Quality Health Indicators

1. Quality Health Indicators Brought to you by… Left click mouse or use down arrow to proceed through this presentation

2. Main Menu • About QHi • The PiHQ Portal • Defining your facility • Selecting Measures • Entering Data • Dashboards • Reports • How we use the data Select any menu item above to go directly to a topic or Click to continue through the presentation

3. Quality Health Indicators • The Quality Health Indicator (QHi) web site was developed through the Kansas Hospital Association (KHA) and the Kansas Rural Health Options Project (KRHOP) 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.

4. Quality Health Indicators • More than 1000 users in over 295 Critical Access and other small rural hospitals in Arizona, California, Colorado, Illinois, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Mexico, Oklahoma, Oregon 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.

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

6. QHi Core Measures Set All participating hospitals are asked to collect and report the 8 QHi Core Measures: • Clinical Quality • Healthcare Associated Infections per 100 inpatient days • Unassisted Patient Falls per 100 inpatient days • Pneumococcal Immunization – Age 65 and Older (CMS IMM-1b) • Discharge Instructions (CMS HF-1) • Employee Contribution • Benefits as a Percentage of Salary • Staff Turnover • Financial Operational • Days Cash on Hand • Gross Days in AR

7. Additionally, facilities can select from over 100 measures in the QHi library of indicators: • Clinical Quality Measures • Inpatients Screened for Pneumonia Vaccine Status (not a CMS measure) • Medication Omissions Resulting in Medication Errors per 100 inpatient days • Medication Errors Resulting from Transcription Errors per 100 inpatient days • Percentage of ER Provider Response Times • Percentage of Return ER Visits within 72 hours with same/similar diagnosis • Percentage of Readmissions Within 30 Days with Same or Similar Diagnosis • Healthcare Associated Infections per 100 inpatient days* • Unassisted Patient Falls per 100 inpatient days* • Long Term Care Patient Falls per 100 Long Term Care patient days • CMS Pneumonia Measures: • Inpatients Receiving O2 Assessment within 24 hours of admission - CMS PN-1 (retired) • Inpatients Receiving Pneumococcal Vaccination - CMS PN-2(retired) • Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital - CMS PN-3b • Adult Smoking Cessation Advice/Counseling -CMS PN-4(retired) • Pneumonia Patients Receiving Initial Antibiotic Within 6 Hours of Hospital Arrival - CMS PN-5c(retired) • Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients - CMS-PN6 • Influenza Vaccination - CMS PN-7(retired) • *Part of the 8 Core Measure Set

8. Clinical Quality Measures (continued) CMS OP Transfer Measures: • Median Time to Fibrinolysis in the Emergency Department - CMS OP-1 • Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival in the Emergency Department - CMS OP-2 • Median Time to Transfer to Another Facility for Acute Coronary Intervention in the Emergency Department - CMS OP-3 • Aspirin at Arrival in the Emergency Department - CMS OP-4 • Median Time to ECG in the Emergency Department - CMS OP-5 • Timing of Antibiotic Prophylaxis in Hospital Outpatient Surgery -CMS OP-6 • Prophylactic Antibiotic Selection for Surgical Patients in Hospital Outpatient Surgery - CMS OP-7 CMS Immunization Measures: • Pneumococcal Immunization – Overall Rate - CMS IMM-1a • Pneumococcal Immunization – Age 65 and Older* - CMS IMM-1b • Pneumococcal Immunization – High Risk Populations (Age 5 through 64 years) - CMS IMM-1c • Influenza Immunization - CMS IMM-2 *Part of the 8 Core Measure Set

9. Clinical Quality Measures (continued) CMS HF Measures: • Discharge Instructions* – CMS HF-1 • Evaluation of LVS Function – CMS HF-2 • ACEI or ARB for LVSD – CMS HF-3 • Adult Smoking Cessation Advice/Counseling – CMS HF-4 (retired) CMS SCIP Measures: • Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision – Overall Rate CMS SCIP-Inf-1a • Prophylactic Antibiotic Selection for Surgical Patients – Overall Rate CMS SCIP-Inf-2a • Prophylactic Antibiotics Discontinued Within 24 Hours after Surgery End Time – Overall Rate CMS SCIP-Inf-3a • Surgery Patients with Appropriate Hair Removal – CMS SCIP-Inf-6 • Urinary Catheter Removed on Postop Day 1 or Postop Day 2 with Day of Surgery being Day 0 – 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 Patients with Recommended Venous Thromboembolism Prophylaxis Ordered – CMS SCIP-VTE-1 (retired) • Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery – CMS SCIP-VTE-2 *Part of the 8 Core Measure Set

10. Clinical Quality Measures (continued) MBQIP Phase 3 Measures: • Pharmacist CPOE/Verification of Medication Orders Within 24 Hours • Outpatient Emergency Department Transfer Communication (Pre-Transfer Communication Information) • Outpatient Emergency Department Transfer Communication (Patient Identification) • Outpatient Emergency Department Transfer Communication (Vital Signs) • Outpatient Emergency Department Transfer Communication (Medication-related Information) • Outpatient Emergency Department Transfer Communication (Practitioner generated information) • Outpatient Emergency Department Transfer Communication (Nurse generated information) • Outpatient Emergency Department Transfer Communication (Procedures and Tests)

11. Patient Satisfaction Measures • How well staff worked together to care for the patient (QHi1) • The extent to which the patient felt ready for discharge (QHi2) In addition to these two original QHi patient satisfaction measures, 25 HCAHPS measures are now in the library of indicators. • Employee Contribution Measures • Non-Nursing Staff Turnover • Average Time to Hire (All Staff) • Nursing Staff Turnover • Average Time to Hire (Nursing) • Average Time to Hire (Non-Nursing) • Salary to Operating Expenses Comparison • Benefits as a Percentage of Salary* • Staff Turnover* • Hospital Characteristics Measures • Average Inpatient Days • ALOS (in hours) Comparison *Part of the 8 Core Measure Set

12. Financial & Operational Measures • Bad Debt Expense • Charity Care • Cost per Patient Day • Labor Hours per Patient Day • Operating Profit Margin • Total Margin • Total Margin % • Debt Service Coverage Ratio • Current Ratio • Net Patient Revenue per Adjusted Patient Day • Net Patient Revenue per Patient Days • Financial: • Days Cash on Hand* • Gross Days in AR* • Net Days in Accounts Receivable • Bad Debt as a % of Gross Patient Revenue • Charity Care as a % of Gross Patient • Revenue • Bad Debt and Charity Care as a % of Gross • Patient Revenue • Cost per Adjusted Patient Day • Labor Hours per Adjusted Patient Day • Labor Cost per Adjusted Patient Day • Labor Cost as a % of Net Patient Revenue • Net Patient Revenue as a % of Gross • Patient Revenue *Part of the 8 Core Measure Set

13. Financial&OperationalMeasures (continued) Operational: Physical Therapy Paid Labor Hours per UOS Laboratory Paid Labor Hours per UOS X-ray Paid Labor Hours per UOS Mammogram Paid Labor Hours per UOS Ultrasound Paid Labor Hours per UOS CT Paid Labor Hours per UOS MRI Paid Labor Hours per UOS Pharmacy Paid Labor Hours per UOS Nursing Hours per Acute Inpatient Day Nursing Hours per Patient Day Rural Health Clinic Encounters per FTE Long Term Care Hours per LTC Patient Day Laboratory Hours per Billed Service • Financial (continued): • Payer Mix – Commercial • Payer Mix – Medicaid • Payer Mix – Medicare • Payer Mix – Other • Payer Mix – Other Government • Payer Mix – Self/Private Pay • Acute Occupancy per Day • Swing Bed Occupancy per Day

14. F Financial&OperationalMeasures (continued) Operational (continued): • Lab – Blood Utilization Rate • Lab – Single Unit Transfusions • Lab – Blood Culture Contamination Rate • Lab – Total Billables per Month • Lab – Worked Productivity (24/7 Service) • Lab – Worked Productivity (Non 24/7 Service) • Lab – Paid Productivity (24/7 Service) • Lab – Paid Productivity (Non 24/7 Service) • Lab – Corrected Reports • Lab – Specimen Rejection Rate • Lab – Tests per hour worked • Lab – Total direct cost per test • Radiology – Tests per hour worked • Radiology – Total direct cost per test • Acute Care – Worked Hours per days of care • Acute Care – Total direct cost per days of care • Acute Care – Hospitalist or Other Provider cost per visit • Acute Care – Hospitalist Cost per Acute Inpatient Day • OR – Procedures per patient • OR – Worked Hours per procedure • OR – Total direct cost per procedure • OR – Provider cost associated with CRNA or Anesthesiologist per visit • ED – Hours worked per visit • ED – Total direct cost per visit • ED – Physician/PA/NP cost per visit

15. Financial&OperationalMeasures (continued) Operational (continued): • Skilled Nursing Facility – Average daily census to clinical staffing ratio • Skilled Nursing Facility – Base cost per patient day • Skilled Nursing Facility – Support cost per patient day • Skilled Nursing Facility – Support cost to base cost ratio • Skilled Nursing Facility – Related support to base cost ratio limit • Skilled Nursing Facility – Patient days

16. Quality Health Indicators Web Site Access An email address and password are 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 Provider Contacts in their State Network Administrator – maintains Network profiles & provides support Provider Contact– maintains Provider profiles , adds users & enters data Provider User – enters data and runs reports View Only – views data and runs reports Report Recipient – no access to QHi, only receives reports

17. Defining Your Hospital Return to Main Menu

18. Users navigate through the suite of resources in the PiHQ Portal by clicking on the blue-lettered links in the white menu bar

19. Hover text provides a brief description of each resource

20. All QHi, HSI and SQSS users have access to the PiHQ search engine.

21. …or on any page throughout the portal Users type in search topic here

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

23. The Resource Library holds all resource materials developed for PiHQ.

24. All users have access to the Resource Library

25. Results are pulled from all Portal resources. Icons identify the source of the information.

26. All users have access to the Calendar

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

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

30. All HCAHPS measures can be automatically pulled from HSI and uploaded directly into QHi, eliminating duplicate entry. Future enhancements will allow any HSI measure to be uploaded into QHi.

31. Users with access to this application are directed to their customized home page, without additional log in.

32. Partners in Healthcare Quality are working with two notable Risk Management vendors to pull aggregate data directly into QHi, further reducing data entry, and enhancing comparative analysis and benchmarking opportunities.

33. Defining Your Hospital Return to Main Menu

34. Users navigate through QHi by selecting options from the red main-menu bar and the blue sub-menu bar Click Administration to view Hospital Profile page

35. Provider Contacts are responsible for completing and maintaining the Hospital Profile page for their facility All fields with a red asterisk are required fields Hospital Characteristics define each facility for creation of peer groups when running reports

36. Question mark icons provide pop-up definitions throughout the QHi site Click drop-down to select Level of Measurement . This applies only to Financial/Operational measures

37. Selecting Measures Return to Main Menu

38. Click here or here to go to the Measure Selection page

39. Measure Sets lists the pre-determined sets of measures selected by a state or network for their hospitals to collect Click on question mark icon to display the measures included in each measure set

40. A measure or type of measure can be located by typing in a word identifier or descriptor Individual measures can be selected from the list of measures in each category group. Measure information is available by clicking on the question icon. The number of hospitals collecting each measure is also provided.

41. Entering Data Return to Main Menu

42. Click Data Submissions to access the Data Submission page

43. To create a new month’s Data Submission page, select month and year and click on Add New Submission Click drop-down arrow to select prior months’ data submissions IMPORTANT: You must check Activate data for reporting box and then Save All and Stay for the data entered this month to be displayed on dashboards and in reports Save All and Stay will only save data entered on this Data Submission page and will not forward data to dashboards and reports

44. If data for the month is entered and saved, but not activated, this message will appear to remind the user to activate the data for reporting Click here to import CMS data from your CART report Click on question icon to view information about the measure calculation and element definitions

45. Measures and their data elements automatically populate this page when measures are selected and and saved in the Measure Selection page Prior months’ data is displayed for easy reference Click to immediately calculate and display data results

46. The Dashboard Return to Main Menu

47. The Core Measures Dashboard displays comparison data for the eight Core Measures The Dashboard can be displayed in graph, table, graph/table or PDF views Roll mouse over any Dashboard graph to view the pop-up calculation for that measure

48. Table View

49. Graph and Table View

50. Dashboard data is calculated using a consecutive three-month summing average QHiAvg values reflect data from all hospitals in QHi reporting the same measure in the same time interval State Avg values reflect data from hospitals in the same state as My Hospital and reported in the same time interval