State, hospitals join up for outcomes data
State, hospitals join up for outcomes data
Hospitals supported law to release quality info
Suggest to hospitals that they should provide the public with quality outcomes data, and many balk at the idea. Suggest that a state should adopt a requirement that they do so, and you might expect a full-fledged effort to thwart the legislation.
However, in Rhode Island, hospitals not only welcomed the idea, they helped draft the legislation. Now working with the state department of health, a health care consulting firm, and the state hospital association, Rhode Island’s acute care facilities are readying themselves for the first part of a new system that will allow anyone access to information on patient satisfaction and key outcomes data.
One of the forces behind getting the law implemented is Mary Logan, RN, MS, program coordinator for the Rhode Island Department of Health in Providence. Her job was created as a result of the 1998 passage of the Fogarty Act, which requires all licensed health care facilities to collect and disclose standardized clinical and patient satisfaction data to the public.
The first phase involves patient satisfaction information, which hospitals will start to collect in April and which will be released in September. The decision to start with patient satisfaction data came about because all hospitals already were measuring patient satisfaction to some degree as part of their Joint Commission on Accreditation of Healthcare Organizations accreditation requirements, explains Logan. Clinical data collection starts in 2002.
Logan says some 45 companies vied to assist with the implementation of the law, and in the end, four companies were invited to make presentations. After an in-depth selection process, the group settled on Parkside Associates of Park Ridge, IL, to assist with the patient satisfaction portion of the law.
One reason for choosing Parkside was its large selection of comparable data with which Rhode Island hospitals could use to compare themselves to others, says Kim Kochurka, MS, the principal consultant working on the project at Parkside.
"Their medical patients are compared to national average medical patients," she explains. "They use the same tool our clients around the country use, and they can take hospital-specific or entire state data and compare to national averages."
For the public-release information, data will be broken out by medical, surgical, obstetric, psychological, and rehabilitation patients and compared to national norms. Hospitals also will be able to work with Parkside individually, to get more data and "more crunch ability," says Kochurka. "[Our group] can take individual information and compare it against Rhode Island, another state, or a whole region."
Getting agreement from a baker’s dozen
Kochurka explains that her job was simpler than may first appear. With 13 of the state’s 16 hospitals participating initially, the number of people involved in the meetings to discuss the project was manageable. She still had to listen to any constraints and complaints that they had. After a pilot project runs, Kochurka will have to evaluate what went well, what went wrong, and what needs to change.
"[Parkside has] to make sure it has the same information coming from the hospitals for the sampling, mailing, and coding," she says. The legislation passed by the state also doesn’t include what kind of information has to be presented. "All it requires is a comparable, statistically accurate patient satisfaction survey. [The group] has to choose what to report and display."
Working with the hospitals, the hospital association, the department of health, and some public representatives, the group was able to develop a list of measures that will be included in the public release of information on patient satisfaction. The tentative list — still awaiting final approval, Kochurka explains — includes measures on satisfaction with nursing care, physician care, medical outcome, comfort and cleanliness, admitting, other staff courtesy, food service, and patient education.
"Then in addition, there is a wrap-up scale that is a composite perceptual score, and a loyalty indicator that asks whether [patients] would return or recommend the facility," she says.
Currently, Parkside is meeting with stakeholders to create a public-release format, and after a pilot run, the results will be shown to a consumer focus group for reactions. That should happen at the start of the year. Kochurka sees no problem in having the project up and running in April as planned.
Logan can attest to the fact that hospitals were in favor of the legislation. "I know it’s unusual, but they were on board from the start. Even the hospital association created a position to meet the intent of the legislation."
Not that there haven’t been "lively" discussions, Logan admits. "But even those have been respectful and professional." Mostly they center around what should be included and at what level of detail.
"For patient satisfaction, we have agreed to a layered approach of presenting information," she says. A basic report is available for the public, with a technical appendix for those who want more specific information. The printed report will be about 15 pages including graphics, with the appendix available on the department’s Web site. "By agreeing prior to the results being out what we will report, we aren’t being colored by the actual data."
Getting the word out
Less controversial is how the report will be disseminated. "We are working on that now, and we are in agreement that we will be using information intermediaries," explains Logan. "We don’t know if we will mail it out or insert it in the paper, but we will make sure that community groups, churches, and senior centers are involved in the effort."
There is already wide agreement on the second phase of the legislation, the clinical aspect. Logan says that initially the group will look at congestive heart failure, myocardial infarction (MI), and pneumonia. "There is a lot of work going on in those areas already."
Cathy Boni, RN, MSN, vice president for clinical affairs, at the Hospital Association of Rhode Island in Providence, says the goal for the clinical piece is to make sure there isn’t an additional burden placed on her members. "For licensure here, we all have to be accredited by the Joint Commission and do the Medicare Conditions of Participation, and we really wanted to look at the requirements that the commission and [the Health Care Financing Administration] have in common."
It didn’t hurt that Rhode Island was one of five states chosen to participate in the Joint Commission’s core measures projects, three of which are the areas the state will look at for its initial public release of clinical data.
"In some ways, the clinical part will be harder," Boni says. "We have to determine what is appropriate for public reporting. If we report early administration of aspirin for MI, will that mean anything to the public?"
Although hospitals will have access to each other’s data, Boni says there is little concern among members that they will lose some competitive edge from that reporting.
"All of our hospitals are on board," she says. "I know that sounds strange, but the public expects accountability, and our members are proud of what they are doing. All this does is provide a way for us to collect data in a more standardized way."
Maybe, she continues, the hospital CEOs in Rhode Island are just better at seeing the big picture and the positive impact on quality of care that public accountability can bring. "Maybe part of it is that I can get all my members in the same room. Perhaps bigger states have more of a problem. We always have all the same people in front of us."
Another reason for the smooth sailing of this project is that the health department didn’t go in with an attitude of dictating some regulatory approach, Logan concludes. "We are in this together and talking about it."
Kochurka, as an outsider on the project, can attest that what is happening in Rhode Island is very different from what happens in other places when collaboration is mandated. "This is a truly good relationship," she says. "It is a unique situation that you just don’t see every day."
[For more information, contact:
• Kim Kochurka, MS, Principal Consultant, Parkside Associates, Park Ridge, IL. Telephone: (847) 698-4813
• Mary Logan, RN, MS, Coordinator for the Health Quality Performance Measurement and Reporting Program, Rhode Island Department of Health, Providence. Telephone: (401) 222-4872.
• Cathy Boni, RN, MSN, Vice President for Clinical Affairs, Hospital Association of Rhode Island, Providence. Telephone: (401) 274-1649.]
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