Leveraging Transparent

Reporting for Quality Improvement

NCHICA Forum on Quality Reporting

June 22, 2016

North Carolina Quality Center Empowering Excellence Informing Understanding

Engaging Action Sharing Progress

North Carolina Quality Center

Vision North Carolina delivers the best healthcare

Mission The North Carolina Quality Center partners with

providers and communities on their improvement journey to provide safe, quality healthcare

Values Leadership, collaboration, integrity, transparency,

patient-centered, excellence and responsiveness

Objectives

• Context for hospital quality data reporting: what’s been done and why?

• Who’s reporting? Lessons learned to date?

• North Carolina Quality Center (NCQC) public reporting

What is transparency?

Wikipedia: Transparency (behavior) Implies openness, communication, and accountability. Transparency is operating in such a way that it is easy for others to see what actions are performed.

Merriam Webster: Transparent a : free from pretense or deceit : frank b : easily detected or seen through : obvious c : readily understood d : characterized by visibility or accessibility of information especially concerning business practices

Indiana

Massachusetts

Wisconsin

New York Washington

Milestones in transparent quality reporting

2001 Institute of Medicine: Crossing the Quality Chasm 1999 Institute of Medicine: To Err is Human

2010 Affordable Care Act included national strategy for quality improvement with performance reporting

2005 CMS HospitalCompare.gov

2010 CMS Value Based Purchasing tied hospital performance to payment

1990 Best Hospitals, US News and World Report

2002 National Quality Forum: Reportable Events in Healthcare

2002 Nursing Home Quality Initiative, Home Health Quality Initiative, Hospital Quality Initiative

2004 Medicare Physician Focused Quality Initiative: Doctor’s Office Quality Project

2015 CMS HCAHPS Summary Star Ratings for hospitals 2014 CMS Hospital Acquired Conditions (HAC) reduction program

1984 CMS reporting of hospital mortality rates of Medicare patients

2007 NC Hospital Association Community Benefit reports publically available

2012 Readmissions reduction program 2013 NC DHHS makes Hospital Acquired Infections (HAI) data public 2013 Health Care Cost Reduction & Transparency Act - payment data public for top 100 DRGs

Transparent reporting accelerates improvement

• Studies show improvement pace is faster when data is more transparent.

• Transparent reporting leverages professionalism and desire to be high achievers.

• Encourages hospital sharing of best practices.

Concerns about transparent reporting

• Wrong measures

• Unintended consequences

• Frustration with complexity

• Unclear nuances

• Uninformed audiences

• Inappropriate benchmarks and targets

• Poorly designed reports

Report card on report cards

http://www.hanys.org/quality/data/report_cards/2013/

Hospital quality reports: lessons learned

• Public reporting adds value • Collaboration appears to be essential

(involving the public and private sectors as well as purchasers and providers)

• Reports must be designed carefully • Automated data collection is needed to

reduce burden of reporting • Many state and local efforts have

proven successful • Research and evaluation have played

a critical role

J. M. Colmers, Public Reporting and Transparency, The Commonwealth Fund, February 2007 http://www.commonwealthfund.org/publications/fund-reports/2007/feb/public-reporting-and-transparency

Transparent quality reporting changes outcomes: Early Elective Delivery

Playbook for the Successful Elimination of Early Elective Deliveries, NQF Maternity Action Team 2014, Accessed: http://www.leapfroggroup.org/sites/default/files/Files/mat_eed-playbook.pdf

Adverse Event Area

Number of events avoided (3-year estimate)

Cost per event

Total costs averted (incurred)

OB EED 1075 $4,100 $4,407,500

NC Partnership for Patients Results

July 2012 – March 2014 :

NC Quality Center Reporting Website

(www.nchospitalquality.org)

Motivation for Our Recent Redesign

• Re-focus the website on areas where NC hospitals had meaningful opportunities to improve

• Align reporting with strategic goals of the Quality Center and where the NCQC currently offers improvement resources

60%

65%

70%

75%

80%

85%

90%

95%

100%

2006 2007 2008 2009 2010 2011 2012 2013

Aggregate Optimal Care Trends for NC Hospitals

Heart Attack (AMI4-OC) Heart Failure (HF-OC)

Pneumonia (PNE2-OC) Surgical Care (SCIP9-OC)

The SCRUM Process

The SCRUM Process (continued)

• “Sprints”– breaking the project up into smaller tasks; estimating complexity of each sub-task (not number of hours to complete a task) so that each sprint is completed successfully

• Daily 15 minute huddles to summarize what we accomplished the previous day, what we want to accomplish today, any impediments to our work

• Use of a Kanban board to track backlog items

The SCRUM Process (continued)

Intended Impact of NCQC Reporting Website

Intended Impact of NCQC Reporting Website (continued)

Intended Impact of NCQC Reporting Website (continued)

Hospital Input

• Top quality priorities include infections, sepsis, readmissions

• Hospitals must move beyond scorecards to more predictive analytics

• In a perfect world.. • NCQC support around data/measurement

Contact information

Thank you for attending today’s presentation! Contact information: Josh McGowan - jmcgowan@ncha.org Elizabeth Mizelle - emizelle@ncha.org