The Importance of Public Reporting on Quality

Nancy Foster

Vice President

“Bottom Line It for Me”

Public Reporting Drives Improvement If It Is:

• Scientifically sound

• Actionable

• Fair

• Important

Actions From Data

• Boards examine– Link leaders compensation to performance

• Leadership team – Examines data routinely

– Share with clinical staff

– Lead efforts to improve

• Collaboratives bring together providers trying to address challenges

Scientifically Sound

• Measure looks at: – Reasonably expected outcomes

– Processes shown to be directly linked to better outcomes

• Reliable data collection

• Relevant numerators and denominators

Soundness Example

Vascular Catheter Associated Infections

• Outcome measure, evidence of preventability

• Data collection good for NHSN, less than sound for HAC

• HAC Rate– Numerator = patients with vascular catheter associated infections– Denominator = Medicare patients– Highest = Villa Veliciana (1 of 33 patients)– Among highest, academic medical centers

Actionable

• Proven strategies exist that will enable change in performance

• Change is within the influence of the organization

• Regulations don’t stand in the way

Fairness in Measurement

• Adjust for differences in patients as they present to the hospital– Risk adjustment

– Exclusions

• Adjust for other factors?– Patient preference

– Genetic information???

How might this change as we move to measures across the continuum of care?

Fairness Example

• 30 day readmissions

• Those with high rates include:– Safety net hospitals

– Disproportionate number with low mortality rates

Important

• Significant opportunity to improve outcomes for patients

Accountability Measures — Using Measurement to Promote

Quality ImprovementMark R. Chassin, M.D., M.P.P., M.P.H., Jerod M. Loeb, Ph.D.,

Stephen P. Schmaltz, Ph.D.,

and Robert M. Wachter, M.D.NEJM, June 30, 2010

Thank You

Nancy Foster

Vice President for Quality and Patient Safety Policy

nfoster@aha.org