Hm306 week 8
- 1. © 2016© 2016 A Practical Approach to Analyzing Healthcare Data Chapter 9 – Benchmarking and Analyzing Externally Reported Data
- 2. © 2016 The Benchmarking Process • Benchmarking – comparing performance to a standard • Internal benchmarking – comparison to internal goals or year-over-year • External benchmarking – comparison to external norms or competitors • Benefits – Identify strong or weak areas – Part of quality improvement culture
- 3. © 2016 Benchmarking Steps 1. Identify the issue to benchmark 2. Locate internal data related to the issue 3. Analyze internal data 4. Identify external data available for benchmarking 5. Collect public domain data or purchase data, if appropriate 6. Compare internal and external data 7. Determine whether a performance gap exists 8. Communicate benchmarking findings 9. Establish performance-level targets and action plans for achievement 10. Implement plans; monitor and communicate progress 11. Recalibrate benchmarks as necessary 12. Repeat the process
- 4. © 2016 Hospital Value Based Purchasing Programs (HVBP) • CMS HVBP is example of a formal benchmarking program • HVBP includes four domains – Process of care – Outcomes – Patient experience – Efficiency of care • Generates Total Performance Score (TPS) that is used to determine an incentive payment added to Medicare inpatient payments for participating hospitals
- 5. © 2016 Dashboards and Scorecards • Method to represent performance in terms of key performance indicators (KPI) • Guide management decisions • Include a combination of indicators measured on a ‘per unit’ basis for comparability across time • Categories may include: – Clinical – Operational – Financial
- 7. © 2016 AHRQ HCUP Data • HCUPnet – online querying tool to select regional/national statistics based on claims data • Collects data from state organizations • Creates a probability sample from the state databases and additional sample data from selected hospitals • Updated annually • Used by many researchers and practitioners for benchmarking • Only publicly available source of all payer claims data
- 8. © 2016 AHRQ HCUP Data • National Inpatient Sample (NIS) – All payer inpatient data • Kids’ Inpatient Database (KID) – Pediatric inpatient data • Nationwide Emergency Department Sample (NEDS) – All payer emergency department data • State Inpatient Surgery Database (SASD) – All payer ambulatory surgery data for selected states – Primarily hospital based clinics • State Emergency Department Databases (SEDD) – All payer data for selected states
- 9. © 2016 AHRQ Quality Measures • Types of care – Preventive measures – Acute care measures – Chronic care measures • Settings of care – Hospital care measures – Ambulatory care measures – Home health care measures • Care by clinical area – Cancer measures – Diabetes measures – Heart disease measures – Maternal and child health measures – Respiratory diseases measures
- 10. © 2016 National Quality Forum (NQF) • Provides a framework for endorsing healthcare quality measures by: – Convenes working groups to foster quality improvement in both public- and private-sectors; – Endorses consensus standards for performance measurement; – Ensures that consistent, high-quality performance information is publicly available; and – Seeks real time feedback to ensure measures are meaningful and accurate. • Endorsement of a quality measure requires the following steps: 1. Measure is proposed and supported with scientific evidence 2. Validity and reliability of the measure is established 3. Feasibility is tested typically via pilot testing; includes cost and potential administrative burden for data collection 4. Usability is assessed; does the measure provide enough feedback so that users can improve performance 5. Assessment of related or competing measures
- 11. © 2016 Medicare Quality Measures • Data.medicare.gov – Hospital Compare – Nursing Home Compare – Physician Compare – Home Health Compare – Dialysis Facility Compare • Data provided in online query and comparison format as well as a bulk download of national statistics
- 13. © 2016 Risk adjustment • Quality measurement should include an adjustment for the risk of an adverse outcome • Patient level adjustment – Age/gender – Comorbidities • Provider level adjustment – Teaching status – Location (urban/rural) – Socio-economic attributes of patient mix – Payer mix • Used to compare actual performance to expected performance based on the risk factors – SIR – standardized infection rate (observed infection rate divided by the expected infection rate) – SRR – standardized readmission rate – SMR – standardized mortality rate • For all standardized rates, a value of greater than one is interpreted that a facility’s rate is higher than expected given the risk attributed to their patient mix
- 14. © 2016 Leapfrog Group • Data collected via hospital survey • Areas of measurement – Prevention of medication errors – Appropriate ICU staffing with professionals specially trained in critical care – Steps to avoid harm – Reduction of pressure ulcers – Reduction of in-hospital injuries – Managing serious errors • May compare again Leapfrog Group criteria
- 15. © 2016 Bridges to Excellence • Not-for-profit organization • Developed by employers, physicians, and industry experts • Pay-for-performance program • Providers submit data • Standard data exchange • Standard performance measurement • May be implemented by state governments, health plans or employers
- 16. © 2016 HealthGrades • Data licensed from CMS and selected states • 31 procedures and diagnoses – State/geographic area via website – More detail may be purchased • Hospitals receive a 1 to 5 star rating based on performance – Patient safety – Clinical performance – Patient experience
- 17. © 2016 HEDIS • Healthcare effectiveness data and information set • Administered by the National Committee for Quality Assurance (NCQA) • Data tracks the performance of health plans • Data is validated