1. 1 Quality Health Indicators Brought to you by…

2. 2 Quality Health Indicators  The Quality Health Indicator (QHi) web site was developed through the Kansas Hospital Association, KHA, and KRHOP the Kansas Rural Health Options Project to facilitate a benchmarking project for rural Kansas hospitals.  The goal of QHi is to provide hospitals an economical instrument to evaluate internal processes of care and to seek ways to improve practices by comparing specific measures of quality with like hospitals.  Using QHi as a tool, regional networks of hospitals and individual facilities can select from a library of indicators to determine which measures meet their unique needs.

3. 3 Quality Health Indicators  More than 700 users in over 200 Critical Access and other small rural hospitals in Alaska, Arizona, California, Colorado, Kansas, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Mexico, Oklahoma and Wyoming use QHi as a data collection and benchmarking tool.  As a user-driven multi-state project, QHi is well-positioned to serve as a significant repository of information on quality of care and performance in rural hospitals nationwide.

4. Why participate in a National Benchmarking Project?  Diverse perspectives  Strength in numbers  Communication 4 Quality Health Indicators

5. Using benchmarking data to strengthen quality activities 1.Identify 2.Benchmark 3.Implement 5 Quality Health Indicators

6. 6 A user name and password is required to enter this secure web site. The level of access is determined by the user type. System Administrator – maintains the site – KHA/KHERF State Administrator –provides support to Hospital Contacts in their State Network Administrator – maintains Network profiles & provides support Hospital Contact – maintains Hospital profiles, adds users & enters data Hospital User – enters data and runs reports View Only – views data and runs reports Report Recipient – no access to QHi, only receives reports Quality Health Indicators

7. 7 State Administrators State QHi State AdministratorEmail Address Alaska Rod Betit rodbetit@msn.com Arizona Joyce Hospodar hospodar@u.arizona.edu California Rochelle Spinarski rspinarski@rhsnow.com Colorado Jennifer Dunn jd@coruralhealth.org Kansas Stuart Moore smoore@kha-net.org Louisiana Kandi Smith Kandi.Smith@LA.GOV Minnesota Bonnie Terveer bterveer@mnhospitals.org Missouri Barbara Brendel barbara.brendel@dhss.mo.gov Nebraska Nikki Gohring ngohring@neb.rr.com New Mexico Carlene Brown CBrown@nmmra.org Oklahoma Corie Kaiser corie.kaiser@okstate.edu Wyoming Keri Wagner keri.wagner1@health.wyo.gov

8. 8 Four Pillars Of Measurement Quality Health Indicators Clinical Quality Employee Contribution Patient Satisfaction Financial Operational

9. QHi Advisory Committees Direct and Drive the Project Charge of Committees: –Continuously re-evaluate current measures, their calculations and definitions –Consider new measures –Insure Core Measure Set remains relevant and meaningful –Make recommendations for site enhancements All QHi registered users are invited to participate 9 Quality Health Indicators

10. 10 QHi Core Measure Set Clinical Quality Healthcare Associated Infections per Patient Day - January 2009 Pneumonia Patients Given Antibiotics within 6 hours of admission - CMS PN-5c - June 2009 Pneumonia Patients Receiving Pneumonia Immunization - CMS PN-2 Unassisted Patient Falls Employee Contribution Benefits as a Percentage of Salary Staff Turnover All participating hospitals are asked to collect and report the 8 QHi Core Measures Financial Operational Gross Days in AR Days Cash on Hand - April 2009

11. 11 Clinical Quality Measures Healthcare Associated Infection rate * Unassisted Patient Falls * Inpatients Screened for Pneumonia Medication Omissions Resulting in Medication Error Medication Errors Resulting from Transcription Errors ER Provider Response Times Return ER Visits within 72 hours with same diagnosis Readmits Within 30 Days with Same or Similar Diagnosis CMS Heart Failure Measures Discharge Instructions provided to HF patients - Compare to CMS HF-1 Evaluation of LVS Function - Compare to CMS HF-2 ACEI or ARB for LVSD - Compare to CMS HF-3 Adult Smoking Cessation Advice/Counseling - Compare to CMS HF-4 CMS Pneumonia Measures Inpatients Receiving O2 Assessment within 24 hours of admission - CMS Pn-1 - retired by CMS Inpatients Receiving Pneumonia Immunization * - CMS Pn-2 Pneumonia Given Antibiotics within 6 hours of admission * - CMS Pn-5c CMS OP Transfer Measures Percentage of eligible patients who received thrombolytic therapy - CMS OP-1 and OP-2 Median Time from Emergency Dept Arrival to Time of Transfer to another Facility for Acute Coronary Intervention -compare to CMS OP-3 Number of AMI pts without aspirin contraindications who received aspirin within 24 hrs - CMS OP-4 Percent of AMI or Chest Pain pts receiving ECG within 10 min. of arrival - prior to transfer CMS OP-5 Additionally, facilities can select from over 60 measures in the QHi library of indicators * QHi Core Measure Set

12. 12 SURGICAL CARE IMPROVEMENT PROJECT (SCIP) National Hospital Inpatient Quality Measures Clinical Quality Measures, cont. Prophylactic Antibiotic Received Within One Hour Prior to Surg. Incision - CMS SCIP-Inf-1a Prophylactic Antibiotic Selection for Surg. Patients - CMS SCIP-Inf-2a Prophylactic Antibiotics Disc. Within 24 Hours after Surgery End Time - CMS SCIP-Inf-3a Surgery Patients with Appropriate Hair Removal - CMS SCIP-Inf-6 Urinary Catheter Removed on POD 1 or POD 2 with Day of Surgery being Day Zero - CMS SCIP-Inf-9 Surgery Patients with Perioperative Temperature Management - CMS SCIP-Inf-10 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker during the Perioperative Period - CMS SCIP-Card-2 Surgery Pts with Recommended Venous Thromboembolism Prophylaxis Ordered - CMS SCIP-VTE-1 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours Prior to Surgery to 24 Hours after Surgery - CMS SCIP-VTE-2

13. 13 Bad Debt Expense Charity Care Cost per Patient Day Current Ratio Days Cash on Hand * Gross Days in AR * Labor Hours per Patient Day Net Patient Revenue per Patient Days Operating Profit Margin - percent Payer Mix - Commercial Payer Mix - Medicaid Payer Mix - Medicare Payer Mix - Other Payer Mix - Other Government Payer Mix - Self/Private Pay Financial Operational * QHi Core Measure Set Newest Financial Operational Measures Physical Therapy Labor Hours per Unit of Service Laboratory Labor Hours per Unit of Service X-Ray Labor Hours per Unit of Service Mammogram Labor Hours per Unit of Service Ultrasound Labor Hours per Unit of Service CT Labor Hours per Unit of Service MRI Labor Hours per Unit of Service Pharmacy Labor Hours per Unit of Service Nursing Hours per Patient Day Rural Health Clinic Encounters per FTE Long Term Care Hours per LTC Patient Day Laboratory Hours per Billed Service In 2009, 12 new measures related to productivity were introduced to the library of indicators: Quality Health Indicators

14. Employees Average Time to Hire - All Staff Average Time to Hire - Non-Nursing Average Time to Hire - Nursing Benefits as a Percentage of Salary * Non-Nursing Staff Turnover Nursing Staff Turnover Salary to Operating Expenses Comparison Staff Turnover * Patient Satisfaction How well staff worked together to care for the patient The extent to which the patient felt ready for discharge In addition to these original QHi patient satisfaction measures, all HCAHPS measures are now in the library of indicators. * QHi Core Measure Set Quality Health Indicators

15. 15 Users navigate through the suite of resources in the PiHQ Portal by using blue links across the top. Hover text provides a brief description of each resource.

16. 16 Users navigate through QHi by clicking the main menu and sub-menu options Click Administration to view Hospital Profile page

17. 17 Each hospital completes a Hospital Profile that defines their facility. This information is used to create peer groups.

18. 18 All hospitals collect the QHi Core Measure Set States and Networks can create customized measure sets for their hospitals

19. 19 Hospitals select from over 90 additional measures to collect. Number of hospitals collecting each measure is provided Question mark icons “?” display definitions throughout the site.

20. 20 Data elements populate the data entry screen based on measures selected in the Hospital Profile. Users key in monthly aggregate data Data is pulled into the database when the Activate data for reporting box is checked Reports are available immediately upon data activation

21. 21 The Core Measures Dashboard provides comparison data for the eight QHi Core Measures Dashboard data is calculated using a consecutive three-month summing average

22. 22 Dashboard Options include a table view, graph view and PDF conversion. The 3-month time frame can be adjusted All reports in QHi can be scheduled to run and then emailed as PDF attachments to selected recipients.

23. 23 Users create unlimited customized dashboards based on the measures of their choice.

24. 24 There are 6 categories of reports: 1.Clinical Quality 2.Employees 3.Financial Operational 4.Hospital Characteristics 5.Patient Satisfaction 6.System The measures being collected by the hospital are listed in each category

25. 25 This reporting ‘wizard’ assists in the creation of customized reports. Users select from default peer groups Select date range. Rolling dates are used when creating scheduled reports.

26. 26 Users create an optional peer group based on information pulled from each Hospitals Profile.

27. 27 Line graphs, Bar graphs and tables are options for display. Line Graphs, Bar Graphs and Tables are options for display All reports can be exported to Excel for easy manipulation

28. 28 Note that peer hospitals are not identified by name Envelope icons allow users to contact identified best practice hospitals directly.

29. 29 Training and educational materials are available for download on the Help page

30. 30 Users navigate through the suite of resources in the PiHQ Portal by using blue links across the top.

31. 31 The intent of the PiHQ Portal is to provide a single resource for rural hospitals that will support their quality initiatives. All QHi, HSI and SQSS users have access to the PiHQ search engine.

32. 32 Results are pulled from all Portal resources. Future enhancements will allow users to pull from resources outside of PiHQ as well.

33. 33 All users have access to the Resource Library

34. 34 The Calendar provides registration information for upcoming Quality Training Sessions

35. 35 Users with access to the application are directed to the home page, without additional log in.

36. 36 HSI is a patient satisfaction survey and reporting application developed by Darlene Bainbridge and Associates. Hospitals participating in both QHi and HSI can auto-upload data directly from HSI into QHi for additional reporting and benchmarking opportunities.

37. 37 Developed by Darlene Bainbridge and Associates, SQSS is a calendar system that facilitates risk management, patient safety and overall quality initiatives in small hospitals.

38. Quality Health Indicators All QHi users have access to quality education sessions presented by Darlene Bainbridge. These monthly webinars are designed to teach hospitals how to use the data they pull from QHi and how to implement initiatives with their facilities to improve quality performance. For those new to the project or just in need of a refresher, Back to Basics Training sessions conducted by Sally Perkins, are offered throughout the year. Upcoming Calls and Training Webinars QHi March Quality Education Session Tuesday, March 8 from 2:00 to 3:30 Central Time Darlene Bainbridge will present on “Performance Improvement” Back to Basics Training Wednesday, April 13 from 2:00 to 3:00 Central Time

39. 39  I print a copy of the graphs and take it to the board for discussion. They appreciate seeing in color how we compare to other CAHs in KS as well as others in the USA.  On a quarterly basis I am giving a copy of the bar graphs to our Board Members at their meeting.  I give the Quality Committee a copy of the quality reports on a quarterly basis.  We track and present our indicators monthly and are usually above the norm. On the occasions when we fall below, it prompts us to review processes to seek improvements.  If we fall below expectations, we look for ways to improve and then report back to the board in the next quarter.  We like the Days in AR report. This is our only source for comparative information on this measure. Quality Health Indicators What do we do with the data? A few comments from our hospitals…

40. 40 Thank you for viewing this demonstration. If you have any questions or would like additional information on the QHi project, please contact: Sally Perkins, QHi System Administrator sperkins@kha-net.org 785-276-3118 or Stuart Moore, QHi Coordinator smoore@kha-net.org 785-276-3104 Quality Health Indicators