Transcript Document

Publishing Data to Promote Change
Massachusetts General Hospital and Partners Health Care experience with transparency
Elizabeth Mort, MD, MPH
Vice President Quality & Safety, MGH
Associate Chief Medical Officer, MGH
Team Leader for Uniform High Quality,
Partners HealthCare Inc.
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
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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 MAwide 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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MA Health Quality Partnership
http://www.mhqp.org
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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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North Shore Medical
Center - Union
North Shore Medical
Center - Salem
McLean Hospital
Shaughnessy-Kaplan
Rehabilitation Hospital
Partners HealthCare
Hospitals
Spaulding
Rehabilitation Hospital
Massachusetts
General Hospital
Brigham and
Women’s Hospital
Nantucket Cottage
Hospital
Martha’s Vineyard
Hospital
Newton-Wellesley
Hospital
Faulkner Hospital
Rehab Hospital of the
Cape and Islands
Non-Acute Hospital
H Acute Care Hospital
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MGH Current Campus
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Goals for MGH/MGPO External Site
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.
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Categories of Measures
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MGH-People, Facilities & Services
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Delivering the Right Care (NHQM)
Keeping Patients Safe (Infection control
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Listening to Patients (HCAHPS)
Providing Equitable Care (HF, AMI and PNA
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Improvement stories
(structural measures-# of board certified, technologies,
Magnet status)
measures, Leapfrog safety goals)
segmented by race/language)
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Click on Performance
Reports to see list of
categories.
Goals for MGH/MGPO Internal Site
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
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Integrated Outcomes Data Warehouse:
building the IT infrastructure
Quality & Safety Performance Measurement Portal
Information Source Hub
Clinical Analysts
Power Users
Query & Reporting
Query & Reporting
Dashboard & Scorecard
IODW
AppDM
QSD
Senior Management
Staff
Integration Layer
Application Layer
Curation Layer
Preservation Layer
Real-Time Layer
Data Files and Data Feeds from Source Systems
(e.g. TSI, PATCOM, NSQIP, etc.)
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MGH Quality & Safety Governance
MGH/MGPO Boards of Trustees
MGH/MGPO Board Quality Subcommittee
Patient Care Assessment Committee
General Executive Committee
Quality and Safety Steering Committee
Quality Oversight Committee
Center for Quality and Safety Activities
Non-CQS Quality and Safety Activities
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Board engagement in Quality & Safety
Comparing Average % of MGH BOT time spent on Q&S v. Finance per Calendar Yr
25%
20%
Percent of Time
15%
Q&S
Finance
Linear (Q&S)
Linear (Finance)
10%
5%
0%
2002
2003
2004
2005
2006
2007
Meeting Year
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Backup
Integration of Operations & Improvement
Organizational
strategy
Executive
oversight
MGH/MGPO
Culture
Executive
incentives
Operations
cycle
Practitioner
influence and
incentives
Performance
reporting
Regular Operations
Operations
design
Improvement Efforts
Improvement
cycle
Performance
Measurement
(Signal detection)
Immediate Response
Analysis of
problem
Short term
implementation
Longer term
implementation
Process
Improvement
Design
Research
enterprise
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Backup
Integration of Operations & Improvement
Organizational
strategy
Executive
oversight
MGH/MGPO
Culture
Executive
incentives
Operations
cycle
Practitioner
influence and
incentives
Performance
reporting
Regular Operations
Operations
design
Improvement Efforts
Improvement
cycle
Performance
Measurement
(Signal detection)
Immediate Response
Analysis of
problem
Short term
implementation
Longer term
implementation
Process
Improvement
Design
Research
enterprise
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MGH site:
http://qualityandsafety.massgeneral.org/
North Shore Medical
Center - Union
North Shore Medical
Center - Salem
McLean Hospital
Shaughnessy-Kaplan
Rehabilitation Hospital
Partners HealthCare
Hospitals
Spaulding
Rehabilitation Hospital
Massachusetts
General Hospital
Brigham and
Women’s Hospital
Nantucket Cottage
Hospital
Martha’s Vineyard
Hospital
Newton-Wellesley
Hospital
Faulkner Hospital
Rehab Hospital of the
Cape and Islands
Non-Acute Hospital
H Acute Care Hospital
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Partners HealthCare, Inc.
• 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
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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
Cancer Care
PARTNERS HEALTHCARE SYSTEM, INC.
Two Physicians
Appointed by Partners
Partners International
Medical Services, LLC
Brigham and Women’s/
Faulkner Hospitals, Inc.
The Brigham and Women’s
Hospital, Inc.
Brigham and Women’s
Physicians Organization,
Inc.
The Massachusetts
General Hospital
NSMC HealthCare, Inc.
The General Hospital
Corporation
North Shore Medical
Center, Inc.
Massachusetts General
Physicians
Organization, Inc.
North Shore
Physicians Group,
Inc.
Faulkner Hospital, Inc.
McLean HealthCare,
Inc.
The McLean Hospital
Corporation
The MGH Institute of
Health Professions, Inc.
Newton-Wellesley
Hospital
Newton-Wellesley
Physician Hospital
Organization, Inc.
Partners Continuing
Care, Inc.
Partners Community
HealthCare, Inc.
The Spaulding
Rehabilitation Hospital
Corporation
Rehabilitation Hospital
of the Cape and
Islands, Inc.
Shaughnessy Kaplan
Rehabilitation
Hospital, Inc.
Partners Home
Care, Inc.
FRC, Inc.
Martha’s Vineyard
Hospital, Inc.
Nantucket Cottage
Hospital
REVISED:
49184v6
11/12/07
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Goals for external reporting at PHS
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
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The story for the first PHS release
High performance medicine: Better, Safer, & more Costeffective 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
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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
Using resources costeffectively
Connecting Congestive Heart Failure patients to post-discharge services
Increasing the appropriate use of Generic Drugs
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http://qualityandsafety.partners.org/
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Partners High Performance Medicine
Leadership Structure
Executive Committee
James Mongan, MD, Thomas
Lee, MD, Jennifer Daley, MD,
Cindy Bero, John Glaser, Robin
Jacoby, and Sheridan Kassirer
Operating Units
(Advisory on
Resource Issues
CMO’s/Physicians
Executive Council
(Advisory on
Clinical Priorities)
Director
Thomas H. Lee, MD
Chief Operating Officer
Sheridan Kassirer
Team 1
Team 2
Team 3
Team 4
Team 5
Cynthia Bero
Tejal Gandhi, MD
Elizabeth Mort, MD
Timothy Ferris, MD
Jennifer Daley, MD
Sheridan Kassirer
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PHS site:
http://www.s180.com/phs_quality