AcademyHealth 2012 Identify Rural Hospital Quality

Peiyin Hung MSPhD student

Division of Health Policy and Management

School of Public Health,

University of Minnesota

Identifying High Quality Rural HospitalsPeiyin Hung, MS; Ira S. Moscovice, PhD, Michelle M. Casey, MS

2INTRODUCTION METHODS RESULTS CONCLUSION

Acknowledgements

The study is funded by grant U27RH0180 from the Federal Office of Rural Health Policy.

April 15, 2023


Agenda

• Introduction• Data sources and sample• Methods• Results• Conclusion

April 15, 2023


Introduction

• Health care reform– Increased attention on potential ways to

identify and reward high performing health care providers

• Most quality assessments excluded small rural hospitals– Missing data (public reporting is not

required of Critical Access Hospitals)– Small volume problems

April 15, 2023 INTRODUCTION


Data Sources & Sample

April 15, 2023 METHODS

CMS Hospital Compare Inpatient

quality of care measures

AHA Annual Survey

2005 (N=1,686)

2006 (N=1,815)

2007 (N=1,883)

2008 (N=1,887)

2009 (N=1,902)

First Time Period

(N=1,830)

Second Time Period

(N=1,961)

CAHs+

Rural PPS

*Hospitals reporting data on ANY measure with 1 or more patients are included.

Data Sources Sample


Methods

• Step 1: Calculate condition-specific composite scores in two time periods

• Step 2: Compare quality of rural hospitals using three quantitative concepts– Capability– Stability– Improvement

• Step 3: Identify consistency of top quality rural hospitals across three approaches



Condition-Specific Composite Score

• By condition• Score: Percentage of opportunities

given recommended care in a period

• Example:

2/16/2012

𝑪𝒐𝒎𝒑𝒐𝒔𝒊𝒕𝒆 𝑺𝒄𝒐𝒓𝒆𝒊𝟎𝟓−𝟎𝟔 = 𝟏𝟎𝟎ቆσ 𝑵 𝒐𝒇 𝒑𝒂𝒕𝒊𝒆𝒏𝒕𝒔 𝒈𝒊𝒗𝒆𝒏 𝒓𝒆𝒄𝒐𝒎𝒎𝒆𝒏𝒅𝒆𝒅 𝒄𝒂𝒓𝒆𝒊𝒌𝑲𝒌=𝟏 σ 𝑵 𝒐𝒇 𝒑𝒂𝒕𝒊𝒆𝒏𝒕𝒔 𝒊𝒏 𝟐𝟎𝟎𝟓− 𝟐𝟎𝟎𝟔𝒊𝒌𝑲𝒌=𝟏 ቇ

𝒘𝒉𝒆𝒓𝒆 𝑲 𝒊𝒔 𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒎𝒆𝒂𝒔𝒖𝒓𝒆𝒔 𝒇𝒐𝒓 𝒂 𝒄𝒐𝒏𝒅𝒊𝒕𝒊𝒐𝒏 𝒊

METHODS


Why Use Composite Scores?

AMI

Hea

rt F

ailu

re

Pneum

onia

Surg

ical

Imp.

..

163

747

1167922

613

15091757

10431079

17701893

1205

Number of Hospitals with a Minimum 25 Cases

Measure (2009) Composite (2009)Composite (2007-2009)



Methods-Capability

•Score: Time-period condition-specific composite scores

•Criterion: Rural hospitals in the top quartile of each condition-specific composite score in a period



Methods-Stability

• Score: Condition-specific composite scores in both 2005-2006 and 2007-2009 period

• Criterion: Composite scores in the top quartile in both periods


INTRODUCTION METHODS RESULTS CONCLUSION

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Co

mp

osit

e S

co

re 2

00

7-2

00

9Distribution of Heart Failure Scores

112/16/2012

Composite Score 2005-2006 METHODS


Methods- Relative Improvement

Scores: Percentage of reduction for missed opportunities by comparing the 2007-2009 period with the 2005-2006 period.Criterion: Above median improvements for all rural hospitals


𝑅𝑒𝑙𝑎𝑡𝑖𝑣𝑒 𝐼𝑚𝑝𝑟𝑜𝑣𝑒𝑚𝑒𝑛𝑡 𝑆𝑐𝑜𝑟𝑒𝑖 =

100× 𝐶𝑜𝑚𝑝𝑜𝑠𝑖𝑡𝑒 𝑆𝑐𝑜𝑟𝑒𝑖2007−2009 − 𝐶𝑜𝑚𝑝𝑜𝑠𝑖𝑡𝑒 𝑆𝑐𝑜𝑟𝑒𝑖2005−2006100− 𝐶𝑜𝑚𝑝𝑜𝑠𝑖𝑡𝑒 𝑆𝑐𝑜𝑟𝑒𝑖2005−2006

INTRODUCTION METHODS RESULTS CONCLUSION

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

100%

Rela

tive

Im

pro

vem

ent

Sco

reDistribution of Heart Failure Scores

132/16/2012

Composite Score 2005-2006

METHODS


RESULTS

April 15, 2023 RESULTS


Capability Approach

Among all rural hospitals, non-CAHs, accredited hospitals, and system-

affiliated hospitals performed significantly better than their

counterparts in both time periods.



Stability Approach

64% of top-performing rural hospitals in the baseline were in the

top quartile in the subsequent period for heart failure and 58% for

pneumonia.

Non-CAHs were more stable than CAHs.



Relative Improvements Approach

Median improvement was 42% reduction for missed opportunities

for heart failure, and 50% for pneumonia.

Non-CAHs, accredited, and system-affiliated hospitals had significantly higher relative improvements from

2005-2006 to 2007-2009.



Conclusion

• Consistency across three approaches– Of all rural hospitals, 11% were high

quality across three approaches.– Of the high capability hospitals in the

baseline• High stability: 58%~64%• High improvement: 45%~50%• High stability & improvement: 43%~45%

April 15, 2023 CONCLUSION

19

Q&A

Additional information please contact:Peiyin Hung: [email protected]

Thanks for your attention!


Measures Used

• Heart Failure (4 measures)– Discharge instructions– Evaluation of left ventricular systolic function– ACE inhibitor or ARB for left ventricular systolic

dysfunction – Smoking cessation advice/counseling

• Pneumonia (5 measures)– Assessed and given pneumococcal vaccination– Patients whose initial emergency room blood culture

was performed prior to the administration of the first hospital dose of antibiotics

– Smoking cessation advice/counseling– Given initial antibiotics within 4/6 hours after arrival– Given the most appropriate initial antibiotic

2/16/2012


Measures Used

• AMI (6 measures)– Heart attack patients given aspirin at arrival– Heart attack patients given aspirin at discharge– Heart attack patients given ACE inhibitor or ARB for

left ventricular systolic dysfunction– Heart attack patients given smoking cessation

advice/counseling– Heart attack patients given beta blocker at

discharge– Heart attack patients given fibrinolytic medication

within 30 mins of arrival• Surgical Improvement (2 measures)

– Given an antibiotic at the right time to help prevent infection

– Preventive antibiotics were stopped at the right time2/16/2012


80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Com

posit

e S

core

20

07

-20

09

/R

ela

tive I

mp

rovem

en

t

Heart Failure Scores & Relative Improvements Among Baseline High Capable Rural Hospitals

2/16/2012 RESULTS


Heart Failure Composite Scores Among High Stable Rural Hospitals

232/16/2012

80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100%80%

85%

90%

95%

100%


Com

posit

e S

core

20

07

-20

09

RESULTS


Heart Failure: Composite Scores & Relative Improvements Among High Stable Rural Hospitals

242/16/2012

80% 85% 90% 95% 100%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Com

posit

e S

core

20

07

-20

09

/ R

ela

tive I

mp

rovem

en

ts

RESULTS

Date post:	09-Aug-2015
Category:	Healthcare
Upload:	peiyin-hung
View:	16 times
Download:	3 times

AcademyHealth 2012 Identify Rural Hospital Quality

Healthcare