Lesson - Outcomes Report Retriever

  • COMING SOON! The Outcomes Report Retriever will enable Users to benchmark each HCP, HCO Group Practice and or HCO Facility and provide peer-to-peer rankings based on longitudinal analyses of each provider’s volumes of “adverse” events and suboptimal outcomes. Users will be able to use a variety of standard quantitative performance measures, such as Mortality, Hospital Acquired Conditions (HACs), Central Line-associated Blood Stream Infection (CLABSI), Catheter-Associated Urinary Tract Infection [CAUTI), Surgical Site Infections (SSI), Risk-Standardized Complication Rates (RSCRs), Prolonged Length of Stay (prLOS) or Risk-Standardized Readmission Rates (RSRRs), Excess Acute Care Days (EDACs) and apply one of these and other quantitative performance measures to any of the more than 2,000 pre-built conditions or procedure code groups. The Outcomes Report Retriever will produce standardized reports for each provider’s unadjusted, risk stratified and risk adjusted quantitative performance measures and Users will be able to view provider’s expected outcomes, realized outcomes and variations as well as trends, forecasts and projections. The Outcomes Report Retriever is intended to give researchers across the healthcare continuum quick, validated, peer-to-peer comparisons of “adverse” events and suboptimal outcomes within a clinical group of interest.
  • Complications
  • Mortality: Example #1
    • Headline: Unnecessary / Otherwise Preventable Deaths Occur Each Year
    • Major Findings: The National Academy of Medicine (NAM), previously known as the Institute of Medicine (IOM), found as far back as 1999 – that as few as 44,000 people and as many as 98,000 people – die in hospitals each year as a result of medical errors that could have been prevented according to estimates from two major studies. Even using the 44,000 death estimate, preventable medical errors in hospitals exceed attributable deaths to more well known and feared threats, including deadly automobile accidents, breast cancer, and AIDS.
    • Citation: To Err Is Human: Building a Safer Health System, Institute of Medicine, November 1999.
    • Abstract/Article
  • Mortality: Example #2
    • Headline: Both HCP provider procedure case volumes as well as HCO provider case volumes are determinants of outcomes.
    • Major Findings: Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominal aortic aneurysm repair. With AAA repair, mortality reduction was associated with annual institution volume (low <7, medium 7-30, and high >30) and annual surgeon volume (low ≤ 2, medium 3-9, and high >9). High surgeon volume conferred a greater mortality reduction than did high institution volume.
    • Citation: McPhee, James T. et al. Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominal aortic aneurysm repair. Journal of Vascular Surgery , Volume 53 , Issue 3 , 591 – 599
    • Abstract/Article
  • Mortality: Example #3
    • Headline: Critical Access Hospital (CAH) can opt out of Medicare quality measures, including those published on the Hospital Compare website as well as those on Quality.net.
    • Major Findings: Critical Access Hospital (CAH) designation was established to provide rural residents local access to emergency and inpatient care. CAHs – while exempt from comparison to non-CAH hospitals – demonstrate worse outcomes. CAH hospitals show worse short-term outcomes for pneumonia, heart failure, and myocardial infarction compared to other non-CAH hospitals.
    • Citation: Lichtman JH, et. al., 30-Day Risk-Standardized Mortality and Readmission Rates after Ischemic Stroke in Critical Access Hospitals. Stroke; a journal of cerebral circulation. 2012;43(10):2741-2747
    • Abstract/Article
  • Complications
    • Direct Measures of Complications
      • Post-Event Complications:
        • Healthcare Associated Infections (HAIs):
          • Complications of Infections:
            • Headline: Multiple studies confirm that Medicare’s payment reduction policies for complications has not resulted in reductions in complications.
            • Major Findings: The CMS policy of withholding additional Medicare payment for mediastinitis was not associated with a reduction in actual infection rates during the first 2 years after policy implementation. Similar findings were associated with catheter-associated urinary tract infections (CAUTIs), which actually continued to rise after Medicare instituted payment reduction policies. Notwithstanding the lack of reduction or production in increased rates of healthcare associated infections, claims-based evidence showed changes in coding for infections but not reduction in infections.
            • Citation #1: Calderwood MS, et. al., Impact of Medicare’s payment policy on mediastinitis following coronary artery bypass graft surgery in US hospitals.Infect Control Hosp Epidemiol. 2014 Feb;35(2):144-51
            • Citation #2: Schuller K., et. al., Initial impact of Medicare’s nonpayment policy on catheter-associated urinary tract infections by hospital characteristics. Health Policy. 2014 Apr;115(2-3):165-71
            • Abstract/Article #1
            • Abstract/Article #2
          • Disordered Wound Healing Complications
            • Complications: Example #2
              • Headline: Both HCP provider procedure case volumes as well as HCO provider case volumes are determinants of outcomes.
              • Major Findings: Surgeon case volume as well as institution case volume are determinants permanent stoma associated with post colorectal surgery. Higher hospital volume was associated with significantly lower rates of permanent stomas (OR=0.64, 95% CI 0.45 to 0.90) and APER (OR=0.55, 95% CI 0.42 to 0.72). High-volume surgeons and specialists also achieved lower rates of permanent stoma formation (0.75, 95% CI 0.64 to 0.88) and (0.70, 95% CI 0.53 to 0.94, respectively).
              • Citation: Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012 Mar 14;(3):
              • Abstract/Article
            • Indirect Measures of Complications: Prolonged Length of Stay (prLOS)
              • Prolonged Length of Stay Related to Complications
                • Headline: Complications account for nearly 10 percent of inpatient hospital costs
                • Major Findings: Potentially Preventable Complications (PPC) increased lengths of stay for inpatient admissions resulting in dramatically increased total costs of care. A study of 3 hospitals for two 9 month periods showed that two PPCs — urinary tract infection and pneumonia – experienced substantially longer inpatient stays than those who did not suffer from these PPCs. Patients with a PPC of urinary tract infection stayed a mean of 8.9 – 11.9 days or 161 – 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 – 2,427 additional patient days. Patients with a PPC of pneumonia stayed a mean of 13.0 – 16.3 days or 232 – 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 – 3,456 additional patient days.  The additional costs associated with just these two PPCs for just a 3 month time period was estimated to be between $2,000,000 – $3,000,000.
                • Lagoe, R., Johnson, P., Murphy, M., “Inpatient Hospital Complications and Lengths of Stay,” Short Report, BMC Research Notes, May, 2011.
                • Abstract/Article
              • Excess Acute Care Days: IP and HHA 30-day
                • Readmissions
                  • Headline: Mortality and Readmissions are not inversely related.
                  • Major Findings: Median RSMR was 16.57% for AMI, 11.06% for HF, and 11.46% for pneumonia. The RSMRs ranged from 10.90% to 24.90% for AMI, from 6.60% to 19.85% for HF, and from 6.36% to 21.58% for pneumonia. The median RSRR was 19.87% for AMI, 24.42% for HF, and 18.09% for pneumonia. The RSRRs ranged from 15.26% to 29.40% for AMI, from 15.94% to 34.35% for HF, and from 13.05% to 27.57% for pneumonia. For AMI, 381 hospitals (8.5%) were in the top-performing quartile of both measures, with lower RSMRs and RSRRs. For HF, 259 hospitals (5.4%) were in the top-performing quartile; and for pneumonia, 307 hospitals (6.4%) were in the top-performing quartile for RSMRs and RSRRs. For AMI, 302 hospitals (6.7%) were in the bottom-performing quartile of both measures, with higher RSMRs and RSRRs; for HF, 252 hospitals (5.3%) were in the bottom-performing quartile; and for pneumonia, 344 hospitals (7.2%) were in the bottom- performing quartile for RSMRs and for RSRRs
                  • Citation: Krumholz HM, et al. Relationship of Hospital Performance with Readmission and Mortality Rates for Patients Hospitalized with Acute Myocardial Infarction, Heart Failure, or Pneumonia. JAMA : the journal of the American Medical Association. 2013;309(6):587-593.
                  • Abstract/Article

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