Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study.

BACKGROUND: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. METHODS: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007⁻March 2008 (prior to report-card program implementation) and between April 2009⁻March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. RESULTS: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. CONCLUSIONS: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved.

Performance Indicators in Spine Surgery.

STUDY DESIGN: Systematic review. OBJECTIVE: To elucidate how performance indicators are currently used in spine surgery. SUMMARY OF BACKGROUND DATA: The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. METHODS: MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. RESULTS: The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. CONCLUSION: The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. LEVEL OF EVIDENCE: 1.

CMS changes in reimbursement for HAIs: setting a research agenda.

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. OBJECTIVE: To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections. METHODS: An invitational day-long conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. RESULTS: Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. CONCLUSIONS: This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in non-experimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety.

National hospital quality measures data: supporting nurses' key roles in organizational performance improvement.

With the emergence of so many methodologies for generating comparison data and with the growing accountability demands from so many sectors (each, seemingly, with its own preferred comparative methodology), nurses and quality improvement professionals may feel as if they have many masters to serve. This article outlines the Maryland Hospital Association's Quality Indicator Project's approach to working with quality improvement professionals to build their understanding of comparative data and help them determine which data analysis tools best fit their reporting needs.

Safety is part of quality: a proposal for a continuum in performance measurement.

OBJECTIVES: Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi-national Quality Indicator Project (QI Project) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization-level and patient-level data in hospital performance improvement. DESIGN AND SETTING: Retrospective data are used to ascertain how the use of safety indicators has changed in comparison to other QI Project indicators. 'Continent' rather than 'hospital' is used as the unit of analysis and P-values of the differences in use percentages across Asia, Europe and the USA are calculated. RESULTS: There was a significant increase in the use of QI Project indicators in Asia between 1999 and 2006. Measured as the mean percentage of usage, the safety versus 'all other' indicators' increase in Asia was 43.7% versus 27% (P < 0.05) and 37.2% versus 24.4% (P < 0.05), respectively, during the study's time period. The European participants used both safety and all other indicators less frequently, 14.7% versus 18% (P < 0.05) and 9.5% versus 19.8% (P < 0.05), respectively. Finally, USA hospitals demonstrated a larger difference in the decrease of QI Project indicator use than European hospitals between the 'safety' and 'all other' indicators, 12.7% decrease for safety indicators and 7.1% for all others (P < 0.05). These findings are consistent with trends reported in a previous study. CONCLUSION: Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient-level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominantly in the USA but anticipated to be adopted both in Europe and Asia.

Statistical process control for hospitals: methodology, user education, and challenges.

The health care industry is slowly embracing the use of statistical process control (SPC) to monitor and study causes of variation in health care processes. While the statistics and principles underlying the use of SPC are relatively straightforward, there is a need to be cognizant of the perils that await the user who is not well versed in the key concepts of SPC. This article introduces the theory behind SPC methodology, describes successful tactics for educating users, and discusses the challenges associated with encouraging adoption of SPC among health care professionals. To illustrate these benefits and challenges, this article references the National Hospital Quality Measures, presents critical elements of SPC curricula, and draws examples from hospitals that have successfully embedded SPC into their overall approach to performance assessment and improvement.

Are performance indicators generic? The international experience of the Quality Indicator Project.

Performance indicators for healthcare organizations represent a strategy for accountability worldwide. A universal approach to either the design for indicators or their applicability to local needs remains a work in progress. The Maryland Hospital Association's Quality Indicator Project (QIP) is the only indicator-based performance measurement system used worldwide. This paper presents, for the first time in QIP's 17 years of existence, data showing why MHA's QIP may qualify as the most accepted generic methodology for healthcare performance measurement and evaluation.