Quality Health Indicators

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• About QHi• The PiHQ Portal• Defining your facility• Selecting Measures• Entering Data• Dashboards• Reports• How we use the data

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Main Menu

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.

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.

Four Pillars Of Measurement

Clinical

Quality

Employee

Contribution

Patient

Satisfaction

Financial

Operational

QHi Core Measures Set

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

All participating hospitals are asked to collect and report the 8 QHi Core Measures:

Financial Operational• Days Cash on Hand • Gross Days in AR

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

Additionally, facilities can select from over 100 measures

in the QHi library of indicators:

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 Set8

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 9

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)

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*

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.

Hospital Characteristics Measures Average Inpatient Days

ALOS (in hours) Comparison

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

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 & Operational Measures (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

F Financial & Operational Measures (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

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

Financial & Operational Measures (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

Web Site AccessAn 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

Defining

HospitalReturn to Main Menu

Users navigate through the suite of resources in the PiHQ Portal by clicking

on the blue-lettered links in the whitemenu bar

Hover text provides a briefdescription of each resource

All QHi, HSI and SQSS users have access to the

PiHQ search engine.

Users type in search topic here

…or on any page throughout the portal

Results are pulled from all Portal resources.

Future enhancements will allow users to pull from resources outside of PiHQ as well.

The Resource Library holds all resource materials developed for PiHQ.

All users have access to the Resource Library

Results are pulled from all Portal resources.

Icons identify the source of the information.

All users have access to the Calendar

The Calendar provides registration information for upcoming Quality Training Sessions

Users with access to this application are directed to the home page,

without additional log in.

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.

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

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.

Defining

HospitalReturn to Main Menu

Users navigate through QHi by selecting options from

the red main-menu bar andthe blue sub-menu bar

Click Administration to viewHospital Profile page

Provider Contacts are responsible forcompleting and maintaining the

Hospital Profile page for their facility

All fields with a redasterisk are required

fields

Hospital Characteristicsdefine each facility for

creation of peer groupswhen running reports

Click drop-down to select Level of

Measurement . This applies only to

Financial/Operational measures

Question mark icons provide pop-up

definitions throughout the QHi site

Selecting

Measures

Return to Main Menu

Click here or here to go to the Measure Selection page

Measure Sets lists the pre-determined sets of

measures selected by astate or network for their

hospitals to collect

Click on questionmark icon to display

the measures includedin each measure set

Individual measurescan be selected from the list of measures ineach category group.

A measure or type ofmeasure can be located

by typing in a word identifier or descriptor

Measure information is available byclicking on the question icon.

The number of hospitals collectingeach measure is also provided.

Entering

Return to Main Menu

Click Data Submissions to accessthe Data Submission page

Click drop-down arrow toselect prior months’ data

submissions

To create a new month’s DataSubmission page, select

month and year and click onAdd New Submission

IMPORTANT: You must checkActivate data for reporting

box and then Save All and Stayfor the data entered this month

to be displayed ondashboards and in reports

Save All and Stay will onlysave data entered on this

Data Submission page andwill not forward data to dashboards and reports

If data for the month is entered andsaved, but not activated, this

message will appear to remindthe user to activate the data for

reporting

Click here to import CMS datafrom your CART report

Click on question icon to viewinformation about the

measure calculation andelement definitions

Measures and their dataelements automatically

populate this page whenmeasures are selected andand saved in the Measure

Selection page

Prior months’ datais displayed for easy reference

Click to immediately calculateand display data results

Dashboard

Return to Main Menu

The Core Measures Dashboarddisplays comparison data for the

eight Core Measures

Roll mouse over anyDashboard graph to

view the pop-up calculationfor that measure

The Dashboard can bedisplayed in graph,table, graph/table or

PDF views

Table View

Graph and Table View

Dashboard data is calculated using aconsecutive three-month summing average

State Avg values reflect data fromhospitals in the same state asMy Hospital and reported in

the same time interval

QHi Avg values reflect data from allhospitals in QHi reporting the samemeasure in the same time interval

A hospital must have activated data for at least one of the three

months in the Date Range in order for the measure to be

displayed on the Dashboard

My Hospital data for some clinical measures will not

display on the Dashboard if the hospital had no

occurrences during the Date Range period

Financial measures on the Dashboard default to peer groups determined by

the hospital’s selection of level ofreporting (Hospital Only or EntireEnterprise) in the Hospital Profile

The three months in the Date Range canbe changed by clicking the drop-down to

select the start month for the desiredthree-month period

Click here to view theDashboard as a PDF

PDF view

The PDF format allows the user to save, print

or email the Dashboard in graph, table or

graph/table views

Users can email the Dashboard in PDF tothemselves by clicking To Myself

…or choose another recipient

User selects from a list ofexisting registered users

…or choose to add a new recipient

Enter the name and Emailaddress of the new recipient

…and click Add New

Click Create Schedule to establish apre-determined schedule for mailing

Dashboard reports to selected recipients

1. Select run date by clicking on calendar2. Select frequency (monthly, quarterly, annually)3. Select recipients4. Click on Save Schedule5. Report is sent through email as a PDF attachment

Click View My Dashboard tocreate a customized Dashboard

Only those measures being collected by the

hospital will be available in the list

Click drop-down to select a measure to display on

Dashboard

Selected measures are retained and are

user specific

Notes section available to add comments or

additional information

Click At A Glance Dashboard toview a twelve-month trending

graph/table view of each of theeight Dashboard core measures

At A Glance twelve-monthtrending graphs for each

Core measure withtimeline and view options

Reports

Return to Main Menu

Reports is still available tousers to create peer reports.

However, its function hasbeen replaced by the

enhanced and upgradedNew Reports

Click New Reports to view measures andcreate peer reports

Select report start and end dates

Select peer groups

Select data grouping

Users can select up to five additional peer groups

Available criteria selections for each peer group

Users can only create a reporton measures that are being

collected by their hospital

Click on the blue measurescategory bar to display the

list of measures (beingcollected by that hospital)

in that category

Users can select more thanone measure from more

than one category

Select output format

Select how wish to view report

Webpage At A Glance view

Webpage Line Graph view

Webpage Bar Graph view

Webpage Table view

The user’s facility isidentified as Hospital

Webpage Table with detail view

Note that peer hospitals arenot identified by name but

have been assignedrandom numbers

Click on the envelope icon tocontact a peer hospital forbest practice information

The Hospital Contact at theselected peer hospital will receive the email message

Export format applies toTable and Table with detail

From the Excel reportusers can create

customized graphs to meet their needs

Gray Scale format displaysgraphs in black and white

Click on Best Practice Reportto view and create reports that

list the top five performersfor any measure in QHi

Hospitals can create a customizedBest Practice report by selecting:

1. Comparison quarter2. Sorting and display options3. Criteria4. Measures5. Clicking on Run Report

Top performers aredefined by the summed

average of the mostrecent or selected

quarter’s data

Previous two quartersare displayed forreference only

If your hospital is not in the top 5 performers, it will be shown at the end of the list with the ranking identified

If your hospital is in the top 5performers of a core measure,

it will be identified on theDashboard with green stars and

the message: “Best PracticeTop Performer”

Click on the envelope iconto contact a top performerhospital for best practice

information

Training, educational materialsand QHi documents are availablefor download on the Help page

How we use the data

Return to Main Menu

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.

What do we do with the data? A few comments from our hospitals…

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

785-276-3118or

Stuart Moore, QHi Coordinatorsmoore@kha-net.org

785-276-3104

Quality Health Indicators

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