to 70 hospitals (or hospital groups or regions) in a single report. To add more hospitals to a single report, please register for the site and log in.


Recommended Care (Core Measures)

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): Hospital Quality Alliance (CMS, Joint Commission)
Technical Specifications: http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx
Data Collection: Medical record, all-patients 18 years and older, all-payer.

These measures report how often hospitals delivered recommended care processes in the following four areas: heart attack, heart failure, pneumonia, and surgical care improvement.  

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=25813


Composite Measures of Recommended Care

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): IPRO, Commonwealth Fund
Technical Specifications: https://sites.google.com/a/ipro.us/pelliki/home/qualitymine/category-measures-catalogue/composite-measures
Data Collection: Medical record, all-patient 18 years and older, all-payer.
WhyNotTheBest.org presents composite performance scores for each hospital for each of the following four conditions:

  • Overall Heart Attack Summary Rate (composite of four process-of-care measures for this condition)
  • Overall Heart Failure Summary Rate (composite of three process-of-care measures for this condition)
  • Overall Pneumonia Summary Rate (one process-of-care measure for this condition)
  • Overall Surgical Care Improvement Summary Rate (composite of nine care processes used to improve surgical care/prevent surgical infections)

To create composite scores for each condition, the site uses a methodology prescribed by the Joint Commission. This approach suggests that the composite score be the number of times a hospital performed the appropriate action across all measures for that condition, divided by the number of opportunities the hospital had to provide appropriate care for that condition. Composite scores will not be displayed if all measures in that condition were less than 30 cases.

Scores are not weighted, except that measures with larger denominators do contribute more weight to the calculation of the mean for that measure. None of the measures is risk adjusted.

We also create an overall quality composite (Overall Recommended Care) that takes into account 31 Hospital Quality Alliance process-of-care measures, including stroke care and blood clot measures. 

It is possible for a hospital to submit “0” on a particular measure, indicating that it had no patients whose treatment was relevant to that measure. For example, a hospital reporting seven measures of heart attack care could submit denominators of 0, 6, 2, 12, 30, 29, and 14 and still have a composite score calculated.

In all instances we calculate a weighted average, wherein we add all the numerators and divide by the total of the denominators.

We also rank hospitals on these composite measures, but to be ranked hospitals must satisfy the following additional criteria:

  • Measures must contain all available quarters worth of data.
  • Must report all indicators within the topics (i.e. be fully reported). For example, HF composite score will be ranked only if all 4 HF indicators were reported.
  • At least one indicator in the topic had denominator >= 30.

Some hospitals report enough data to be considered eligible for inclusion in the WhyNotTheBest.org top performers listing. These criteria are detailed below.

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Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.hcahpsonline.org/techspecs.aspx
Data Collection: Patient survey, all-patient 18 years and older, all-payer.

The site includes 11 measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This survey asks a random sample of recently discharged patients about important aspects of their hospital experience.  HCAHPS is a relatively new survey, and hospitals across the U.S. are not yet achieving very high scores across all of the questions. Nevertheless, some hospitals are scoring significantly better than others, and a 2011 Press Ganey study [http://www.healthleadersmedia.com/content/QUA-276127/Hospital-HCAHPS-Scores-Beat-Expectations.html] found that some hospitals are achieving rapid improvement on these measures. Patients rate certain questions on a scale of 0 to 10, where 0 is the worst and 10 is the best. Responses to other questions consist of the following possible answers: Always, Usually, Sometimes, or Never.  For example, one survey question asks how often their nurses communicated well, and respondents reported their nurses ("Always," "Usually," "Sometimes," or "Never") communicated well.  Hospital rankings are displayed on the measure detail page when applicable.

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=25772

www.hcahpsonline.org.

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Emergency Care

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Electronic medical record, paper medical records, all emergency department patients, all-payer.

These four measures assess how quickly hospitals treat patients who come to the hospital emergency department. Reducing the time patients remain in the emergency department can improve access to treatment and increase quality of care. The measures are:

  • Median time from ED arrival to ED departure for admitted ED patients,
  • Median admit decision time to ED departure time for admitted patients,
  • Percentage of patients who left the emergency department before being seen, and    
  • Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival (Note: only 345 hospitals reported data for this measure as of April 2013.) 

Read more: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=22&objid=26099


Immunization

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative claims, paper medical records, all-payer.

These measures assess whether hospitals screen their patients for influenza vaccine status (age 6 months and older) and pneumococcal vaccine status (age 65 and older and high risk patients age 6-64) and provide vaccine to patients prior to discharge if indicated. Influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A sizable proportion of pneumococcal infections and deaths are potentially preventable through pneumococcal vaccination. The highest mortality from pneumococcal disease occurs among the elderly and patients who have underlying medical conditions.

Read more: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=11&objid=35559


Timely and Effective Stroke Care

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection:  Medical record, all patients 18 years and older, all-payer.
 
Strokes occur when blood flow to the brain is interrupted.  Brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.  A stroke can be caused by either a blood clot that blocks a blood vessel in the brain (ischemic stroke) or by a blood vessel in the brain that breaks and bleeds into the brain (hemorrhagic stroke). Serious complications of strokes include a loss of the ability to speak, memory problems, paralysis on one side of the body, and difficulties in swallowing or eating.   Getting the right care at the right time can help reduce the risk of complications and another stroke. These measures show the percentage of adults who receive various recommended standards of care from a hospital following a stroke.  Higher percentages are better.
 
  • Thrombolytic Therapy –This measure shows the percentage of ischemic stroke patients who arrived at the emergency department within 2 hours of the onset of their symptoms and who got medicine to break up a blood clot within 3 hours after symptoms started.  This medicine, called tissue plasminogen activator, a type of thrombolytic therapy, can limit the damage and disability caused by an ischemic stroke when given within 3 hours after a stroke begins.
  • Antithrombotic Therapy By End of Hospital Day 2 – This measure shows the percentage of ischemic stroke patients who started antithrombotic therapy within 2 days of arriving at the hospital.  This medicine prevents and treats clots and reduces death, disability, and the risk of another stroke.
  • Venous Thromboembolism (VTE) Prophylaxis – Stroke patients are at increased risk of developing new blood clots in their veins that break off and travel to other parts of the body, like the brain or lung, a condition called venous thromboembolism or VTE.  Treatment to prevent new blood clots from forming includes medicine, medical devices, and tightly fitting stockings.  This measure shows the percentage of ischemic or hemorrhagic stroke patients who either received treatment to prevent blood clots on the day of or day after arrival at the hospital or had paperwork in their chart to explain why they had not received this treatment.
  • Discharged on Antithrombotic Therapy – Ischemic stroke patients are at risk for developing complications like another stroke even after discharge from the hospital.  This measure shows the proportion of ischemic stroke patients prescribed antithrombotic therapy (medicine that prevents the formation of blood clots in the blood vessels) at hospital discharge.
  • Anticoagulation Therapy for Atrial Fibrillation/Flutter - This measure shows the percentage of ischemic stroke patients with an irregular heartbeat (also called atrial fibrillation/atrial flutter) who were prescribed an anticoagulant before they were discharged from the hospital.  Anticoagulants are medicines that thin the blood and this reduces the chance of another stroke in these patients.
  • Discharged on Statin Medication - This measure shows the percentage of ischemic stroke patients who received a prescription for a statin before they were discharged from the hospital.  Statins are medicines that lower LDL cholesterol and this helps lower the chance of another stroke in these patients.  Patients who shouldn’t take statins are excluded from this measure.
  • Stroke Education - This measure shows the percentage of ischemic or hemorrhagic stroke patients or their caregivers who received written information about all of the five following topics during their hospital stay: 1) how to activate the hospital emergency system, 2) the importance of doing follow-up after discharge from the hospital, 3) medicines prescribed at discharge, 4) risk factors for stroke, and 5) warning signs and symptoms of stroke.

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Blood Clot Prevention and Treatment

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection:  Medical record, all patients 18 years and older, all-payer.
 
All hospital patients have an increased risk of developing blood clots in their veins during their hospital stay because of the long periods of time they often have to stay in bed.  These blood clots (also called venous thromboembolism or VTE) can cause damage, and even death, by breaking off and traveling to other parts of the body like the heart, brain, or lung.  Fortunately, there are safe, effective, and proven methods to prevent blood clots or to treat them when they occur.  The measures listed below show how well hospitals are providing these recommended standards of care and how often blood clots occur that could have been prevented.
 
  • Venous thromboembolism prophylaxis – This measure shows the percentage of hospital patients who either got treatment to prevent blood clots on the day of or day after hospital admission or surgery or had paperwork in their chart to explain why they had not received this treatment. Treatment to prevent new blood clots includes tightly fitting stockings, blood thinners, and/or other medicines. 
  • ICU venous thromboembolism prophylaxis - This measure shows the percentage of ICU patients who either got treatment to prevent blood clots on the day of or day after hospital admission or surgery or transfer to the ICU, or had paperwork in their chart to explain why they had not received this treatment.  Treatment to prevent new blood clots includes tightly fitting stockings, blood thinners, and/or other medicines. 
  • Incidence of potentially preventable VTE – This measure shows the percentage of hospital patients who developed a blood clot while in the hospital who did not get preventive treatment beforehand, such as tightly fitting stockings, blood thinners, and/or other medicines. 
  • Anticoagulation overlap therapy – Hospital patients who develop blood clots in their veins (also called venous thromboembolism, or VTE) need treatment to break up the clots quickly and prevent others from forming.  The recommended treatment is to first give a blood thinner that can get into the bloodstream quickly through an intravenous (IV) method or injection (heparin), then give a slower-acting oral blood thinner medicine (warfarin), and continue giving both blood thinners for 5 days or until it is safe for the patient to transition off of the IV blood thinner and use only the oral blood thinner medicine. This measure shows the percentage of hospital patients who had a confirmed diagnosis of blood clot when admitted to the hospital or during their hospital stay, and received both medicines for at least 5 days, or were discharged from the hospital on both kinds of medicine, unless they no longer needed it.
  • Unfractionated heparin with dosages/platelet count monitoring – Patients who have a blood clot (also called venous thromboembolism, or VTE) are usually treated with a blood thinner.  One type of intravenous blood thinner, called unfractionated heparin, increases the risk of bleeding more than a different type, called low molecular weight heparin.   Patients getting unfractionated heparin should be given regular blood tests to check if they are at an increased risk of bleeding from getting the medication. This measure shows the percentage of hospital patients with a blood clot treated with unfractionated IV heparin who had their blood checked using recommended procedures.
  • Warfarin therapy discharge instructions – Hospital patients with blood clots in their veins (also called venous thromboembolism or VTE) are usually given blood thinner medicines when they leave the hospital.  This measure shows the percentage of hospital patients with a blood clot (either present at admission or developed during their hospital stay) discharged from the hospital on blood thinners (anticoagulants or anticoagulant therapy or warfarin therapy) who received written discharge instructions or other educational materials at hospital discharge on all of the following topics: 1) compliance issues, 2) dietary advice, 3) follow-up monitoring, and 4) potential for adverse drug reactions and interactions.
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Readmission Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates include patients readmitted to a hospital within 30 days of discharge from a previous hospital stay for heart attack, heart failure, or pneumonia. Readmissions rates reflect three years' worth of data. Regional rates are derived by calculating a simple average of all risk-adjusted averages for hospitals reporting within the region. Regional rates should not be directly compared to a hospital's risk-adjusted rate. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day readmission rates for heart failure, heart attack, and pneumonia.  

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?objid=26098

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Value-Based Purchasing – Readmissions Program

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/
Data Collection: Medicare Provider Analysis and Review (MEDPAR) File (claims data)

Hospitals participating in the Acute Care Hospital Inpatient Prospective Payment System (IPPS) contract with Medicare to furnish acute hospital inpatient care and agree to accept predetermined acute IPPS rates as payment in full. The Hospital Readmissions Reduction Program requires CMS to reduce payments to IPPS hospitals with excess readmissions. A readmission is defined as an admission to a general, acute-care, short-term hospital within 30 days of a discharge from the same or another acute-care hospital. Planned readmissions are excluded. Currently, CMS calculates the excess readmission rate for three conditions: acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Excess readmissions are determined by comparing a hospitals’ readmission rates for the three conditions (AMI, HF, & PN) with what would be expected in that hospital based on national averages and adjusted for factors that are clinically relevant including patient demographic characteristics, comorbidities, and patient frailty. A minimum of 25 cases is needed for a condition (AMI, HF, or PN) to be included in the excess readmissions calculations for a given hospital.

For fiscal year 2014, CMS calculated an excess readmission rate for discharges occurring from July 1, 2009, through June 30, 2012. The penalty for excess readmissions is expressed as an "adjustment factor" that is applied to Medicare reimbursements for care for patients admitted for any reason (not just for the 3 conditions used to calculate the penalty). For fiscal year 2014, the lowest adjustment factor, 0.9800, is the maximum penalty and means that a hospital would receive only 98 percent of the amount Medicare usually pays. The highest adjustment factor is 1.0000, meaning that a hospital would receive its full Medicare reimbursement, or 100 percent. Maryland hospitals are exempt from the Hospital Readmissions Reduction Program.

Readmissions Payment Adjustment Factor – This measure shows the degree to which an IPPS hospital is penalized in fiscal year 2014 for excess readmissions that occurred from July 1, 2009, through June 30, 2012. An adjustment factor of 1.000 (best possible) means no penalty and the hospital receives its full Medicare reimbursement. The lowest adjustment factor possible, 0.9800, means that the hospital receives a 2% penalty and receives only 98% of the usual Medicare reimbursement.



Mortality Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates take into account deaths within 30 days from all causes after an initial hospitalization with a principal diagnosis of heart attack, heart failure, or pneumonia. Mortality rates displayed on this site reflect three years' worth of data. Regional rates are derived by calculating a simple average of all risk-adjusted averages for hospitals reporting within the region. Regional rates should not be directly compared to a hospital's risk-adjusted rate. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day mortality rates for heart failure, heart attack, and pneumonia.

Read More: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=22&objid=26095 

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Early Elective Delivery Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualityforum.org/QPS/QPSTool.aspx
Data Collection:  Web-based hospital data entry from administrative claims, electronic clinical data, and paper medical records.
 
It’s best to wait until the 39th completed week of pregnancy to deliver a baby because important fetal development takes place in a baby’s brain and lungs during the last few weeks of pregnancy.  Therefore, hospitals should work with doctors and patients to avoid early elective deliveries when they are not medically necessary.  
 
This measure shows the percentage of newborns whose elective deliveries (vaginal or by C-section) were scheduled too early (1-3 weeks early) when a scheduled delivery was not medically necessary.  Lower percentages are better. Higher numbers may indicate that hospitals aren’t doing enough to discourage this unsafe practice. 
 

Spending per Medicare Beneficiary

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: https://www.cms.gov/HospitalQualityInits/32_MedicarePaymentAndVolume.asp
Data Collection: Claims/payment data, Medicare patients, acute care hospitals only.

Spending per Hospital Patient with Medicare:
This measure shows whether Medicare spends more, less or about the same per Medicare patient treated in a specific hospital, compared to how much Medicare spends per patient nationally. This measure includes any Medicare Part A and Part B payments made for services provided to a patient during the 3 days prior to the hospital stay, during the stay, and during the 30 days after discharge from the hospital.
 
Note: A value of 1 means that Medicare spends about the same amount per patient for an episode of care initiated at this hospital as it does per hospital patient nationally.  A value >1 indicates that Medicare spends more per patient and a value <1 means that Medicare spends less per patient for an episode of care initiated at this hospital than it spends per hospital patient nationally.  So, for example, a value of 1.50 indicates that Medicare spends 50% more per patient at this hospital compared to what it spends per patient nationally and a value of 0.70 indicates that Medicare spends 30% less per patient at this hospital compared to national spending.

Read More: https://www.cms.gov/HospitalQualityInits/32_MedicarePaymentAndVolume.asp

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Health Care Costs

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html
Data Collection: Medicare claims.

WhyNotTheBest.org reports average covered charges per discharge and average total payments per discharge for 13 diagnosis-related groups (DRG) for U.S. hospitals that received Medicare Inpatient Prospective Payment System (IPPS) payments in fiscal year 2011. DRGs make up a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during a patient’s stay. The DRG assignment is determined by the patient’s principal diagnosis, up to 24 secondary diagnoses that may include comorbidities or complications, up to 25 procedures furnished during the hospital stay, and a patient’s gender, age, and discharge status disposition.

  • DRG 065 - Intracranial hemorrhage or cerebral infarction with complication or comorbidity
  • DRG 194 - Simple pneumonia and pleurisy with complication or comorbidity
  • DRG 247 - Percutaneous cardiovascular procedure with drug-eluting stent without major complication or comorbidity
  • DRG 249 - Percutaneous cardiovascular procedure with non-drug-eluting stent without major complication or comorbidity
  • DRG 291 - Heart failure and shock with major complication or comorbidity
  • DRG 313 - Chest pain
  • DRG 392 - Esophagitis, gastroenteritis, and miscellaneous digestive disorders without major complication or comorbidity
  • DRG 469 - Major joint replacement or reattachment of lower extremity with major complication or comorbidity
  • DRG 470 - Major joint replacement or reattachment of lower extremity without major complication or comorbidity
  • DRG 480 - Hip and femur procedures, except major joint, with major complication or comorbidity
  • DRG 481 - Hip and femur procedures, except major joint, with complication or comorbidity
  • DRG 690 - Kidney and urinary tract infections without major complication or comorbidity
  • DRG 871 - Septicemia or severe sepsis without mechanical ventilation greater than 96 hours with major complication or comorbidity

Average Covered Charges - The hospital's average charge for services covered by Medicare for all discharges in the DRG. This amount is determined by the hospital and varies from hospital to hospital because of differences in hospital charge structures.

Average Total Payments - The average of Medicare payments to the hospital for all cases for a given DRG. Total costs include the total amount paid by Medicare (for DRG amount, capital, teaching hospital, disproportionate share of low-income patients, and high-cost outlier payments) as well as co-payment and deductible amounts for which the patient is responsible.

Limitations of Maryland Data: The state of Maryland has a unique waiver that exempts it from Medicare’s prospective payment systems for inpatient care. Maryland instead uses an all-payer rate setting commission to determine its payment rates.  Medicare claims for hospitals in other states break out additional payments for indirect medical education (IME) costs and disproportionate share hospital (DSH) adjustments. 

Read More: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html

 


Health Care-Associated Infections

(Central Line-Associated Bloodstream Infections, Catheter-Associated Urinary Tract Infections, Surgical Site Infections from Colon Surgery, Surgical Site Infections from Abdominal Hysterectomy)
Data Source(s): Centers for Medicare & Medicaid Services (CMS); Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN)
Measure Author(s): Centers for Disease Control and Prevention (CDC) 
Technical Specifications: http://www.cdc.gov/nhsn/acute-care-hospital/index.html; http://www.cdc.gov/nhsn/PDFs/Newsletters/NHSN_NL_OCT_2010SE_final.pdf
Data Collection: Clinical data - medical and laboratory records, all-payer.
 
WhyNotTheBest.org includes six healthcare-associated infection (HAI) measures that general, acute-care, short-term hospitals are required by CMS to report to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). HAIs are among the leading causes of death in the United States, increase the number of days that patients are hospitalized, and add to healthcare costs. These infections can often be prevented when hospitals follow guidelines for safe care. The HAI measures show how often patients in a particular hospital contract certain infections during the course of their medical treatment, when compared with similar hospitals.  HAI measures are expressed as standardized infection ratios (SIRs), adjusting for several risk factors that have been found to be significantly associated with differences in infection incidence.  The SIR is calculated by dividing the number of observed infections by the number of expected infections, using infection rates from a standard population during a baseline time period.  
 
A SIR greater than 1.0 means that more HAIs were observed in a facility or state than predicted, and a SIR less than 1.0 means there were fewer HAIs observed than predicted.  A score of 0, meaning no infections, is best.
 
  • Central Line-Associated Bloodstream Infections (CLABSIs) - CLABSI is a type of infection introduced when a central-line catheter or tube is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications to critically ill patients. CLABSIs can be prevented through proper insertion and care of the central line. Acute-care hospitals must report CLABSIs from all adult, pediatric, and neonatal intensive care units.  The CLABSI score is reported using a SIR that compares the number of central-line infections in a hospital’s intensive care unit (ICU) to a national benchmark based on data reported to NHSN from 2000-08.  The SIR is adjusted based on certain factors such as the type and size of a hospital or ICU.
  • Catheter-Associated Urinary Tract Infections (CAUTIs) - A catheter is a drainage tube that is inserted into a patient’s urinary bladder through the urethra and is left in place to collect urine.  Serious infections in the urinary tract can occur if the catheter is not put in correctly or kept clean. Acute care hospitals must report CAUTIs from all adult and pediatric intensive care units.  The CAUTI score is reported using a SIR that compares the number of catheter-associated infections in a hospital’s intensive care unit to a national benchmark based on data reported to NHSN in 2009 and is adjusted based on factors such as the type and size of a hospital or ICU.
  • Surgical Site Infections (SSIs) for Colon Surgery; Abdominal Hysterectomy - Surgical operative procedures involve making at least one incision through the skin or mucous membrane.  Infection can enter the body at the surgical site if surgery is not conducted in a sterile environment and following sterile procedures.  Acute-care hospitals must report surgical site infections (SSIs) for inpatient colon surgeries and abdominal hysterectomies.  The SIRs for colon surgeries and abdominal hysterectomies compare the number of infections from a specific type of operative procedure conducted at a hospital to a national benchmark based on data reported to NHSN from 2000-08.  SSI data are risk-adjusted based on factors related to the patient and surgery.  Only SSIs in patients 18 years or older at the time of surgery and with onset within 30 days of the surgery are included.
  • Methicillin-Resistant Staphylococcus Aureus (MRSA) Blood Infections - Antibiotic-resistant blood infections such as MRSA are associated with increased lengths of stay, costs, and mortality and options for treating patients with these infections are often extremely limited.  The SIR for MRSA blood infections is calculated by dividing the number of observed infections by the number of expected infections based on national baseline data from 2010-11, adjusting for hospital admission prevalence rate of MRSA infections, facility bedsize, and medical school affiliation.
  • Clostridium Difficile (C.diff.) Infections – Clostridium difficile infections of the gastrointestinal tract can result in uncomplicated diarrhea, pseudomembranous colitis, and toxic megacolon, which in some instances can lead to sepsis and even death. The SIR for C. diff. infections compares the number of observed infections in a hospital to the number of expected infections based on national baseline data from 2010-11, adjusting for test type, hospital admission prevalence rate of C. diff. infections, facility bedsize, and medical school affiliation.
 
 
Read More: http://www.cdc.gov/nhsn/acute-care-hospital/index.html

 

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Health Information Technology (HIT)

Centers for Medicare and Medicaid Services HIT Measures: Outpatient Hospital Department

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?cid=1196289981244&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page
Data Collection: Self-reported by hospitals

The HIT measures from CMS assess how outpatient hospital departments (such as emergency, imaging, surgery, and clinics) use electronic medical records.

The first measure (Able to receive lab results electronically) assesses whether a facility has the ability to receive electronic laboratory data directly into a certified electronic medical record and whether the facility actually uses this feature.  Facilities answer the following questions:

  • Does/did your facility have the ability to receive laboratory data electronically directly into your ONC certified EMR system as discrete searchable data? (Yes/No)
  • Did your facility use this feature during the performance period? (Yes/No)

The second measure (Tracking clinical results between visits) assesses whether a facility tracks results of laboratory tests, diagnostic tests (such as screenings), or patient referrals using a certified electronic health record.  This measure applies to all outpatient departments associated with the facility that bill under the Outpatient Prospective Payment System. This may include the emergency department, the outpatient imaging department, the outpatient surgery department, and the facility’s clinics.

Read more: http://www.qualitynet.org/dcs/ContentServer?cid=1196289981244&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page

 

 

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Inpatient Quality Indicators, Patient Safety Indicators, Prevention Quality Indicators

Data Sources: Individual contributing state departments of health and hospital associations.
Measure Authors: Agency for Healthcare Research and Quality (AHRQ)
Technical Specifications: http://www.qualityindicators.ahrq.gov/
Data Collection: Administrative clinical data, uniform billing data, all patients, all payers.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. 
On WhyNotTheBest.org, we report on a subset of the Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Prevention Quality Indicators (PQIs).

Currently, we have data from hospitals in 20 states:  Arizona, California, Florida, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin.  In the fall of 2014, all data for AHRQ measures were analyzed using AHRQ QI SAS version 4.5. 

IPRO's publication of the AHRQ Quality Indicators means that--for the first time--performance data from multiple states can be compared side by side.

While most data on the website are collected nationally under strict standards, data for the AHRQ measures are collected by the states and are therefore subject to minor variations in the method and manner of collection, validation, and reporting. Users are cautioned that comparing facilities across state lines may be less accurate than similar comparisons using federal data. All quality measures go through periods of development, refinement, and standardization, and we expect the consistency of these measures to improve over time.

The Inpatient Quality Indicators (IQIs) are a set of measures that reflect quality of care inside hospitals; they include mortality rates, utilization rates, and volume.  We report 14 IQIs on WhyNotTheBest.org because they are either endorsed by the National Quality Forum or related to conditions reported in other data sets included here (i.e., acute myocardial infarction, heart failure, pneumonia, and maternity).

The 14 IQIs are:

  • Mortality for Selected Procedures Composite -- IQI 90 - The IQI 90 composite score combines hospital mortality information for eight major surgeries - esophageal resection (IQI 08), pancreatic resection (IQI 09), abdominal aortic aneurism repair (IQI 11), coronary artery bypass graft (IQI 12), craniotomy (IQI 13), hip replacement (IQI 14), percutaneous coronary intervention (IQI 30), and carotid endarterectomy (IQI 31). The composite score is the weighted average of the scaled and reliability-adjusted ratios of the eight component indicators with an expected score of 1.  A score <1 indicates that the hospital had fewer deaths following these surgeries than other hospitals with a similar case mix.  A score >1 indicates the hospital had more deaths following these surgeries than other hospitals with a similar case mix.
  • Mortality for Selected Conditions Composite -- IQI 91 - The IQI 91 composite score combines hospital mortality information for six common conditions - acute myocardial infarction (IQI 15), heart failure (IQI 16), acute stroke (IQI 17), gastrointestinal hemorrhage (IQI 18), hip fracture (IQI 19), and preumonia (IQI 20). The composite score is the weighted average of the scaled and reliability-adjusted ratios of the six component indicators with an expected score of 1.  A score <1 indicates that the hospital had fewer deaths following these conditions than other hospitals with a similar case mix.  A score >1 indicates the hospital had more deaths following these conditions than other hospitals with a similar case mix.
  • Risk-adjusted Mortality Rates for Medical Conditions -- Congestive heart failure IQI 16 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of congestive heart failure (CHF).
  • Risk-adjusted Mortality Rates for Medical Conditions -- Stroke IQI 17 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of stroke.
  • Risk-adjusted Mortality Rates for Medical Conditions -- Hip fracture IQI 19 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of hip fracture.
  • Risk-adjusted Mortality Rates for Medical Conditions,--Pneumonia IQI 20 - This measure is used to assess mortality per 100 discharges with principal diagnosis code of pneumonia.
  • Risk-adjusted  Mortality Rates for Medical Conditions -- Acute myocardial infarction (AMI) IQI 15 --  This measure is used to assess the number of deaths per 100 discharges with the principle diagnosis of heart attack (acute myocardial infarction).
  • Cesarean Delivery Rate, Uncomplicated (IQI 21) – This measure assesses the number of Cesarean deliveries without a hysterotomy procedure per 100 uncomplicated deliveries.  It is displayed as a percent.  Deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, or breech procedure) are excluded.
  • Vaginal Birth After Cesarean (VBAC) Delivery Rate, Uncomplicated (IQI 22) – This measures assess the number of vaginal births per 100 uncomplicated deliveries among women with previous Cesarean deliveries.  It is displayed as a percent.  Deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, or breech procedure) are excluded.  This measure is the same as IQI 34 below, except that complicated deliveries are excluded.  In other words, IQI 22 is measured in a subset of those deliveries included in IQI 34 below.
  • Primary Cesarean Delivery Rate, Uncomplicated (IQI 33) – This measure assesses the number of first-time Cesarean deliveries without a hysterotomy procedure per 100 uncomplicated deliveries.  It is displayed as a percent.  Deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, or breech procedure) are excluded.
  • Vaginal Birth After Cesarean, All (VBAC) (IQI 34) – This measure assesses the number of vaginal births per 100 deliveries, both complicated and uncomplicated, among women with previous Cesarean deliveries.  It is displayed as a percent.  This measure is the same as IQI 22 above, except that both complicated and uncomplicated deliveries are included (i.e., complicated deliveries are NOT excluded).
  • Coronary artery bypass graft (CABG) - area rate IQI 26 (STATE and COUNTY ONLY) - This measure is used to assess the number of coronary artery bypass grafts (CABGs) per 100,000 population.
  • Percutaneous transluminal coronary angioplasty  -(PTCA) - area rate IQI 27 (STATE and COUNTY ONLY) - This measure is used to assess the number of percutaneous transluminal coronary angioplasty (PTCA) procedures per 100,000 population.
  • Hysterectomy - area rate IQI 28 (STATE and COUNTY ONLY) -- This measure is used to assess the number of hysterectomies per 100,000 female population.

The IQIs include seven measures of mortality rates, which have been shown to vary across institutions and there is evidence that high mortality may be associated with worse quality of care.  WhyNotTheBest.org thus includes two different types of mortality data from two different sources.

  • CMS Hospital Compare -- CMS mortality rates are 30-day, all-cause mortalities among patients hospitalized with a principal diagnosis of heart attack, heart failure, and pneumonia. All-cause mortality is defined as death from any cause within 30 days after the admission date, regardless of whether the patient dies while still in the hospital or after discharge. It measures deaths that occur within 30 days of a hospital admission, rather than inpatient mortality only, or mortality over some other post-discharge period. The CMS mortality rates measure deaths among Medicare patients only.
  • AHRQ Inpatient Quality Indicators -- AHRQ defines mortality as in-hospital mortality following procedures  for common medical conditions. It measures mortality among all patients -- not just those in Medicare.

The Patient Safety Indicators reflect quality of care inside hospitals, but focus on potentially avoidable complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses. On this site we report the following PSIs:

  • Patient Safety for Selected Procedures Composite -- PSI 90 - The PSI 90 composite score combines information for eight common patient safety problems in the hospital - pressure ulcer (PSI 03), iatrogenic pneumothorax (PSI 06), infection due to medical care (PSI 07), postoperative hip fracture (PSI 08), postoperative pulmonary embolism or deep vein thrombosis (PSI 12), postoperative sepsis (PSI 13), postoperative wound dehiscence (PSI 14), and accidental puncture or laceration (PSI 15).  The composite score is the weighted average of the scaled and reliability-adjusted ratios of the eight component indicators with an expected score of 1.  A score <1 indicates that the hospital had fewer selected patient safety events than other hospitals with a similar case mix.  A score >1 indicates the hospital had more selected patient safety events than other hospitals with a similar case mix.
  • Risk-adjusted Failure to Rescue PSI 4 -- This measure is used to assess the number of deaths per 1,000 patients having developed specified complications of care during hospitalization.
  • Risk-adjusted Postoperative pulmonary embolism or deep vein thrombosis PSI 12 -- This measure is used to assess the number of cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 1,000 surgical discharges with an operating room procedure.
  • Risk-adjusted Decubitus ulcer PSI 3 -- This measure is used to assess the number of cases of decubitus ulcer per 1,000 discharges with a length of stay greater than 4 days.
  • Risk-adjusted Selected Infections Due to Medical Care PSI 7 -- This measure is used to assess the number of cases of infections per 1,000 discharges. The Central Venous Catheter-related Blood Stream Infections indicator is intended to flag cases of infection due to medical care, primarily those related to intravenous (IV) lines and catheters.
  • Risk-adjusted Postoperative hip fracture PSI 8 -- This measure is used to assess the number of cases of in-hospital hip fracture surgical discharges with an operating room procedure, per 1,000 discharges.
  • Risk-adjusted Postoperative Sepsis PSI 13 -- This measure is used to assess the number of cases of sepsis per 1,000 elective surgery patients with an operating room procedure and a length of stay of 4 days or more.
  • Transfusion reaction PSI 16 -- This measure is used to assess the number of cases of transfusion reaction either from incompatible or mismatched blood.
  • Foreign body left during procedure - area rate PSI 21 (STATE and COUNTY ONLY) -- This measure is used to assess the number of discharges with foreign body accidentally left in during procedure per 100,000 population.
  • Iatrogenic pneumothorax - area rate PSI 22 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of iatrogenic pneumothorax per 100,000 population.
  • Selected infections due to medical care - area rate PSI 23 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of infections per 100,000 population. The Central Venous Catheter-related Blood Stream Infections indicator is intended to flag cases of infection due to medical care, primarily those related to intravenous (IV) lines and catheters.
  • Accidental puncture or laceration - area rate PSI 25 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of technical difficulty (e.g., accidental cut or laceration during procedure) per 100,000 population.
  • Transfusion reaction - area rate PSI 26 (STATE and COUNTY ONLY) -- The Transfusion Reaction indicator is intended to flag cases of major reactions due to transfusions (ABO and Rh). This indicator is defined both on a provider level (by including cases based on secondary diagnosis associated with the same hospitalization) and on an area level (by including all cases of transfusion reactions). This measure reflects the number of cases of transfusion reaction per 100,000 population.
  • Postoperative hemorrhage or hematoma requiring a procedure - area rate PSI 27 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of hematoma or hemorrhage requiring a procedure per 100,000 population.

The Prevention Quality Indicators (PQIs) measure hospital admissions that might have been avoided with better medical care outside of the hospital.  The PQIs are based on the county where patients live, and presumably receive their primary outpatient care, not on where hospitals are located.  PQIs provide a good starting point for assessing the quality of health services in the community. We report the following state and county-level PQIs (STATE and COUNTY ONLY):

  • Overall Preventive Care (PQI 90) -- AHRQ collects various measures related to preventive quality improvement. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account nearly all PQIs, including: PQI 1 - Diabetes Short-Term Complications Admission Rate; PQI 3 - Diabetes Long-Term Complications Admission Rate; PQI 5 - Chronic Obstructive Pulmonary Disease Admission Rate; PQI 7 - Hypertension Admission Rate; PQI 8 - Congestive Heart Failure Admission Rate;  PQI 10 - Dehydration Admission Rate; PQI 11 - Bacterial Pneumonia Admission Rate; PQI 12 - Urinary Tract Infection Admission Rate; PQI 13 - Angina Without Procedure Admission Rate; PQI 14 - Uncontrolled Diabetes Admission Rate; PQI 15 - Asthma Admission Rate; and PQI 16 - Rate of Lower-Extremity Amputation Among Patients with Diabetes. This is the number of hospitalizations per 100,000 population.
  • Overall Acute Preventive Care (PQI 91) -- AHRQ collects various measures related to preventive quality improvement of acute conditions. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account: PQI 10 - Dehydration Admission Rate; PQI 11 - Bacterial Pneumonia Admission Rate; and PQI 12 - Urinary Tract Infection Admission Rate.  This is the number of hospitalizations per 100,000 population.
  • Overall Chronic Preventive Care (PQI 92) -- AHRQ collects various measures related to preventive quality improvement of chronic conditions. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account: PQI 1 - Diabetes Short-Term Complications Admission Rate; PQI 3 - Diabetes Long-Term Complications Admission Rate; PQI 5 - Chronic Obstructive Pulmonary Disease Admission Rate; PQI 7 - Hypertension Admission Rate; PQI 8 - Congestive Heart Failure Admission Rate;  PQI 13 - Angina Without Procedure Admission Rate; PQI 14 - Uncontrolled Diabetes Admission Rate; PQI 15 - Asthma Admission Rate; and PQI 16 - Rate of Lower-Extremity Amputation Among Patients with Diabetes.  This is the number of hospitalizations per 100,000 population.
  • Perforated Appendix (PQI 2) -- This measure is used to assess the number of admissions for perforated appendix per 100 admissions for appendicitis within a county. As a Prevention Quality Indicator (PQI), admission for perforated appendix is not a measure of hospital quality, but rather one measure of outpatient and other health care.
  • Hypertension Admissions (PQI 7) -- This measure is used to assess the number of admissions for hypertension per 100,000 population. As a Prevention Quality Indicator (PQI), hypertension is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting.
  • Uncontrolled Diabetes Admissions (PQI 14) -- This measure is used to assess the number of admissions for uncontrolled diabetes per 100,000 population.As a Prevention Quality Indicator (PQI), uncontrolled diabetes is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator.
  • Adult Asthma Admissions (PQI 15)  This measure is used to assess the number of admissions for asthma in adults per 100,000 population. As a Prevention Quality Indicator (PQI), adult asthma is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Admission rates that are drastically below or above the average or recommended rates should be further examined.
  • Dehydration Admissions (PQI 10)  --This measure is used to assess the number of admissions for dehydration per 100,000 population. As a Prevention Quality Indicator (PQI), dehydration is not a measure of hospital quality, but rather one of the measures of outpatient and other health care.
    This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some dehydration care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
  • Bacterial Pneumonia Admissions (PQI 11) --This measure is used to assess the number of admissions for bacterial pneumonia per 100,000 population. As a Prevention Quality Indicator (PQI), admission for bacterial pneumonia is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Because some pneumonia care takes place in an emergency room setting, combining inpatient and emergency room data may give a more accurate picture of this indicator.
  • Urinary Tract Infection Admissions (PQI 12) --This measure is used to assess the number of admissions for urinary tract infection per 100,000 population. As a Prevention Quality Indicator (PQI), admission for urinary tract infection is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some urinary tract infection care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
  • Angina Admissions (PQI 13)  --This measure is used to assess the number of admissions for angina (without procedures) per 100,000 population.
    As a Prevention Quality Indicator (PQI), angina without procedure is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality of care by shifting care to an outpatient setting. Some angina care takes place in emergency rooms. Combining inpatient and emergency room data may give a more accurate picture.
  • Lower Extremity Amputations (PQI 16) --This measure is used to assess the number of admissions for lower-extremity amputation among patients with diabetes per 100,000 population. As a Prevention Quality Indicator (PQI), lower-extremity amputations among patients with diabetes is not a measure of hospital quality, but rather one measure of outpatient and other health care. PQIs are correlated with each other and may be used in conjunction as an overall examination of outpatient care.
  • Diabetes Short-term Complications Admissions (PQI 1) --This measure is used to assess the number of admissions for diabetes short-term complications per 100,000 population. As a Prevention Quality Indicator (PQI), short-term diabetes complication rate is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator. Examination of both inpatient and outpatient data may provide a more complete picture of diabetes care.
  • Congestive Heart Failure Admissions (PQI 8) --This measure is used to assess the number of admissions for congestive heart failure (CHF) per 100,000 population. As a Prevention Quality Indicator (PQI), CHF is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some CHF care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
  • Diabetes Long-term Complications Admissions (PQI 3) --This measure is used to assess the number of admissions for diabetic long-term complications per 100,000 population. As a Prevention Quality Indicator (PQI), diabetes long-term complication rate is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator. Examination of both inpatient and outpatient data may provide a more complete picture of diabetes care.
  • Chronic Obstructive Pulmonary Disease Admissions (PQI 5)--This measure is used to assess the number of admissions for chronic obstructive pulmonary disease (COPD) per 100,000 population. As a Prevention Quality Indicator (PQI), COPD is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some COPD care takes place in emergency rooms, so combining inpatient and emergency room data may give a more accurate picture.

All of the AHRQ Quality Indicators are calculated using either AHRQ QI SAS 4.4 or MONAHRQ 3.0 software that generates observed rates, expected rates, risk-adjusted rates, and lower and upper 95 percent confidence limits for risk-adjusted rates. Observed rates are the raw rates. Expected rates are the rates the hospital would have if it performed the same as the reference population given the hospital's actual case mix (e.g., age, gender, modified DRG and comorbidities). Risk-adjusted and expected rates are derived from applying the average case mix of a baseline file that reflects a large proportion of the U.S. hospitalized or residential population.  Tthe PQIs were calculated as hospitalizations per 100,000 persons for the entire dataset and by county.  The three composites were constructed by summing the hospitalizations across the component conditions and dividing by  the population.

 

Read morehttp://www.qualityindicators.ahrq.gov/.
Interpretation:

Around each measure’s rate we calculate the 95 percent confidence interval, which takes the denominator into account. A rate with a small denominator would yield a very wide confidence interval, and a large denominator would yield a smaller confidence interval.  If the statewide rate falls within the hospital’s confidence interval then there is no statistically significant difference between the hospital and the statewide rate. If the statewide rate falls outside of the hospital’s confidence interval then there is a statistically significant difference.  For measures where a higher rate is desirable and the hospital's confidence intervals are above the statewide rate, then the hospital is reported as performing better than the state. Conversely, for measures where a lower rate is desirable and the hospital's confidence intervals falls below the statewide rate, then the hospital is reported as performing better than the state.

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Population Health and Utilization & Costs

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Institute of Medicine
Technical Specifications: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/Downloads/Geo_Var_PUF_Methods_Paper.pdf
Data Collection: CMS Chronic Condition Data Warehouse (CCW) containing Medicare claims for beneficiaries (all ages) enrolled in the fee-for-service (FFS) program as well as enrollment and eligibility data

The site includes the following measures of population health:

  • Average Hierarchical Condition Category (HCC) risk score expressed as a Ratio to the National Average (see definition below);
  • Percent of Medicare beneficiaries of all ages with Diabetes; and
  • Percent of Medicare beneficiaries of all ages with Heart Failure.

It also includes the following measures of utilization and costs:

  • Standardized Risk-Adjusted Per Capita Costs -- total annual Medicare payments per beneficiary standardized to remove geographic differences in payment rates for individual services and adjusted for differences in beneficiaries’ health using the risk-adjusted model that CMS uses to pay Medicare Advantage plans;
  • Inpatient Days Per 1000 Beneficiaries of all ages -- annual number of hospital inpatient days covered by Medicare per 1,000 Medicare beneficiaries in the geographic area, including inpatient acute care hospitals paid under the Prospective Payment System (PPS), critical access hospitals, and other inpatient hospitals as inpatient psychiatric facilities and cancer hospitals;
  • Imaging (IMG) standardized per user Medicare costs -- total annual Medicare payments for imaging services per Medicare beneficiary in the geographic area who used imaging services during the year, standardized to remove geographic differences in payment rates for imaging services;
  • Test events per 1000 Medicare beneficiaries of all ages -- annual number of laboratory and non-laboratory tests per 1,000 Medicare beneficiaries in the geographic area; and
  • Emergency Department Visits per 1000 Beneficiaries of all ages -- annual number of hospital emergency department visits (including both visits that result in an admission and visits that do not result in an admission) per 1,000 Medicare beneficiaries in the geographic area.

The Hierarchical Condition Category (HCC) risk score model is used by CMS to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees. The model measures disease burden, taking into account HCC categories, which are correlated to diagnosis codes. The risk scores estimate how beneficiaries’ fee-for-service spending will compare to the overall average for the entire Medicare population. The risk score for the overall average is set at 1.0. Beneficiaries with scores greater than 1 are expected to have above-average spending; beneficiaries with scores less than 1 are expected to have below-average spending. Risk scores are based on a beneficiary’s age and sex; whether the beneficiary is eligible for Medicaid, first qualified for Medicare on the basis of disability, or lives in an institution (usually a nursing home); and the beneficiary’s diagnoses from the previous year.

Read More: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/GV_PUF.html.

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County Health Rankings

Data Source(s): County Health Rankings and Roadmaps Program, Behavioral Risk Factor Surveillance System (BRFS), Health Resources and Services Administration (HRSA), Medicare/Dartmouth Institute
Measure Author(s): Health Rankings and Roadmaps Program
Technical Specifications: http://www.countyhealthrankings.org
Data Collection: Random digit dial telephone survey, Medicare claims data, HRSA Area Resource File
 
The County Health Rankings and Roadmaps program synthesizes health information from a variety of national data to rank the counties in each state based on measures in three broad categories: health outcomes, health factors, and policies and programs.  Health outcomes measure how healthy the residents of a particular county are.  Health factors and policies and programs influence county residents' health. The following eight measures are reported on WhyNotTheBest.org:
 
Health Outcomes:
  • Poor or Fair Health - Percent of adults reporting “fair” or “poor” when asked: “In general, would you say that your health is excellent, very good, good, fair, or poor?”   The measure is age-adjusted to the 2000 US population.
Health Factors:
  • Primary Care Physicians per 100,000 Population – The number of practicing primary care physicians (M.D.s and D.O.s) under age 75, specializing in general practice medicine, family medicine, internal medicine, or pediatrics per 100,000 population.
  • Ratio of Population to Primary Care Physicians – The number of people present in a given area as compared to the number of physicians servicing that population. Expressed as the amount of people for each physician.
  • Dentists per 100,000 Population – The number of dentists per 100,000 population.
  • Preventable Hospital Stays – The hospitalization rate for ambulatory care–sensitive conditions per 1,000 Medicare enrollees.
  • Diabetic Screening – Percent of Medicare patients with diabetes who received an A1C test (glycated hemoglobin) in the past year to assess their blood sugar control.
  • Mammography Screening – Percent of female Medicare enrollees age 67–69 that had a least one mammogram over a two-year period.
  • Percent Inadequate Social Support – Percent of adults answering “never,”, “rarely,” or “sometimes” when asked: “How often do you get the social and emotional support you need?”
 
Read more: http://www.countyhealthrankings.org/about-project
 

Data Not Available

Note that not all hospitals report data for all measures; the site only publishes data when there are at least four quarters' worth of data available for a particular measure.  Not all hospitals report all data for all measures.

There is never data available in certain cases:

  • There are no top 1 percent, top 5 percent, top 10 percent or top 25 percent benchmark data for reimbursement rates.
  • There are no top 25 percent benchmark data for mortality rates and readmission rates
  • There are no benchmark data for HCAHPS ratings of 7 or 8.  There are also no benchmark data for HCAHPS rating 6 or lower (except for state and national averages).
  • There are no national benchmark data for the AHRQ Inpatient Quality Indicators and Patient Safety Indicators.

In some cases, data is not reported by a facility or is not calculated for a benchmark.  In other cases, data is reported but does not meet the minimum criteria for inclusion.  In the latter case, N/A will be accompanied by a footnote.

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Compare Performance by Groups and Regions

WhyNotTheBest.org allows users to explore data by hospital characteristics and regions of the U.S.

Compare by Groups

Users can compare hospitals by characteristics such as size, ownership, health system membership, and type—for example, comparing performance of all hospitals in health systems to those not belonging to health systems, or comparing all safety net hospitals to all for-profit hospitals.

Users also can follow the map links from group reports to examine the geographic distribution of U.S. hospitals by various characteristics.

Compare by Regions

Compare by Regions reports enable users to explore aggregated hospital performance by region (i.e., rolled up measurements from all the hospitals within a region) or population health in communities around the nation (i.e., indicators of population health and utilization/costs from the Institute of Medicine). For example, users can select a group of counties or HRRs, and then add in benchmarks from the relevant states as well as the national average.

WhyNotTheBest.org includes regional data for the nation, states, counties, and hospital referral regions (HRRs). Please note: not all measures are available for both county and HRR aggregation.

Users can follow the map links from regional reports to explore regional performance on an interactive map.
 


Top Performers

For each measure included on the site (excluding reimbursement rates, CLABSI data, and AHRQ IQIS and PSIs), the site identifies the top 1 percent of performers—the “top performers.” It also includes other benchmarks: the top 5 percent, top 10 percent and the top 25 percent, as well as top performers by hospital type (e.g., safety net, teaching, etc.).

Top Performers on Process-of-Care Measures

To appear among the top performers on the CMS process-of-care measures, a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement).

No explicit weighting was incorporated, but higher-occurring cases give weight to that measure in the average. Since these are process measures (versus outcome measures), no risk adjustment was applied. 

Top Performers on HCAHPS

To appear among the top performers on the HCAHPS data, hospitals are ranked according to the percentage of survey respondents giving a 9 or 10 rating of overall hospital care. The site uses the results of the following question as a measure of patients' overall experiences:

"Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?"

Note that the site does not apply exclusion criteria to create these performance rankings. All hospitals are included in the calculation of the percentile scores.

Top Performers on Readmission and Mortality Rates

The site identifies hospitals whose performance is statistically better than the national rate, as reported on Hospital Compare.

To review notes on how scores on this site may vary from scores on public reports, or for more details on how we aggregate scores read about Comparative Reporting.

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Benchmarks

For the purposes of calculating benchmarks, we identified hospitals in the following way:

  • Safety Net Hospitals: membership in the National Association of Public Hospitals and Health Systems and/or serving 30 percent or more Medicaid patients
  • Rural Hospitals: Hospitals designated by CMS as Critical Access Hospitals
  • Teaching Hospitals: membership in the Council of Teaching Hospitals and Health Systems
  • Academic Health Centers: membership in the Association of American Medical Colleges
  • For-Profit: based on ownership, from the American Hospital Association database
  • Not-for-Profit/Private: based on ownership, from the American Hospital Association database
  • Government – Non-Federal: based on ownership, from the American Hospital Association database
  • Government – Federal: based on ownership, from the American Hospital Association database
  • Health Systems: based on system classification from the American Hospital Association database

A system is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation. Read more about health systems.

Note that these multi-hospital systems are often horizontally integrated collections of hospitals—as opposed to integrated delivery systems, which WhyNotTheBest.org defines as a system with two or more facilities, including one non-hospital (e.g., a nursing home). The integrated delivery systems identified on the WhyNotTheBest.org map are drawn from an SDI list of high-performing systems; for more information please see the SDI website.

Top 1 percent, Top 5 percent, Top 10 percent, Top 25 percent: Top n percent  is the lowest score achieved by a hospital in the top n percent (i.e. the minimum threshold to be in the top n percent).

Benchmark calculations are based on hospitals that meet the eligibility criteria for high perfomer status, which is: a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement). 

 

To review notes on how scores on this site may vary from scores on public reports, or for more details on how we aggregate scores read about Comparative Reporting.

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Interactive Map

The WhyNotTheBest.org interactive map shows performance variation on the national, state, county, and hospital referral region (HRR) levels. It also includes overlays tracking quality improvement activity and displaying health care performance recognitions in various ways, as described below.

The map includes health care performance measures, in the following categories:

  • Process-of-care; 
  • Patient experience;
  • Health Information Technology adoption;
  • Population Health
  • Utilization and Costs;
  • Readmission rates;
  • Mortality rates
  • Inpatient Quality Indicators;
  • Patient Safety Indicators; and
  • Prevention Quality Indicators.

For the measures from CMS Hospital Compare, the hospital performance values were adjusted by the denominator so that hospitals with higher reported numbers of observations carried a greater weight toward the regional rate.  Weighting was also used to address hospitals that share identifiers.  CMS Hospital Compare provides data at the level of Medicare Provider Numbers (MPNs).  For the map, hospitals sharing MPNs were weighted so as to not overcount their data.  This also allowed hospitals to contribute to the regional rate, regardless of whether their shared MPNs crossed counties.  The HCAHPS measures of patient experience are an exception.  As denominators are not provided for these data, we instead calculate an unweighted average.  Starting in 2012, HCAHPS values are weighted by the total admissions to the hospitals. Note: for some regions there are no data displayed, since there are no hospitals located in that region.

CMS periodically retires measures, which are referred to on WhyNotTheBest.org as "legacy" measures.  While legacy measures are included in the tabular reports, they do not appear on the map.

Overlays

The interactive map also includes overlays that let users explore the following:
 
Hospital Types - Identifies hospitals with selected characteristics.  These include: Joint Commission accreditation; American College of Surgeons approved Cancer Program; Residency Training approved by ACGME; Medical School affiliation; National League of Nursing nursing school; Commission on Accreditation of Rehabilitation Facilities accreditation; membership in Council of Teaching Hospitals; Blue Cross contracting or participating; Medicare certification; American Osteopathic Association accreditation; Catholic Church operated; and membership in the Federation of American Health Care Systems. We derive all of the above designations from the American Hospital Association database.  We also display hospitals that have the following characteristics: Academic Medical Center; Safety Net Hospital; membership in the National Assoiation of Public Hospitals. For more information on these characteristics, read about the benchmarks.
  
The hospital type overlay shows the number of hospitals matching the selected criteria in a given area. The squares are placed at the state / county / geographic center and are sized and numbered according to the number of hospitals they represent. 
 
Accountable Care Organizations – shows the location of the 32 Pioneer accountable care organizations (ACOs) as well as the Medicare Shared Savings Program accountable care organizations (there were 219 as of March 2013). Mousing over the hexagons that display the numbers of ACOs in a particular region brings up a list of the ACOs, links to their websites, and the estimated numbers of participating physicians and members, when available. The locations shown on the overlay are generated by the mailing address of each ACO.
 
Beacon Communities – shows the location, name, and website of the 17 regions receiving funds from the HHS Office of the National Coordinator for Health IT to strengthen their health IT infrastructure and thereby improve health and control costs. The locations shown on the overlay are generated by combining counties included in their service area, as of November 2012.
 
Integrated Delivery Systems – shows the location of the integrated delivery systems around the nation as of November 2011. WhyNotTheBest.org defines an integrated delivery system as a health system with two or more facilities, including one non-hospital facility (e.g., a nursing home). The integrated delivery systems identified on the WhyNotTheBest.org map are drawn from an SDI list of high-performing systems; for more information please see the SDI website. The locations shown on the overlay are generated by creating a 25-mile radius from a fixed location (e.g., a hospital).
 
Chartered Value Exchanges – shows the location of the 24 community-based collaboratives funded by the Agency for Healthcare Research and Quality to improve health care quality and promote transparency. The locations shown on the overlay are generated by combining counties included in their service area, as of November 2012.
 
 

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Differences from CMS Hospital Compare

WhyNotTheBest.org (WNTB) publishes indicators derived from the publicly available dataset provided by the Hospital Compare website hospitalcompare.hhs.gov

 

There are certain instances when scores published on WNTB differ from Hospital Compare. Please note the following criteria used by WNTB:

  • HHS does not publish numerators. WNTB derives a numerator from the data by multiplying the score by the denominator. i.e. 80% of 100 cases results in a numerator of 80.
  • At least 50% of hospitals must report a given measure for that measure to be published to WNTB.
  • Aggregate scores (e.g. county, HRR, state averages) for process of care and patient experience are weighted by hospital admissions.
  • Comparator benchmarks (e.g. Top 10%, Safety Net Hospitals) only include those hospitals meeting inclusion criteria of reporting all available measures for all available quarters.
  • In instances where a minimum denominator is required, WNTB requires 30. Hospital Compare requires 25.
  • WNTB calculates some AHRQ Quality Indicators using state-contributed all-payer data. Medicare uses Medicare-only data.

For further information about the methodology, please contact wntb-support@ipro.us.