1. Leapfrog Quality and Safety Hospital Survey Town Hall Barbara Rudolph, Ph.D. Director, Leaps and Measures

2. Topics for Today Introductions (Dennis, Chuck, Carol, Franck, Sarah) Background (Barb) –Why do we ask you to complete the survey? First 3 Leaps (Barb) NQF Safe Practices (TMIT) “Mechanics” of data submission (Dennis) –Security Codes –Re-submissions of information –Website updates Q & A

3. Why are we asking hospitals to complete the survey? Five years later—still need to improve safety First estimates between 44,000-98,000 Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999) More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)

4. The Quality Chasm 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)

5. The Quality Chasm Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000) Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)

6. The Leapfrog Group’s Mission Trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed health care decisions by those who use and pay for health care Promoting high-value health care through incentives and rewards

7. Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:  Evidence-based  High impact  Understandable by Consumers  Achievable by Providers  NQF endorsed The Leapfrog Group Strategy on Hospital Measurement and Public Reporting

8. Safety ‘Leap’ Summary 1.An Rx for Rx –Computer Physician Order Entry (CPOE) Up to 8 in 10 serious drug errors prevented 2.Sick People Need Special Care –ICU Daytime Staffing with CCM Trained M.D. live or via tele-monitoring, or risk- adjusted outcomes comparison 29% mortality reduction (JAMA, 11/02)

9. Safety ‘Leap’ Summary 3.The Best of the Best –Evidence-based Hospital Referral (EHR) or risk-adjusted outcomes comparison > 30% mortality reduction for 7 complex treatments 4.Leapfrog Safety Index –Rolled-up score of the remaining 27 of the 30 NQF-endorsed Safe Practices

10. Computerized Physician Order Entry (CPOE) Each hospital fulfilling this Leap: Assures that prescribers* enter 50% of hospital medication orders via a computer system that includes decision support software to reduce prescribing errors; Requires that prescribers electronically document a reason for overriding an interception prior to doing so. Linked to pharmacy, admitting-discharge-transfer (ADT) information systems * “Prescribers” used throughout this section refers to all clinicians authorized by the hospital to order pharmaceuticals for patients.

11. ICU Physician Staffing A hospital fulfilling this leap assures that all patients in its adult or pediatric general medical and/or surgical ICUs are managed or co-managed by physicians certified in critical care medicine who: Are ordinarily present in the ICU (on-site, or via telemedicine that meets Leapfrog specifications) during daytime hours a minimum of 8 hours per day, 7 days per week, and during this time provide clinical care exclusively in the ICU; and At other times... returns more than 95% of ICU pages within 5 minutes, based on a quantified analysis of pager response time;* and can rely on a physician or FCCS-certified non- physician “effector” who is in the hospital and able to reach ICU patients within 5 minutes in more than 95% of cases, based on a quantified hospital analysis of pager response time.*

12. Evidence-based Hospital Referral: Volume, Outcomes, and Process Treatments (See specifications below) Favorable Hospital Volume Characteristic * Coronary artery bypass graft **  450 or more procedures/year Percutaneous coronary intervention***  400 or more procedures/year Abdominal aortic aneurysm repair  50 or more procedures/year Pancreatic resection  11 or more procedures/year Esophagectomy  13 or more procedures/year NICU average daily census > 15

13. Outcomes: CABG and PCI State reported risk-adjusted mortality for CABG in NY, NJ, CA, and PA (Top Quartile) State reported risk-adjusted mortality for PCI in NY (Top Quartile) Risk-adjusted CABG mortality from STS (at or above average performance) Risk-adjusted PCI mortality from ACC (at or above average performance)

14. Process Measures-developed by Zynx 80% or greater adherence to at least 2 of the measures in each high risk procedure or condition. CABG (Process measure examples) –All patients undergoing CABG should receive aspirin upon hospital discharge. –All patients undergoing CABG without contraindications should receive a beta-blocker within 24 hours after surgery. PCI (example) –Patients without contraindications who have undergone PCI should receive aspirin AAA High Risk Infants (neo-natal steroids)

15. Scoring Algorithm for EHR EHR Credit based on Volume Thresholds Full Credit (full circle) ¾ Circle½ Circle¼ CircleNo Credit (empty circle) CABG see Notes 1-3 below 450+<450Did not disclose PCI see Notes 1-2 below 400+<400Did not disclose AAA Repair see Note 4 below 50+17-49<17Did not disclose Esophagectom y 13+8-125-7<5Did not disclose Pancreatic resection 11+6-103-5<3Did not disclose High Risk Deliveries see Note 4 below Average daily NICU census >15 NICU with average daily census <15 or High-risk deliveries but no NICU Did not disclose

16. Safe Practices Section (TMIT) Commitments—lapse after one year Need to review and update all questions that have a specified time period…e.g., within the last 12 months… Review FAQs for changes Review Implementation Strategies

17. Timelines for Submission Hospitals participating in LHRP must submit by May 31 st First report on hospital submission (June 30 th ) available on web by first week of July Updates can be done monthly Last survey submissions March 2007

18. Submission Issues (Dennis) Security Codes and CEO Delegation Maintaining survey records of answers How to refresh the data—must re-affirm each section Helpdesk services Website resources

19. Question and Answer Period Helpdesk access— leapfrog.medstat@thomson.com

20. Leapfrog’s Hospital Quality and Safety Survey Display

21. Quality and Safety Hospital Survey: The 2006 Refresh Barbara Rudolph, Ph.D. Director, Leaps and Measures April 19, 2006

22. Topics for Today Introductions (Dennis, Chuck, Carol, Franck, Sarah) Background (Barb) –Why are we still doing this? Cover the changes to the survey –Survey questions (Barb) –Scoring (Barb) –Timeline (Barb) –FAQs (Chuck) Cover the “mechanics” of the refresh (Dennis) –Security Codes –Re-submissions of information –Website updates Q & A

23. Why are we still doing this? Five years later—still need to improve safety First estimates between 44,000-98,000 Americans die from medical errors annually (Institute of Medicine, 2000; Thomas et al., 2000; Thomas et al., 1999) More recently--only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions (McGlynn et al., 2003)

24. The Quality Chasm 18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them (Chassin, 1997; Institute of Medicine, 2003a) More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately (Institute of Medicine, 2003c)

25. The Quality Chasm Medication-related errors for hospitalized patients cost roughly $2 billion annually (Institute of Medicine, 2000) Nosocomial infections alone, which are preventable account for more than 90,000 deaths per year. (CDC, MMWR Morb Mort Weekly Report, 2000)

26. The Leapfrog Group’s Mission Trigger giant leaps forward in the safety, quality and affordability of health care by: Supporting informed health care decisions by those who use and pay for health care Promoting high-value health care through incentives and rewards

27. Comparative performance measures provide information for decision-making for consumers and purchasers—Leapfrog selects measures that are:  Evidence-based  High impact  Understandable by Consumers  Achievable by Providers  NQF endorsed The Leapfrog Group Strategy on Hospital Measurement and Public Reporting

28. Safety ‘Leap’ Summary (Barb) An Rx for Rx –Computer Physician Order Entry (CPOE) –Up to 8 in 10 serious drug errors prevented Sick People Need Special Care –ICU Daytime Staffing with CCM Trained M.D. live or via tele- monitoring, or risk-adjusted outcomes comparison –29% mortality reduction (JAMA, 11/02) The Best of the Best –Evidence-based Hospital Referral (EHR) or risk-adjusted outcomes comparison –> 30% mortality reduction for 7 complex treatments Overall Safety –Rolled-up score of the remaining 27 of the 30 NQF Safe Practices (CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)

29. Survey Refresh (Barb) See Page 1—What’s New in the 2006 Survey –No substantive content changes to survey wording –Changes to Section 3, EHR process measures— questions changed from yes/no to percent adherence (hospitals won’t need to collect additional information to answer this.. –Responses needed for time-sensitive items—see items with clock in survey (many of the NQF questions have a 12 month timeframe—need for updates—no clock on survey) –Authorization and release to share hospital data for the LFHRP

30. Scoring and Timeline Changes (Barb) Scoring – related to lapsed/failed commitments –Assess whether met the self-imposed commitments—hospitals can achieve partial credit for committing to fully implementing the Leap by 3/31/2007. –For CPOE, if fail two years of commitments—no credit for commitment But can get to “Good Progress” credit if in last 12 months—hospital brought up EMR hospital-wide or results reporting in hospital-wide Can only achieve good early stage credit –For IPS, if fail two years of commitments—will not be eligible for Good Progress credit in 2007 Timeline changes –Review, update and re-affirm by June 30 th –LHRP submitters must submit by May 31, 2006 –First Public Report July 2006 –In 2007, all surveys will be due on May 31

31. Safe Practices Section (Chuck) Commitments—lapse after one year Need to review and update all questions that have a specified time period…e.g., within the last 12 months… Review FAQs for changes Review Implementation Strategies

32. Submission Issues (Dennis) Security Codes and CEO Delegation Maintaining survey records of answers How to refresh the data—must re-affirm each section Helpdesk services Website resources

33. Question and Answer Period Helpdesk access— leapfrog.medstat@thomson.com

34. Leapfrog’s Hospital Quality and Safety Survey Display