An Introduction to NACHRI Analytics

Champions for Children’s Health An Introduction to NACHRI Analytics Mary Gorman V.P., Education, Member Services & Management Information Services Mitch Harris, PhD Director, Research & Statistics Webinar Logistics Webinar will last approximately one hour – a 45 minute presentation and 15 minutes for questions Sessions will be recorded and posted to NACHRI website within 48 hours Please put your phone on mute (not Hold!) until it is time for questions Please save your Adobe Connect password - you may register for additional webinars with the same username and password If you have difficulty during the webinar, please call 703/684-1355 and ask for Vikki Sara NACHRI Analytics: Discover the Value of Our Research and Analysis September Webinar Series A month-long series of educational programs exploring how NACHRI Analytics - a suite of data, benchmarking, and quality improvement programs and statistical services - can make a difference for your hospital and children’s health care. The webinars are free and open to NACHRI members, but require registration. Why do this Webinar Series? ….robust, credible, and reliable data are available……. ….members are knowledgeable about and have easy access to NACHRI data resources and services……. ….NACHRI is an indispensible source for data and applied research……. Today’s Objectives Introduction to the tools and databases available to members Examples of how NACHRI Analytics support children’s hospitals’ operations and advance the health and well-being of all children Encourage broader participation in these databases and utilization of these services across the membership Introduction to the tools and databases available to members Overview NACHRI Analytics tools & databases • Clinical Productivity and Staffing Program (CPSP) • Annual Survey on Utilization and Financial Indicators of Children’s Hospitals • Survey Center • VPS, LLC • FOCUS Groups • Pediatric Quality Measurement System (PQMS) • Case Mix Comparative Data Program Clinical Productivity & Staffing Program (CPSP) What is CPSP? A comparative data program which provides a single access point for pediatric staffing and utilization information for the inpatient and outpatient settings. CPSP Target Audience / Primary Users: - Nurse Executives - Nurse Managers - Budget Analysts - Financial Analysts - Directors of Patient Care - Business Operations Staff - Quality Specialists - Performance Improvement Staff Questions that are answered by CPSP: - How does my unit compare to others regarding worked hours per patient day? - What is my unit’s trended performance in percent daily turnover and average patients treated per day? - What impact will specific changes in my unit’s staff mix have? CPSP Inpatient Access to over five (5) years of data Data on 22 inpatient units (e.g. PICU, Med/Surg, etc.) 50+ hospitals Outpatient Clinic level data for tracking, trending, managing, and benchmarking for 21 clinic types Direct Clinic Hours and Time by Staff Category CPSP Additional Information Clinical Productivity and Staffing Program (CPSP) Webinar: Staffing and Utilization Benchmarking Opportunities, Thursday, Sept. 4 NACHRI Contact: Sharlene Davis sdavis@nachri.org 703/797-6026 Annual Survey on Utilization and Financial Indicators of Children’s Hospitals What is the Annual Survey? The NACHRI Annual Survey collects information on the utilization, operating, and financial aspects of children’s hospitals and provides the ability for hospitals to benchmark against like institutions. Annual Survey Target Audience / Primary Users: - Finance Staff - Public Policy Staff - Decision-Support Staff - Public Relations Staff - Strategic Planning and Development Staff Questions that are answered by the Annual Survey: - How does my hospital compare to peers regarding certain inpatient utilization indicators? - How does my hospital’s trended financial performance compare to other children’s hospitals? - What programs and services are provided at different children’s hospitals? Annual Survey NACHRI Annual Survey on Utilization and Financial Indicators of Children’s Hospitals web-based since FY2000 survey Historic data back to 1994 Average 150 hospitals participating Information vital to NACHRI/N.A.C.H. benchmarking and public policy activities Annual Survey Additional Information Annual Survey Webinar: Providing Children's Hospital Statistics, Friday, Sept. 5 NACHRI Contact: Donna Shelton dshelton@nachri.org 703/797-6020 VPS, LLC A clinical database dedicated to standardized data sharing and benchmarking among pediatric ICUs. VPS, LLC Target Audience / Primary Users: - ICU Clinicians (Physician/Nursing/Fellows) - ICU Administrative Staff - Quality Specialists Questions that are answered by VPS: - How does my unit’s severity adjusted mortality rate compare to other ICUs? - What are the most common conditions treated in ICUs? - How do the type and number of interventions performed at my unit compare to other ICUs? VPS, LLC • A partnership between NACHRI, Childrens Hospital Los Angeles, and the National Outcome Center of Children’s Hospital of Wisconsin in Milwaukee • Expanse of data elements covering the PICU care experience from admission through discharge, including severity of illness indicators • Standardized comparative clinical dataset of over 225,000 cases and 74 participating units VPS, LLC Additional Information VPS Webinar: Bridging Research, Quality Improvement, and Management for Children’s Hospitals, Tuesday, Sept. 9 NACHRI Contact: Lesley Sedehi Staff@VPSLLC.org 703/797-6099 Patient Care FOCUS Groups What are FOCUS Groups? NACHRI FOCUS Groups are multidisciplinary teams from children’s hospitals that address pressing issues affecting quality and cost-effective care. The FOCUS Groups experience offers hospitals an opportunity to use peer consultants in a facilitated learning environment to benchmark and improve practices and processes. FOCUS Groups Target Audience / Primary Users: - Department Directors (both Nurses and Physicians) - Financial Analysts - Quality Specialists - Business Operations Staff - Performance Improvement Staff Questions that are answered by FOCUS Groups: - What is the ideal number of nurses needed to safely care for critically ill children? - What are children’s hospitals’ best practices regarding clinic appointment readiness? - How do you improve patient flow in the emergency department? FOCUS Groups Since 1994, NACHRI has provided an organized effort to improve the quality of care provided to children through its FOCUS Group Initiatives. FOCUS Group areas for 2008 – Ambulatory - PICU – Emergency - Oncology/BMT 8-25 hospitals in a FOCUS Group Accomplish their work over the course of one year FOCUS Groups Additional Information FOCUS Groups: Limitless Networking Opportunities Webinar, Wednesday, Sept. 10 NACHRI Contact: Lynne Lostocco llostocco@nachri.org 401/732-8111 Pediatric Quality Measurement System (PQMS) What is PQMS? NACHRI PQMS is a measurement tool used by the children’s hospital community to collect, report, and collaborate on quality measures that apply to their unique patient population. PQMS Target Audience / Primary Users: - Directors of Patient Care - Quality Specialists - Performance Improvement Staff Questions that are answered by PQMS: - How does my hospital perform regarding the use of relievers and systemic corticosteroids for inpatient asthma? - How does my hospital’s low acuity pediatric asthma ALOS and readmission rate compare with other children’s hospitals? PQMS 47 participating hospitals An online measuring tool • Reporting the first Joint Commission core measure specific to pediatrics: Children’s Asthma Care (CAC) • Incorporation of both NACHRI and CHCA (non-core) measures • Offers Hospital Based Inpatient Psychiatric Services (HBIPS) core measure PQMS Additional Information Pediatric Quality Measurement System (PQMS) Webinar: Single Solution for Core and Non-core Reporting, Tuesday, Sept. 23 NACHRI Contact: Charles Murray cmurray@nachri.org 703/797-6038 Case Mix Comparative Data Program What is Case Mix? The Case Mix Comparative Data Program is a highly flexible information system containing a wealth of nationally representative pediatric inpatient data that allows users to create internal benchmarks and contrast own hospital experience against truly comparable data. Case Mix Target Audience / Primary Users: - Directors of Patient Care - Quality Specialists - Department Managers - Performance Improvement Staff - Business Operations Staff - Decision-Support Staff - Financial Staff - Public Policy Staff - Strategic Planning and Development Staff Questions that are answered by the Case Mix database: - How does my hospital’s CMI and Wage Adjusted Charges per case compare with other children’s hospitals? - In which of 16 key departmental ―cost buckets‖ does your hospital vary compared to your peers? - What is your hospital’s observed-vs.-expected mortality ratio for specific clinical conditions? Case Mix 89 NACHRI members currently contributing: 44 Freestanding 39 Children’s hospitals within hospitals 6 Specialty Access to over 5 million records from 2000-2008 1st Quarter Case Mix Additional Information Case Mix Webinar: A Health Care Data Repository, Wednesday, Sept. 24 NACHRI Contact: Dukhbhanjan Kaur (D.K.) dkaur@nachri.org 703/797-6071 Program Participation Fees Program Case Mix Comparative Data Program Departmental Costs Pediatric Quality Measurement System (PQMS) Clinical Productivity & Staffing Program (CPSP) Fee $14,500 $ 2,500 $ 13,000 Fee Occurrence Annual Annual (add-on program for case mix participants) Annual $ 7,500 Annual VPS, LLC $12,500 to $25,000 dependent on total annual admissions to unit Annual (one-time $8,000 licensing fee) FOCUS Groups $15,500 Annual (3-person team; additional groups are $14,000 each) Examples of how NACHRI Analytics support children’s hospitals’ operations and advance the health and well-being of all children Applications & Utility of NACHRI Analytics Supports internal decision-making and benchmarking  Custom peer group analyses  Quality improvement initiative identification  Cost savings initiatives  Protocol identification and implementation Applications & Utility of NACHRI Analytics ―Collective Good‖ NACHRI is an indispensable source for data and applied research which support the health and well-being of all children Public Policy Research CHGME Information from Case Mix, Annual Survey and other NACHRI surveys provides qualitative and quantitative arguments for program authorization and funding appropriations Children’s Hospital Graduate Medical Education Payment Program re-authorized for 5 years >$2b appropriated since 2000 Case Mix data provides CMI for annual hospital applications Community Benefit Challenges to hospital tax-exempt status at state and federal levels New reporting requirements mandated by some states and redesigned IRS Form 990/Schedule H NACHRI Community Benefit FOCUS Group and survey provided insight and guidance for public comments, CHA guidelines revisions, and future deliverables Public Policy Research Additional Information Data-driven Public Policy Webinar: Advocating for Children's Health and Children's Hospitals, Thursday, Sept. 11 NACHRI Contact: Donna Shelton dshelton@nachri.org 703/797-6020 NACHRI Examination of the Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDI) NACHRI Examination of the AHRQ PDIs Software applied to data from 2003-2005 from 76 Children’s Hospitals to obtain rates of events Subsequently, clinicians from 28 hospitals volunteered to do retrospective chart reviews of a sample of patients identified as having a potentially preventable patient safety event—done chronologically from most recent charts Reviews done via secure chart review web tool Pre-populated patient information (age, sex, admit date, diagnoses, procedures, etc.) PDI specific review questions (Is this patient’s principal diagnosis correct? Was this event preventable?, etc.) Hospitals reviewed 10 charts per PDI 11 PDIs of interest; 10 charts for each PDI; 110 charts per hospital total A total of 1703 charts and 1890 events were reviewed NACHRI Examination of the AHRQ PDIs PDI # events/3yr (Rate per 1000) # reviewed (%) Event Trigger Correct Event Present on Admission Events Preventable / Non-Preventable / Uncertain Est. Ave. # of Preventable Events per Year per Hospital Accidental Puncture/Laceration (PDI1) Decubitus Ulcer (PDI2) Foreign Body Left During Procedure (PDI3) Iatrogenic Pneumothorax in Neonates at Risk (PDI4) 3168 (1.85) 1688 (5.31) 153 (0.09) 295 (9.31%) 254 (15.05%) 72 (47.06%) 90.51% 7.49% 32.39% / 31.98% / 35.63% Low 3.8 High 7.9 Low 2.1 High 3.2 Low 0.2 High 0.3 Low 0.0 High 0.1 90.94% 40.26% 51.45% / 21.01% / 27.54% 77.78% 19.64% 44.44% / 20.00% / 35.56% 65 (1.25) 11 (16.92%) 184 (28.48%) 164 (33.95%) 90.91% 0.00% 10.00% / 80.00% / 10.00% Iatrogenic Pneumothorax in Non-neonates (PDI5) Postoperative Hemorrhage or Hematoma (PDI8) Postoperative Respiratory Failure (PDI9) Postoperative Sepsis (PDI10) Postoperative Wound Dehiscence (PDI11) Selected Infections Due to Medical Care (PDI12) Transfusion Reaction (PDI13) 646 (0.41) 90.76% 93.29% / 89.63% 11.38% 29.05% / 35.81% / 35.14% Low 0.7 High 1.5 Low 0.2 High 1.0 Low 1.4 High 4.0 483 (2.26) 6098 (35.04) 2.78% 12.86% / 42.86% / 44.29% 287 (4.71%) 74.29% 16.92% 13.89% / 60.19% / 25.93% 4367 (29.41) 102 (1.17) 8922 (7.59) 15 (0.01) 279 (6.39%) 79.93% 40.36% 25.56% / 33.08% / 41.35% Low 2.3 High 6.1 Low 0.1 High 0.3 Low 8.0 High 16.1 52 (50.98%) 94.23% 10.20% 34.09% / 25.00% / 40.91% 285 (3.19%) 89.47% 43.14% 40.00% / 19.31% / 40.69% 7 (46.67%) 100.00% 28.57% 0.00% / 80.00% / 20.00% Low 0.0 High 0.0 Lifecycle of NACHRI Quality Indicator Assessment Project Reports NACHRI Case Mix Database Data Pediatric Quality Measurement Advocacy AHRQ Quality Indicators Assessment Project Improvement Projects Pediatric Quality Indicators Additional Information Pediatric Quality Indicators (PDIs) Webinar: Focus on Potentially Preventable Complications for Pediatric Patients, Thursday, Sept. 25 NACHRI Contact: Mitch Harris mharris@nachri.org 703/797-6072 Collaborative on Eradicating Catheter-Associated Bloodstream Infections (CA-BSIs) Monthly Aggregate PICU CA-BSI Rate 8 BSI Collaborative Began Oct 2006 7 New CDC Definition Jan 2008 BSI Rate per 1,000 Line Days 6 5 4 3 Notes: 1) Prior to October 2006, the aggregate monthly collaborative rate is the average of the rates from all PICUs due to unavailability of line days data. Beginning in October 2006 the aggregate rate is calculated by dividing the total number of infections for the entire collaborative by the total number of line days. 2) Beginning November 2006 control limits have been recalculated to illustrate the apparent change in the process of care. The new control limits are variable, taking into account the number of line days for each month (u-chart) while the previous control limits were constant, only taking into account the change in average BSI rate from month to month (XmR chart) 2 1 0 01/04 n=24 02/04 n=24 03/04 n=24 04/04 n=25 05/04 n=24 06/04 n=26 07/04 n=26 08/04 n=26 09/04 n=27 10/04 n=26 11/04 n=25 12/04 n=26 01/05 n=27 02/05 n=27 03/05 n=28 04/05 n=28 05/05 n=28 06/05 n=28 07/05 n=28 08/05 n=28 09/05 n=28 10/05 n=28 11/05 n=28 12/05 n=28 01/06 n=28 02/06 n=28 03/06 n=28 04/06 n=28 05/06 n=28 06/06 n=28 07/06 n=25 08/06 n=23 09/06 n=23 10/06 n=29 11/06 n=29 12/06 n=29 01/07 n=29 02/07 n=29 03/07 n=29 04/07 n=29 05/07 n=29 06/07 n=29 07/07 n=29 08/07 n=29 09/07 n=29 10/07 n=29 11/07 n=29 12/07 n=29 01/08 n=29 02/08 n=29 03/08 n=29 04/08 n=29 Monthly BSI Rate Center Line Control Limits Examination of CA-BSI Risk Factors Average CA-BSI rate for collaborative was reduced by almost 50% across 29 PICUs Despite this significant improvement, over 300 CA-BSI events were still reported in the 29 units during the initial 15 month period Research undertaken to better understand the residual CA-BSI cases and identify risk factors which could inform next steps in improvement efforts Examination of clinical and demographic characteristics for those patients with central lines who did have events with those patients with central lines who did not have events Examination of CA-BSI Risk Factors VPS Database Inclusion of all patients with central lines CA-BSI Collaborative Database Identification of Patients with CA-BSI Patients with central lines No CA-BSI Patients with central lines CA-BSI Examination of differences in clinical and demographic characteristics Adherence to Screening Guidelines in Cases of Suspected Physical Abuse Adherence to Screening Guidelines in Cases of Suspected Physical Abuse Recommendations for screening suspected infant victims of physical abuse for occult injuries have been developed by the American Academy of Pediatrics There is little information regarding adherence to the guidelines for screening and whether the presence and characteristics of child abuse services have an impact on adherence to guidelines for screening Hypothesize that adherence to screening guidelines will be impacted by whether a hospital has child abuse services and by the characteristics of those services that are available Adherence to Guidelines and Availability of Child Abuse Services Level of hospital’s child abuse services NACHRI 2008 Child Abuse Services Survey Patient age, race, and injury severity Case Mix Database Hospital’s adherence to occult injury screening guidelines Case Mix Database Questions?