NJ Quality Reporting Initiatives

1. NJ Quality Reporting Initiatives State Coverage Initiatives Robert Wood Johnson Foundation February 8, 2008

2. New Jersey Quality Reporting Context • Major focus for the state • Grew out of Department role in public health and as regulator • Some legislation • Support from press and advocates • Build on national efforts

3. Objectives for Today • Context for these projects • Broad overview of these projects • Data sources/general methodology • Describe several projects • Issues for future

4. Public Reporting Efforts: Current • HMO Performance 1997 • CABG Mortality 1997 • Hospital Performances 2004 • Bariatric Surgery 2006 • Patient Safety 2006 • AHRQ Quality Indicators 2007

5. Public Reporting Efforts: In Development • Hospital Associated Infections • Stroke • Other Cardiac

6. Context for Reporting • Grew out of DHSS recognition of need • HMO reporting grew out of revisions in regulations • CABG grew out of press questions and DHSS commitment • Other reports developed from this beginning

7. NJ Context • Legislative requirements for CABG, medical errors, stroke • Advisory Groups for hospital performance, CABG, stroke • DHSS initiation of other efforts within context of public reporting • Started early and grew

8. Administrative discharge data: Additional clinical information: National data collection: AHRQ QIs, bariatric surgery CABG, medical errors, stroke Hospital quality, infections Data Sources: Various

9. Hospital Performance Report: In General • Collect CMS/Joint Commission data • Heart attacks, CHF, pneumonia, surgical improvement • Collect quarterly data from hospitals • Specific patient level data allows research

10. Hospital Performance Report: Web Site • Interactive web site allows sorting on county, individual hospitals • Provides consumer resources and information • Basis for other quality reports • www.nj.gov/health/hpr

11. Hospital Performance Report: Use of Information • Give visibility to public reports-press coverage • Outreach to get visibility for web site • Several grants to work with hospitals on quality improvement initiatives • Presentation at SHIP meetings

12. Patient Safety Initiative • Legislative requirements: • Mandatory reporting • Voluntary reporting • All licensed facilities • Implemented for hospitals in 2005 • Hospital submit events and RCAs

13. Patient Safety Initiative: Data • Use NQF List for events • Work with hospitals on performance • Training and Newsletters • Annual reports-aggregate • www.nj.gov/health/ps

14. Hospital Associated Infections Reporting • Based on broad legislative requirements • Strategy-quick regulatory process • Begin data collection in 2009 • Begin public reporting in 2010

15. Infections Reporting: Changing Context • Following national model-more consumer involvement • Tension between hospital resources and pubic demand for information • Tentative solution

16. Infections Reporting: Technical Issues • Use CDC’s NHSN national data warehouse • Gives states access to individual hospital data • Work on hospital enrollment, training and validation issues • Resource issues

17. Impact of NJ Reports • Improvement in hospital performance scores and national ranking based on Jencks articles • Basis for work with hospitals on quality • CABG mortality decreases 54% between 1994 and 2004

18. On NJ Agenda • Build mandated public reporting • Add quality reports to interactive site • Add measures/costs to interactive site • Build awareness of information • Use for hospitals in financial distress

19. Issues to Consider • Increasing acceptance of public reporting • Still not sure what consumers use • Comprehensibility an issue • Obvious that providers use • Consider pay for performance

20. Additional Information • Health Care Quality Assessment Office • www.nj.gov/health/healthcarequality