What’s New in 2009: The Leapfrog Hospital Survey

1. What’s New in 2009: The Leapfrog Hospital Survey February 18, 2009

2. Behind the Changes Goals for the survey— • Add Leap Categorization • Keep burden as low as possible • Support CMS initiatives • Align with other performance measurement groups (such as CDC-NHSN; CMS) • Maintain consistent measurement structure for Pay-for-Performance and improvement purposes • Add normal delivery measures to address commercial spend • Expand Hospital-acquired conditions • Expand Survival Predictor • Incorporate Safe Practices changes from maintenance work

3. How did we do? • Added new measures but still significantly reduced from 2007 with 106 pages—now 76 survey question pages • Bulk of survey remains similar to 2008 – IPS, Safe Practices, CACs, EBHR questions • Aligned language in Safe Practices to new version; added one new Safe Practice • Added 4 Normal Delivery Measures (two outcome and two process measures • Three of four normal delivery measures endorsed by NQF—fourth is still under review; new Safe Practices endorsed by NQF • Added NQF endorsed catheter-related blood stream infections in the ICU to our hospital acquired conditions • Expanded survival predictor to include: CABG, PCI, AAA, AVR, Bariatric procedures

4. Survey Changes: The Details • Additional questions in demographic section • CPOE Evaluation Tool Scoring • Safe Practices updated • New Hospital-Acquired Condition (HACs)--CLABSI • EBHR Changes: • Survival Predictor--additions • Volume indicators changed to “isolated procedures” to capture same as used in Survival Predictor development • Public Reporting Additions- Blue Cross/BlueShield Michigan • Bariatric—surgeon volume dropped • Normal Deliveries a. Elective Deliveries from 37 weeks through 39 weeks b. Cesarean-section rate for low risk women c. DVT prophylaxis for Cesarean-section mothers d. Screening for newborn bilirubin –identification of jaundice 4

5. 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 a hospital loading computer-generated patient profiles and medication orders into their CPOE system and reporting back on the alerts they received • Hospitals must complete the test and score well to achieve either Fully Meets or Good Progress on the CPOE Leap in 2009 • Scores from the test will be used in a composite with other key indicators of good implementation • Hospitals access the tool from the survey website once they have completed the CPOE section of the online survey 5

7. Critical Success Factors for the Hospital in CPOE Implementation (David Bates] • Strong leadership and long term commitment • Creating a culture of innovation • Excellent project management • Attention to clinical processes • A focus on quality

8. EBHR: Survival Predictor Expanded • 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 • Developers—Drs. Justin Dimmick and John Birkmeyer, U.Mich Medical School, Doug Staiger from Dartmouth • Reported as independent score on consumer pages • White paper available on LF website • Measure in endorsement process • Two articles published thus far. Medical Care Feb 2009; and Annual Review of Medicine Jan 2009. Third article accepted for publication in Health Affairs.

9. EBHR: Survival Predictor • Survival Predictor added for hospitals without risk-adjusted mortality scores to complement quality measures for four procedures/surgeries: CABG, PCI, AAA, AVR, and Bariatric • For each procedure/surgery, hospitals are asked to report: • Volume of procedures • the number of cases within the volume count where death occurred within the inpatient stay. • The clinical information and statistics needed to report these data can be accessed from the hospital’s administrative data system; no chart abstraction will be necessary • Will report the risk-adjusted scores independently from the survival predictor. 9

10. EBHR: Surgeon Volume • Given availability of the “survival predictor” surgeon volume was dropped for bariatric surgeries

11. EBHR Changes • Additional statewide and regional public risk-adjusted mortality outcomes recognized • Michigan BC/BS • Answers from prior year not kept—so hospitals should print their answers from 2008 by the end of the 2008 submission cycle 11

12. Common Acute Conditions: Normal Deliveries Four new measures to address normal deliveries: a. Elective deliveries from 37 weeks through 39 weeks (includes inductions and c-sections) b. Low risk delivery by cesarean section c. DVT prophylaxis for cesarean section d. Screening for billirubin These measures will be scored in a bundle—specific points for achieving all/some/none 12

13. Hospital-Acquired Conditions • New HAC section added to address Catheter-related blood stream infections. Hospitals will report by ICU type and hospital type for specific ICUs; rate denominator is central line days. • We will continue to measure all hospital-acquired pressure ulcers and hospital-acquired injuries (burns, falls, etc.) in 2009 • Pressure Ulcer and Injury results will be reported as a rate per 100 inpatient days • Hospitals will report on 12 months of data 13

14. 2009 Safe Practices • Maintenance committee received feedback to break SP 1—Culture of Safety into four distinct Safe Practices. The 2008 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 • In 2008 Safe Practices section focused on 13 of the 27 non-Leapfrog-created Safe Practices. In 2009, we changed SP1 into four separate practices as was done in the new Safe Practices and added one Safe Practice on Urinary Tract Infections. • The Safe Practices have kept the 4A framework, but have been worded to make the questions more tightly defined and actionable 14

15. Survey Logistics—Dennis Bush