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Publishing Data to Promote Change
Massachusetts General Hospital and Partners Health Care -
experience with transparency
Elizabeth Mort, MD, MPH
Vice President Quality & Safety, MGHAssociate Chief Medical Officer, MGH
Team Leader for Uniform High Quality,Partners HealthCare Inc.
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Outline
• Massachusetts reporting environment• System and hospital reporting
– Partners HealthCare, Inc.– Massachusetts General Hospital– Case studies
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Massachusetts environment
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National data sources
• US News and World Report• HEDIS reports for health plans• CMS Hospital Compare• CMS Nursing Home Compare • The Joint Commission Quality Check• Leapfrog• Health Grades
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State-wide data sources
• MA Health care cost and quality council
• Massachusetts Health Care Partnership
• Department of Public Health
• MHA patients first
• Group Insurance Commission asks Health plans to tier physicians
• Planned: SRE (Spring 2009), BSI’s (March MA-wide rates, Hospital in the fall), others
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MA Health Care Cost and Quality Council (HCCQC) launch November 2008
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MA HCCQC Quality rankings
rating system based on 15/50/85th hospital percentile rankings
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MA HCCQC “Cost” rankings
$ - $$$$ rating system applied to a hospital’s median cost (payment from health plans)
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http://www.mhqp.org
MA Health Quality Partnership
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MHA Patients first
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MA Dept of HHS
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Cost & Quality: The GIC Approach“Clinical Performance Improvement initiative”
• Measure cost efficiency via “ETG” methodology
• Measure quality via HEDIS, etc.
• Squeeze quality and cost scores from claims data
• Incent patient and physician behavior via differentials in co-payments
• Tiers 1,2 and 3• Implemented in 2006
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Martha’s Vineyard Hospital
Nantucket Cottage Hospital
Rehab Hospital of the Cape and Islands
Faulkner Hospital
Newton-Wellesley Hospital
McLean Hospital
Massachusetts General Hospital
Spaulding Rehabilitation Hospital
Shaughnessy-Kaplan Rehabilitation Hospital
North Shore Medical Center - Union
North Shore Medical Center - Salem
Non-Acute Hospital
Acute Care HospitalH
Brigham and Women’s Hospital
Partners HealthCare Hospitals
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MGH Current Campus
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1) Tell our Quality and Safety story MGH/MGPO’s interpretation of quality and safety indicators already publicly available.
2) Highlight aspects of quality and safety that are not publicly reported but that we as the MGH/MGPO community feel should be reported to the public.
3) Educate the public about our internal quality improvement efforts by increasing the visibility of quality/safety data and our stories.
4) Target audience includes informed consumers interested in general information about hospital quality of care, payors, legislators, policy staff.
Goals for MGH/MGPO External Site
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• MGH-People, Facilities & Services (structural measures-# of board certified, technologies, Magnet status)
• Delivering the Right Care (NHQM)
• Keeping Patients Safe (Infection control measures, Leapfrog safety goals)
• Listening to Patients (HCAHPS)
• Providing Equitable Care (HF, AMI and PNA segmented by race/language)
• Improvement stories
Categories of Measures
Click on Performance Reports to see list of categories.
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1) Hold leadership accountable
2) Identify highest organizational priorities
3) Ongoing tracking
3) Target audience internal leadership
4) Eventually develop better IT connections between point of care, acute care documentation, data bases and measurement and reporting tools – a journey
Goals for MGH/MGPO Internal Site
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Preservation Layer
Curation Layer
Real-Time Layer
Application Layer
Integration Layer
IODW
Query & Reporting
AppDM
Query & Reporting
QSD
Dashboard & Scorecard
Quality & Safety Performance Measurement Portal
Info
rmat
ion
Sou
rce
Hub
Clinical AnalystsPower Users
Senior ManagementStaff
Data Files and Data Feeds from Source Systems(e.g. TSI, PATCOM, NSQIP, etc.)
Integrated Outcomes Data Warehouse: building the IT infrastructure
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MGH Quality & Safety Governance
MGH/MGPO Boards of Trustees
General Executive Committee
MGH/MGPO Board Quality Subcommittee
Quality Oversight Committee
Quality and Safety Steering Committee
Center for Quality and Safety Activities Non-CQS Quality and Safety Activities
Patient Care Assessment Committee
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Comparing Average % of MGH BOT time spent on Q&S v. Finance per Calendar Yr
0%
5%
10%
15%
20%
25%
2002 2003 2004 2005 2006 2007
Meeting Year
Pe
rce
nt
of
Tim
e
Q&S
Finance
Linear (Q&S)
Linear (Finance)
Board engagement in Quality & Safety
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Analysis of problem
Integration of Operations & Improvement
Performance reporting
Operations design
Executive oversight
Organizational strategy
Performance Measurement
(Signal detection)
Short term implementation
Executive incentives
Practitioner influence and
incentives
Longer term implementation
Research enterprise
Regular Operations
Improvement Efforts
Process Improvement
Design
Improvementcycle
Operations cycle
Backup
MGH/MGPO Culture
Immediate Response
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Analysis of problem
Integration of Operations & Improvement
Performance reporting
Operations design
Executive oversight
Organizational strategy
Performance Measurement
(Signal detection)
Short term implementation
Executive incentives
Practitioner influence and
incentives
Longer term implementation
Research enterprise
Regular Operations
Improvement Efforts
Process Improvement
Design
Improvementcycle
Operations cycle
Backup
MGH/MGPO Culture
Immediate Response
MGH site: http://qualityandsafety.massgeneral.org/
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Martha’s Vineyard Hospital
Nantucket Cottage Hospital
Rehab Hospital of the Cape and Islands
Faulkner Hospital
Newton-Wellesley Hospital
McLean Hospital
Massachusetts General Hospital
Spaulding Rehabilitation Hospital
Shaughnessy-Kaplan Rehabilitation Hospital
North Shore Medical Center - Union
North Shore Medical Center - Salem
Non-Acute Hospital
Acute Care HospitalH
Brigham and Women’s Hospital
Partners HealthCare Hospitals
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• Partners is an integrated, academic health system founded in 1994 by Brigham and Women’s Hospital and Massachusetts General Hospital
• Partners four-part mission is patient care, teaching, research, and community service
• Partners was formed to preserve academic medicine, create a more rational system of care, and add value in the areas of access, cost, and quality
Partners HealthCare, Inc.
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Patient Care at Partners
• 1.7 million patients receive care from Partners institutions and physicians
• 170,000 hospital inpatient discharges annually
• 4.3 million outpatient and physician visits annually
• 22% of acute hospital discharges in Eastern Massachusetts are from Partners hospitals
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PARTNERS CORPORATE ORGANIZATION CHART
Dana Farber/Partners Two Physicians Cancer Care PARTNERS HEALTHCARE SYSTEM, INC. Appointed by Partners
Partners International Medical Services, LLC
Brigham and Women’s/ The Massachusetts Newton-Wellesley Partners Continuing Partners Community NSMC HealthCare, Inc. Faulkner Hospitals, Inc. General Hospital Hospital Care, Inc. HealthCare, Inc.
The Spaulding The Brigham and Women’s
The General Hospital Rehabilitation Hospital North Shore Medical Newton-Wellesley Hospital, Inc. Corporation Center, Inc. Physician Hospital Corporation
Organization, Inc.
Brigham and Women’s Rehabilitation Hospital Physicians Organization, Massachusetts General North Shore of the Cape and Inc. Physicians Physicians Group, Islands, Inc.
Organization, Inc. Inc.
Faulkner Hospital, Inc. Shaughnessy Kaplan McLean HealthCare, Rehabilitation
Hospital, Inc. Inc.
Partners Home The McLean Hospital Care, Inc. Corporation
The MGH Institute of FRC, Inc. Health Professions, Inc.
Martha’s Vineyard Hospital, Inc.
Nantucket Cottage Hospital
REVISED: 11/12/07 49184v6
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1) Tell the High Performance Medicine Story: what we’re doing to provide better, safer, more cost effective care
2) Educate the viewer about the importance of a system in making the full spectrum of health care services available and in ensuring uniform care throughout the system
3) Share our performance on key quality and safety indicators
4) Highlight improvement strategies 5) Link to entity (hospitals) sites
Goals for external reporting at PHS
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High performance medicine: Better, Safer, & more Cost-effective care
• Maximizing the use of Information Technology
• Making our care as safe as possible, free from harm & errors
• Ensuring high quality across all sites by making care reliable
• Taking expert, tailored care of specific high-risk patients
• Using drugs and imaging technologies cost-effectively
The story for the first PHS release
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The Performance Metrics for the first PHS release
Maximizing the use of Information Technology
Implementing Computerized Order Entry
Adopting of electronic medical record by Primary Care Providers
Adopting of electronic medical records by Specialists
Prescribing medications electronically
Making our care safe, free from harm
Implementing Electronic Medication Administration Records
Bar coding patients, staff and medications
Making transitions in care safer
Ensuring uniform, reliable, high quality care
Adhering to guidelines for care of patients with Heart attacks, Congestive Heart Failure and Pneumonia
Delivering PCI within 90 minutes for eligible heart attack patients
Delivering smoking counseling to targeted populations
Preventing surgical infections
Reducing ICU Bloodstream Infections
Reducing Patient Falls with injury
Caring for High risk populations
Connecting Congestive Heart Failure patients to post-discharge services
Using resources cost-effectively
Increasing the appropriate use of Generic Drugs
http://qualityandsafety.partners.org/
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Partners High Performance MedicineLeadership Structure
Executive CommitteeJames Mongan, MD, Thomas Lee, MD, Jennifer Daley, MD,Cindy Bero, John Glaser, Robin Jacoby, and Sheridan Kassirer
CMO’s/Physicians Executive Council
(Advisory on Clinical Priorities)
Operating Units(Advisory on
Resource Issues
DirectorThomas H. Lee, MD
Chief Operating OfficerSheridan Kassirer
Team 1Cynthia Bero
Team 2Tejal Gandhi, MD
Team 3Elizabeth Mort, MD
Team 4Timothy Ferris, MD
Team 5Jennifer Daley, MD
Sheridan Kassirer
PHS site: http://www.s180.com/phs_quality