Benchmarking Hospital Performance in Health -...

Sanigest Internacional White Paper

Benchmarking Hospital

Performance in Health

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Objectiveperformance should rely on a composite indicator that ranks hospital performance relative to other hospitals and provide insights into hospital performance across key areas. The review of hospital performance indicators in this paper will providehospital managers and clinicians with a range of options for the selection of key performance indicators for hospital benchmarking.

Authors: James Cercone and Lisa O’BrienSanigest Internacional © 2010

This document is a formal publication by Sanigest International and all rights are reserved by the firm. The views expressed in documents carrying the name of the author/s are the sole responsibility of the author/s and do not represent the views of Sanigest International.

Benchmarking Hospital Performance in Health

© Copyright Sanigest Internacional

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Objective: Efforts to assess and rank hospital performance should rely on a composite indicator that ranks hospital performance relative to other hospitals and provide insights into hospital performance across key areas. The review of hospital performance indicators in this paper will provide policymakers, hospital managers and clinicians with a range of options for the selection of key performance indicators for hospital benchmarking.

Authors: James Cercone and Lisa O’Brien

document is a formal publication by Sanigest International and all rights are reserved by the

The views expressed in documents carrying the name of the author/s are the sole responsibility of the author/s and do not represent the views of


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INTRODUCTION ................................................................

MEASUREMENT OF HOSPITAL PERFORMANCE IN T

REVIEW OF HOSPITAL BENCHMARKING TOOLS

HOSPITAL COMPARE ................................................................

Scoring System ................................

HEALTHINSIGHT NATIONAL RANKINGS FOR HOSPITALS

Scoring system ................................

LEAPFROG GROUP ................................................................

Scoring System ................................

MICHIGAN MANUFACTURING TECHNOLOGY C

Scoring System ................................

US NEWS & WORLD REPORT ................................

Scoring System ................................

THOMSON & REUTERS TOP 100 HOSPITALS P

Scoring System ................................

HEALTH CONSUMER POWERHOUSE ................................

Scoring System ................................

NATIONAL HEALTH SERVICES CHOICES HOSPITAL

Scoring System ................................

CHKS TOP HOSPITALS PROGRAM ................................

Scoring System ................................

IASIST TOP 20 HOSPITALS ................................

Scoring System ................................

WORLD HEALTH ORGANIZATION - PERFORMANCE

Scoring System ................................

INTERNATIONAL QUALITY INDICATOR PROGRAM

Scoring System ................................

LESSONS LEARNED ................................

DATA ANALYSIS AND COMPOSITE INDEX

QUALITY ASSURANCE ................................

Background ................................................................

Proposed Methodology for Quality Assurance

ADDITIONAL CONSIDERATIONS ................................

IMPLEMENTATION STRATEGY ................................

SANIGEST INTERNATIONAL ................................

ANNEX 1: INDICATORS USED BY VARIOUS HOSP

TABLE 1: LIST OF HOSPITAL BENCHMARKING

TABLE 2: PROPOSED INDICATORS FOR PILOT

FIGURE 1: STRUCTURE OF THE LATIN AMERICAN





Table of Contents

................................................................................................

TAL PERFORMANCE IN THE UNITED STATES, EUROPE AND LATIN AMERI

ENCHMARKING TOOLS ................................................................................................

................................................................................................

................................................................................................................................

OSPITALS ................................................................................................

................................................................................................................................

................................................................................................

................................................................................................................................

CENTER (MMTC) ................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

PROGRAM ................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

OSPITAL SCORE CARD ................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

ERFORMANCE ASSESSMENT TOOL FOR QUALITY IMPROVEMENT IN HOSPITALS

................................................................................................................................

ROGRAM (IQIP) ................................................................................................

................................................................................................................................

................................................................................................................................

MPOSITE INDEX ................................................................................................

................................................................................................................................

................................................................................................

Proposed Methodology for Quality Assurance ................................................................................................

................................................................................................................................

................................................................................................................................

................................................................................................................................

USED BY VARIOUS HOSPITAL BENCHMARKING SYSTEMS ................................

Tables ENCHMARKING INITIATIVES REVIEWED ................................................................

ILOT PROJECT BY CATEGORY ................................................................

Figure MERICAN HOSPITAL BENCHMARKING TOOL ................................


............................................................. 4

ROPE AND LATIN AMERICA ........................ 5

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............................................................ 13

OSPITALS (PATH ) .................... 14

............................................................ 14

.............................................. 14

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.................................................... 19

............................................................ 21

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Hospitals are a vital part of any health care system and account for a large proportion of a government’s health care budget. Increased competition between providers, the demand for value from payers, patient safety concerns, and mounting evidence of variation in medical practice has placed the assessment of hospital performance high on the agenda of policy makers, world. In low and middle-income countries, such as those found in many emerging markets, hospitals continue to be the main providers of health care. The ability to measure and compare hospital performance within this context is an important step in beginning to address some of the health care disparities that exist in this region. There are four principal methods of measuring hospital performance: regulatory inspection, public satisfaction surveys, third-party asthese methods however, have not been tested rigorously. The use of statistical indicators and thirdhealth care institutions throughout the world. Statistical indicators have been used to develop various hospital benchmarking tools, particularly inpredetermined areas of interest are voluntarily reported and then combined to produce an overall rating; no such systematic tool exists or is routinely used for hospitals in the Latin American context. Furthermore, many hospitals in the North America and Europe have undergone accreditation processes with national and/or international regulatory bodies and this trend is continuing in regions such as Latin America. Benchmarking performance of any kind has beenchange. For example, in the United States, hospital comparison tools and benchmarking initiatives such as Hospital Compare (Centers for Medicare and Medicaid Services) have helped to establish and disseminate best practices for treating conditions such as acute myocardial infarction, congestive heart failure and pneumonia. Furthermore, they have provided an avenue for the patient to become more of an active participant and decision maker in their own healthcar The present paper reviews the top initiatives in the development and comparison of key performance indicators to measure hospital performance. The information provided is intended as a “menu” of options for policymakers, hospital managers and clinictheir healthcare system or hospital.

1 How can hospital performance be measured and monitored? WHO Regional Office for Europe’s Health Evidence Network. August 2003.





Introduction

Hospitals are a vital part of any health care system and account for a large proportion of a government’s care budget. Increased competition between providers, the demand for value from payers, patient

safety concerns, and mounting evidence of variation in medical practice has placed the assessment of hospital performance high on the agenda of policy makers, payers, patients and regulators around the

income countries, such as those found in many emerging markets, hospitals continue to be the main providers of health care. The ability to measure and compare hospital

his context is an important step in beginning to address some of the health care

There are four principal methods of measuring hospital performance: regulatory inspection, public party assessment and comparison of statistical indicators. The majority of

these methods however, have not been tested rigorously.1

The use of statistical indicators and third-party assessments (i.e. accreditation) are becoming popular in health care institutions throughout the world. Statistical indicators have been used to develop various hospital benchmarking tools, particularly in the Untied States. Raw or aggregated data from predetermined areas of interest are voluntarily reported and then combined to produce an overall rating; no such systematic tool exists or is routinely used for hospitals in the Latin American context.

rmore, many hospitals in the North America and Europe have undergone accreditation processes with national and/or international regulatory bodies and this trend is continuing in regions such as Latin

Benchmarking performance of any kind has been shown to be a powerful tool and impetus to for change. For example, in the United States, hospital comparison tools and benchmarking initiatives such as Hospital Compare (Centers for Medicare and Medicaid Services) have helped to establish and

best practices for treating conditions such as acute myocardial infarction, congestive heart failure and pneumonia. Furthermore, they have provided an avenue for the patient to become more of an active participant and decision maker in their own healthcare.

The present paper reviews the top initiatives in the development and comparison of key performance indicators to measure hospital performance. The information provided is intended as a “menu” of options for policymakers, hospital managers and clinicians to choose the most appropriate indicators for

How can hospital performance be measured and monitored? WHO Regional Office for Europe’s Health


Hospitals are a vital part of any health care system and account for a large proportion of a government’s care budget. Increased competition between providers, the demand for value from payers, patient

safety concerns, and mounting evidence of variation in medical practice has placed the assessment of payers, patients and regulators around the

income countries, such as those found in many emerging markets, hospitals continue to be the main providers of health care. The ability to measure and compare hospital

his context is an important step in beginning to address some of the health care

There are four principal methods of measuring hospital performance: regulatory inspection, public sessment and comparison of statistical indicators. The majority of

party assessments (i.e. accreditation) are becoming popular in health care institutions throughout the world. Statistical indicators have been used to develop various

the Untied States. Raw or aggregated data from predetermined areas of interest are voluntarily reported and then combined to produce an overall rating; no such systematic tool exists or is routinely used for hospitals in the Latin American context.

rmore, many hospitals in the North America and Europe have undergone accreditation processes with national and/or international regulatory bodies and this trend is continuing in regions such as Latin

shown to be a powerful tool and impetus to for change. For example, in the United States, hospital comparison tools and benchmarking initiatives such as Hospital Compare (Centers for Medicare and Medicaid Services) have helped to establish and

best practices for treating conditions such as acute myocardial infarction, congestive heart failure and pneumonia. Furthermore, they have provided an avenue for the patient to become more of

The present paper reviews the top initiatives in the development and comparison of key performance indicators to measure hospital performance. The information provided is intended as a “menu” of

ians to choose the most appropriate indicators for

How can hospital performance be measured and monitored? WHO Regional Office for Europe’s Health

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Measurement of Hospital Performance in the United States, Europe and Latin

Many governments, non-governmental institutions and members of the private sector have initiated or engaged in projects, some in partnership with each other, to assess hospital performance. The areas in which hospital performance can be assessed and the rationale for doing so are varied, as such a diverse range of instruments have emerged with varying indicator sets. Benchmarking tools that have emerged in the United States and Europe have primarily focused on outcome and process of care measures; a measure of patient experience/satisfaction is also commonly included in many of these instruments. In creating our proposed indicator set for hospital ranking and benchmarking, we examined benchmarking systems from around the world that used statistical indicators to measure hospital performance (Table 2); a brief overview of 12 of these benchmarking tools are outlined below and a full list of indicators by project can be found in Annex I.

Table 1: List of Hospital Benchmarking Initia

PROJECT TITLE

CHKS Top Hospitals Program Health Consumer Powerhouse HealthInsight National Rankings for Hospitals Hospital Compare IASIST Top 20 Hospitals International Quality Indicator Program Leapfrog Group






America

governmental institutions and members of the private sector have initiated or engaged in projects, some in partnership with each other, to assess hospital performance. The areas in which hospital performance can be assessed and

tionale for doing so are varied, as such a diverse range of instruments have emerged with varying indicator sets. Benchmarking tools that have emerged in the United States and Europe have primarily focused on outcome and process of

e of patient experience/satisfaction is also commonly included

In creating our proposed indicator set for hospital ranking and benchmarking, we examined benchmarking systems from around the world that

tors to measure hospital performance (Table 2); a brief overview of 12 of these benchmarking tools are outlined below and a full list of indicators by project can be found in

: List of Hospital Benchmarking Initiatives Reviewed

COUNTRY/REGION

YEAR INITIATED

United Kingdom

2001

European Union

2005

HealthInsight National Rankings for United States

2004

United States

2003

Spain

2000

International Quality Indicator Program International

1997

United States

2001



NITIATED

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PROJECT TITLE

Michigan Manufacturing Technology Center (MMTC) National Health Services (NHS) Choices Hospital Scorecard Thomson & Reuters Top 100 Hospitals

US News & World Report World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH)





COUNTRY/REGION

YEAR INITIATED

Michigan Manufacturing Technology United States 2005

National Health Services (NHS) Choices United Kingdom

2008

Thomson & Reuters Top 100 Hospitals United States

1994

United States

1990

- Performance Assessment Tool for Quality Improvement in Hospitals

International

2004


NITIATED

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Review of Hospital Benchmarking Tools

Various methodologies have been employed to rank and benchmark hospital performance. A literature review was undertaken to learn from the diverse experiences of hospitals and organizations that have already undertaken ranking and benchmarking processes. Anwas performed using search terms including hospital performance; benchmarking tools; hospital comparison; and ranking hospitals. Publically available data from benchmarking and healthcare organizations were reviewed including but not limited to WHO reports on measuring hospital performance, discussion papers regarding the creation of the WHO Performance Assessment Tool for Quality Improvement in Hospitals and sample benchmarking reports from the Michigan Manufacturing Technology Center. The results of the literature review are presented below.

Hospital Compare

Hospital Compare is a large public database that uses nationally standardized performance measures to compare over 4000 US hospitals that submitted data relating to the quality of care provided in their institutions and allowed it to be made public. The foand reported are:

• Process of care

• Outcome of care

• Patients hospital experience

• Medicare payment and volume This database is the result of collaboration between both public and private stakeholders.

Scoring System

Hospital Compare doesn’t rank hospitals, rather it reports the percentage of patients for which a given indicator was performed/completed (i.e. 98% of the time patient received prophylactic antibiotics prior to surgery). Comparative graphs are also available in which the nationwide and state averages for all hospitals reporting that indicator are displayed alongside the score for the specific hospital(s) chosen. Website: www.hospitalcompare.hhs.gov





Review of Hospital Benchmarking Tools

Various methodologies have been employed to rank and benchmark hospital performance. A literature review was undertaken to learn from the diverse experiences of hospitals and organizations that have already undertaken ranking and benchmarking processes. An internet search was performed using search terms including hospital performance; benchmarking tools; hospital comparison; and ranking hospitals. Publically available data from benchmarking and healthcare organizations were reviewed

ed to WHO reports on measuring hospital performance, discussion papers regarding the creation of the WHO Performance Assessment Tool for Quality Improvement in Hospitals and sample benchmarking reports from the Michigan Manufacturing

results of the literature review are

Hospital Compare is a large public database that uses nationally standardized performance measures to compare over 4000 US hospitals that submitted data relating to the quality of care provided in their institutions and allowed it to be made public. The four areas in which hospital performance is measured

Patients hospital experience

Medicare payment and volume

This database is the result of collaboration between both public and private stakeholders.

Hospital Compare doesn’t rank hospitals, rather it reports the percentage of patients for which a given indicator was performed/completed (i.e. 98% of the time patient received prophylactic antibiotics prior

s are also available in which the nationwide and state averages for all hospitals reporting that indicator are displayed alongside the score for the specific hospital(s) chosen.

.hhs.gov


Hospital Compare is a large public database that uses nationally standardized performance measures to compare over 4000 US hospitals that submitted data relating to the quality of care provided in their

ur areas in which hospital performance is measured

This database is the result of collaboration between both public and private stakeholders.

Hospital Compare doesn’t rank hospitals, rather it reports the percentage of patients for which a given indicator was performed/completed (i.e. 98% of the time patient received prophylactic antibiotics prior

s are also available in which the nationwide and state averages for all hospitals reporting that indicator are displayed alongside the score for the specific hospital(s) chosen.

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HealthInsight National Rankings for Hospitals

HealthInsight is a private not-for-profit organization that conducts various health performance rakings including national rankings for hospitals, home health agencies and nursing homes in an effort improve healthcare systems in Nevada and Utah. It uses publicly reported data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website to conduct the hospital rankings. Healthinsight measures hospital performance by examining the process of care measures for acute myocardial infarction, heart failure, pneumonia and surgical infection prevention as set out by CMS.

Scoring system

Hospitals are ranked based on their overall success rate for performing the process of care measures for the above mentioned conditions; rankings are converted and reported as percentiles. Website: www.healthinsight.org

Leapfrog Group

This initiative is comprised of private and public purchasers of health care that seek to leverage their purchasing power to improve the quality of services provided by health care institutions. Unlike Hospital Compare, here hospital performance is measured by using structural indicators instead of clinical ones to produce a composite index of hospital performance. The Leapfrog Group uses the following structural indicators to measure hospital per

• Computerized physician order entry (CPOE) system

• ICU staffing

• High risk treatments (evidence based hospital referral)

• Leapfrog safe practice scores (27 procedures in place to reduce preventable medical mistakes) Leapfrog invites hospitals from 39 regions of the US to participate in their survey (although any hospital is welcome to participate); they target hospitals predominantly in areas where their members have a large presence. Hospitals voluntarily submit data if they agree to participatecomprehensive incentive and rewards program to encourage and reward hospitals for participating in their program and implementing their quality/safety standards.





HealthInsight National Rankings for Hospitals

profit organization that conducts various health performance rakings including national rankings for hospitals, home health agencies and nursing homes in an effort improve healthcare systems in Nevada and Utah.

It uses publicly reported data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website to conduct the hospital

hospital performance by examining the process of care measures for acute myocardial infarction, heart failure, pneumonia and surgical infection prevention as set out by CMS.

Hospitals are ranked based on their overall success rate for performing the process of care measures for the above mentioned conditions; rankings are converted and reported as percentiles.

This initiative is comprised of private and public purchasers of health care that seek to leverage their purchasing power to improve the quality of services provided by health care institutions.

Unlike Hospital Compare, here hospital performance is measured by using structural indicators instead of clinical ones to produce a composite index of hospital performance. The Leapfrog Group uses the following structural indicators to measure hospital performance:

Computerized physician order entry (CPOE) system

High risk treatments (evidence based hospital referral)

Leapfrog safe practice scores (27 procedures in place to reduce preventable medical mistakes)

om 39 regions of the US to participate in their survey (although any hospital is welcome to participate); they target hospitals predominantly in areas where their members have a large presence. Hospitals voluntarily submit data if they agree to participate in the program. Leapfrog has a comprehensive incentive and rewards program to encourage and reward hospitals for participating in their program and implementing their quality/safety standards.


profit organization that conducts various health performance rakings including national rankings for hospitals, home health agencies and nursing homes in an effort to

Hospitals are ranked based on their overall success rate for performing the process of care measures for the above mentioned conditions; rankings are converted and reported as percentiles.

This initiative is comprised of private and public purchasers of health care that seek to leverage their purchasing power to improve the quality of services provided by health care institutions.

Unlike Hospital Compare, here hospital performance is measured by using structural indicators instead of clinical ones to produce a composite index of hospital performance. The Leapfrog Group uses the

Leapfrog safe practice scores (27 procedures in place to reduce preventable medical mistakes)

om 39 regions of the US to participate in their survey (although any hospital is welcome to participate); they target hospitals predominantly in areas where their members have a large

in the program. Leapfrog has a comprehensive incentive and rewards program to encourage and reward hospitals for participating in

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Scoring System

Leapfrog uses a scoring algorithm to come up with their ratings which fall into five categories. The rating system is based on how far the health care institution has come with regards to meeting the criteria/standards set out by Leapfrog.

• Declined to respond

• Willing to report

• Some Progress

• Substantial Progress

• Fully Meets Standards Website: www.leapfroggroup.org

Michigan Manufacturing Technology Center (MMTC)

This benchmarking system uses 23 metrics to measure a hospital’s performance. the following five categories:

• Business (3)

• Productivity (5)

• Asset utilization (5)

• Throughput (6)

• Clinical outcomes (4) Data on hospital practices are also collected in the areas of clinical practices, cost profile and patient safety policies.

Scoring System

MMTC reports a hospital’s relative performance on each measure within a comparison group of similar hospitals; hospital percentile rankings range Website: http://www.performancebenchmarking.org/hospital.aspx

US News & World Report

Every year the US News & World Report releases a list of the best hospitals in the United States. It ranks hospitals based on 16 specialty areas (e.g., oncology, cardiology)are based on nominations by specialists that





Leapfrog uses a scoring algorithm to come up with their ratings which fall into five categories. The rating system is based on how far the health care institution has come with regards to meeting the criteria/standards set out by Leapfrog. The five categories are:

Michigan Manufacturing Technology Center (MMTC)

This benchmarking system uses 23 metrics to measure a hospital’s performance. These metrics fall into

also collected in the areas of clinical practices, cost profile and patient

MMTC reports a hospital’s relative performance on each measure within a comparison group of similar hospitals; hospital percentile rankings range from 0 (worst in the group) to 100 (best in the group).

http://www.performancebenchmarking.org/hospital.aspx

World Report releases a list of the best hospitals in the United States. It ranks hospitals (e.g., oncology, cardiology), 12 of which are based on hard data while the remaining four

are based on nominations by specialists that were surveyed.


Leapfrog uses a scoring algorithm to come up with their ratings which fall into five categories. The rating system is based on how far the health care institution has come with regards to meeting the

These metrics fall into

also collected in the areas of clinical practices, cost profile and patient

MMTC reports a hospital’s relative performance on each measure within a comparison group of similar from 0 (worst in the group) to 100 (best in the group).

World Report releases a list of the best hospitals in the United States. It ranks hospitals , 12 of which are based on hard data while the remaining four

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To be considered for one of the 12 datacriteria:

• Be a member of the Council of Teaching Hospitals and Health Systems

• Be affiliated with a medical school

• Have at least a certain number of key technologies (e.g., imagedigital mammography)

In addition to the above mentioned criteria, hospitals also had to perform a minimum number of specified procedures (specialty dependent) on Medicare patient

Hospitals that meet all these criteria were then ranked.

Scoring System

A score from 0 – 100 is assigned based on three factors that are given equal weight:

1. Reputation (random sample of 200 physicians from ABMS database)

2. Death rate (mortality index)

3. Care-related factors (nursing staff, technology, volume, patient services)

Hospitals with the 50 highest scores are subsequently ranked.

Website: http://health.usnews.com/sections/health/best

Thomson & Reuters Top 100 Hospitals Program

The primary goal of this program is to objectively identify US hospitals that have the best organizationwide performance and make this data publically avahospital is measured including that of the Board, executives and health care professionals. The organization-wide performance is then compared against national benchmarks. Hospitals are classified into 5 comparison ‘peer’ groups based on bed size and teaching status:

• Major teaching hospitals

• Teaching hospitals

• Large community hospitals

• Medium community hospitals

• Small community hospitals





To be considered for one of the 12 data-driven specialties hospitals had to meet one of the following

Be a member of the Council of Teaching Hospitals and Health Systems

Be affiliated with a medical school

number of key technologies (e.g., image-guided radiation therapy, full

In addition to the above mentioned criteria, hospitals also had to perform a minimum number of specified procedures (specialty dependent) on Medicare patients to qualify for ranking.

Hospitals that meet all these criteria were then ranked.

100 is assigned based on three factors that are given equal weight:

1. Reputation (random sample of 200 physicians from ABMS database)

related factors (nursing staff, technology, volume, patient services)

Hospitals with the 50 highest scores are subsequently ranked.

http://health.usnews.com/sections/health/best-hospitals


The primary goal of this program is to objectively identify US hospitals that have the best organizationwide performance and make this data publically available. The performance of all members of the hospital is measured including that of the Board, executives and health care professionals. The

wide performance is then compared against national benchmarks.

comparison ‘peer’ groups based on bed size and teaching status:

Medium community hospitals


driven specialties hospitals had to meet one of the following

guided radiation therapy, full-field

In addition to the above mentioned criteria, hospitals also had to perform a minimum number of s to qualify for ranking.

The primary goal of this program is to objectively identify US hospitals that have the best organization-ilable. The performance of all members of the

hospital is measured including that of the Board, executives and health care professionals. The

comparison ‘peer’ groups based on bed size and teaching status:

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Scoring System

Statistical analyses of publically available data sscored based on a set of weighted performance measures spanning the following 4 areas:

• Clinical excellence

• Operating efficiency

• Financial health

• Responsiveness to the community Hospitals are subsequently ranked relative to their comparison group; median and quartile values are reported. Website: http://www.100tophospitals.com

Health Consumer Powerhouse

Health Consumer Powerhouse produces an annual index comparing performance of health care systems of the European Union in various areas in an attempt to strengthen the position of the healthcare consumer. It examines indicators in the following 5 sub

• Patients rights and information (9)

• Waiting times (5)

• Outcomes (5)

• ‘Generosity’ of public healthcare systems (4)

• Pharmaceuticals (4)

Scoring System

Each sub-discipline is weighted as follows: Sub discipline Patient rights and information Waiting time for treatment Outcomes “Generosity” Pharmaceuticals





Statistical analyses of publically available data sources is carried out to rank hospitals. Hospitals are scored based on a set of weighted performance measures spanning the following 4 areas:

Responsiveness to the community

ently ranked relative to their comparison group; median and quartile values are

http://www.100tophospitals.com

Health Consumer Powerhouse produces an annual index comparing performance of health care systems of the European Union in various areas in an attempt to strengthen the position of the healthcare

It examines indicators in the following 5 sub-disciplines:

Patients rights and information (9)

‘Generosity’ of public healthcare systems (4)

discipline is weighted as follows:

Relative weight

1.5 2.0 2.0 1.0 1.0


ources is carried out to rank hospitals. Hospitals are scored based on a set of weighted performance measures spanning the following 4 areas:

ently ranked relative to their comparison group; median and quartile values are

Health Consumer Powerhouse produces an annual index comparing performance of health care systems of the European Union in various areas in an attempt to strengthen the position of the healthcare

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Furthermore, each indicator has a maximum possible score of 3; scores are color coded as follows:

green = 3 pts amber = 2 pts red/not available = 1 pt

Scores for each sub-discipline are calculated as a percentage of the maximum possible score and subsequently multiplied by the weight coefficients and added up to make the final country score. These percentages are then multiplied by 133, and rounded to a 1000 indicating “the perfect healthcare system”.

National Health Services Choices Hospital Score Card

The NHS has developed a scorecard in which hospitals are assessed and compared in a variety of areas depending on the treatment/condition a patient is interested in. The following are the areas in which hospitals are assessed.

• Wait time from referral to treatment

• Length of stay in hospital

• Risk of readmission (rated –

• Experience of surgical department with specific procedure

• Patient rating of care received

• Patient experience during treatment (respect, dignity, feeling involved )

• Survival rate for elective procedure (rated

• Survival rate for emergency procedure

• MRSA control for elective patients

• Cleanliness of hospital

Scoring System

The overall quality of service for the trust that runs the hospital is colour coded and given a rating of excellent (green), good (blue), fair (yellow) or weak (red). Hospitals are not ranked against each other, information is only compared. Website: https://www.nhs.uk/ServiceDirectories/Pages/ServiceSearch.aspx






green = 3 pts amber = 2 pts red/not available = 1 pt

discipline are calculated as a percentage of the maximum possible score and subsequently multiplied by the weight coefficients and added up to make the final country score. These percentages are then multiplied by 133, and rounded to a three digit integer; the maximum total score is 1000 indicating “the perfect healthcare system”.

National Health Services Choices Hospital Score Card

The NHS has developed a scorecard in which hospitals are assessed and compared in a variety of areas pending on the treatment/condition a patient is interested in.

The following are the areas in which hospitals are assessed.

Wait time from referral to treatment

– lower than expected, expected, higher than expected)

Experience of surgical department with specific procedure

Patient rating of care received

Patient experience during treatment (respect, dignity, feeling involved )

Survival rate for elective procedure (rated – better than, worse than or as expected)

Survival rate for emergency procedure

MRSA control for elective patients

The overall quality of service for the trust that runs the hospital is colour coded and given a rating of excellent (green), good (blue), fair (yellow) or weak (red). Hospitals are not ranked against each other,

https://www.nhs.uk/ServiceDirectories/Pages/ServiceSearch.aspx



discipline are calculated as a percentage of the maximum possible score and subsequently multiplied by the weight coefficients and added up to make the final country score. These

three digit integer; the maximum total score is

The NHS has developed a scorecard in which hospitals are assessed and compared in a variety of areas

er than expected)

as expected)

The overall quality of service for the trust that runs the hospital is colour coded and given a rating of excellent (green), good (blue), fair (yellow) or weak (red). Hospitals are not ranked against each other,

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CHKS Top Hospitals Program

CHKS is a healthcare benchmarking company that annually prepares a benchmarking repohospitals using data from the National Health Care service. Performance is based on 20 indicators in the following five areas:

• Clinical effectiveness

• Health outcomes

• Efficiency

• Patient experience

• Quality of care

Scoring System

Each indicator has an actual value (reported by hospital) and expected value (derived using overall performance level of the hospital’s peers); from these two values an index is derived and hospitals are subsequently ranked. Website: http://tophospitals.chks.co.uk/

IASIST Top 20 Hospitals

Top 20 Hospitals is a hospital assessment program that benchmarks public and private hospitals in Spain. Top 20 hospitals use six indicators in the following three areas t

• Quality

• Functioning

• Clinical practice

Scoring System

It is not clear how the scoring and ranking system for IASIST works, however, all indicators are equally weighted and summed once normalized. Website: http://www.iasist.com/en/top






CHKS is a healthcare benchmarking company that annually prepares a benchmarking repohospitals using data from the National Health Care service. Performance is based on 20 indicators in the

Each indicator has an actual value (reported by hospital) and expected value (derived using overall performance level of the hospital’s peers); from these two values an index is derived and hospitals are

http://tophospitals.chks.co.uk/

Top 20 Hospitals is a hospital assessment program that benchmarks public and private hospitals in Spain. Top 20 hospitals use six indicators in the following three areas to carry out its benchmarking:

It is not clear how the scoring and ranking system for IASIST works, however, all indicators are equally weighted and summed once normalized.

http://www.iasist.com/en/top--20


CHKS is a healthcare benchmarking company that annually prepares a benchmarking report on UK hospitals using data from the National Health Care service. Performance is based on 20 indicators in the

Each indicator has an actual value (reported by hospital) and expected value (derived using overall performance level of the hospital’s peers); from these two values an index is derived and hospitals are

Top 20 Hospitals is a hospital assessment program that benchmarks public and private hospitals in o carry out its benchmarking:

It is not clear how the scoring and ranking system for IASIST works, however, all indicators are equally

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World Health Organization -

Hospitals (PATH )

In 2003, the World Health Organization (WHO) Regional Office for Europe initiated a project to develop a tool to measure hospital performance. This tool was named Performance Assessment Tool for quality improvement in Hospitals (PATH).

• Clinical effectiveness and safety (7)

• Patient centeredness (1)

• Production efficiency (2)

• Staff orientation (5)

• Responsive governance (2) Within these five dimensions are 17 core quality indicators for PATH; additional tailored indicators exists that can also be used. This tool allows for the collection and analysis of data on a set of indicators for comprehensive performance assessment in hand resource availability. Hospitals in Europe, Canada and Africa have participated in a pilot project using this assessment tool.

Scoring System

The PATH tool does not rank hospitals, rather i

• The number of hospitals reporting the particular/specific indicator

• Number of cases

• Minimum/maximum values

• Mean (standard deviation)

• Value for that hospital on that particular indicator

International Quality Indicator Program (IQIP)

The International Quality Indicator Program is a branch of the Quality Indicator Program (QIP) that was first developed in the US over 20 years ago. The QIP collects data on quality of patient care and seeks to identify opportunities for improvement. It has a variety of performance metrics depending on the type of health care institution as does the IQIP. IQIP is the only other international hospital assessment program aside from the WHO’s PATH program. For acute care institutions, the IQIP examines acute care process and outcome measures in the following areas:





Performance Assessment Tool for Quality Improvement in

In 2003, the World Health Organization (WHO) Regional Office for Europe initiated a project to develop a tool to measure hospital performance. This tool was named Performance Assessment Tool for quality improvement in Hospitals (PATH). It defines five key areas for assessment:

Clinical effectiveness and safety (7)

Within these five dimensions are 17 core quality indicators for PATH; additional tailored indicators exists that can also be used. This tool allows for the collection and analysis of data on a set of indicators for comprehensive performance assessment in hospitals in regions and countries with different cultures and resource availability. Hospitals in Europe, Canada and Africa have participated in a pilot project

The PATH tool does not rank hospitals, rather it reports the following comparative data:

The number of hospitals reporting the particular/specific indicator

Minimum/maximum values

Value for that hospital on that particular indicator

dicator Program (IQIP)

The International Quality Indicator Program is a branch of the Quality Indicator Program (QIP) that was first developed in the US over 20 years ago. The QIP collects data on quality of patient care and

s for improvement. It has a variety of performance metrics depending on the type of health care institution as does the IQIP. IQIP is the only other international hospital assessment program aside from the WHO’s PATH program.

, the IQIP examines acute care process and outcome measures in the


Performance Assessment Tool for Quality Improvement in

In 2003, the World Health Organization (WHO) Regional Office for Europe initiated a project to develop a tool to measure hospital performance. This tool was named Performance Assessment Tool for

Within these five dimensions are 17 core quality indicators for PATH; additional tailored indicators exists that can also be used. This tool allows for the collection and analysis of data on a set of indicators

ospitals in regions and countries with different cultures and resource availability. Hospitals in Europe, Canada and Africa have participated in a pilot project

t reports the following comparative data:

The International Quality Indicator Program is a branch of the Quality Indicator Program (QIP) that was first developed in the US over 20 years ago. The QIP collects data on quality of patient care and

s for improvement. It has a variety of performance metrics depending on the type of health care institution as does the IQIP. IQIP is the only other international hospital

, the IQIP examines acute care process and outcome measures in the

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Acute Myocardial Infarction Cardiac Surgery Colorectal Surgery Appendectomy Hysterectomies Maternity and Childbirth Patient Safety Infection Control Ambulatory Care Over 180 health care organizations in 12 countries use IQIP and its indicators to collect, analyze and compare their data. Several countries in Latin America are participating in IQIP (# of institutions):

• Mexico (7)

• Brazil (8)

• Argentina (5)

• Chile (5)

• Colombia (7)

• Uruguay (2)

Scoring System

IQIP does not rank institutions, rather it produces an institutionquarter, providing both historical and comparative data for each measure that data was submitted more narrowly user-defined peer group reports can also be obtained. Depending on the nature of the data, outcomes reported include numerators, denominators, minimum and maximum rates, median, means (weighted and unweighted), standard deviation and q Website: http://www.internationalqip.com





Acute Myocardial Infarction Heart Failure Pneumonia

Colorectal Surgery Vascular Surgery Liver, Biliary Tract, Pancreatic, or Gallbladder SurgeryAppendectomy Hernia Surgery Hysterectomies Orthopedic Surgery

birth Emergency Care Patient Safety Intensive Care Units Infection Control Internal Medicine Ambulatory Care Methyllin Resistant Staphylococcus Aureus (MRSA)

Over 180 health care organizations in 12 countries use IQIP and its indicators to collect, analyze and Several countries in Latin America are participating in IQIP (# of institutions):

IQIP does not rank institutions, rather it produces an institution-specific report for participants every quarter, providing both historical and comparative data for each measure that data was submitted

defined peer group reports can also be obtained.

Depending on the nature of the data, outcomes reported include numerators, denominators, minimum and maximum rates, median, means (weighted and unweighted), standard deviation and q

http://www.internationalqip.com


Liver, Biliary Tract, Pancreatic, or Gallbladder Surgery

s (MRSA)

Over 180 health care organizations in 12 countries use IQIP and its indicators to collect, analyze and Several countries in Latin America are participating in IQIP (# of institutions):

specific report for participants every quarter, providing both historical and comparative data for each measure that data was submitted for;

Depending on the nature of the data, outcomes reported include numerators, denominators, minimum and maximum rates, median, means (weighted and unweighted), standard deviation and quartiles.

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In developing the proposed ranking and benchmarking tool we reviewed and summarized 12 benchmarking systems, focusing particularly on indicators that may be relevant in the Latin American context, challenges to implementation of such a tool and any other rkey lessons that emerged from the review of the various hospital benchmarking systems and that were taken into consideration when developing the proposed tool are as follows:

• The burden of data collection appears to beimplementation of a successful performance assessment program. It is important to choose indicators that are relevant but do not require extensive data collection or greatly increased resources to collect them. The Phigh for four of their indicators in particular and absenteeism. The PATH project also stated that a lack of personnel, resources, expertise antime for participating hospitals to collect data was an issue.

• It is essential that clear and very specific definitions of what the indicators mean are established to ensure that all participants collect the same data and are able to interpret it andmake the data comparable.

• The ease and cost of collecting data from structural indicators is considerably better than with process and outcomes of care data; however, the relevance of data is greater with process and outcome of care measures i

• The institutional embedding of the performance measurement project at the regional/national level, consideration of various stakeholder interests and technical support during data collection have all been sited as essential parts of a successful quality indicator program.

• Patient experience appears to be a good indicator to include as it is measurable, it can be improved and collection of this type of data is inexpensive and most hospitals already gattype of information.4

• It is important to ensure that the selected indicators reflect measurement areas that are relevant to a broad range of institutions.

• Different stages of development and organizational structures in institutions, resource and cultural differences between regions and countries may be hurdles that have to be overcome when implementing a benchmarking tool.

2 The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): An analysis of the pilot implementation in 37 hospitals. Groene O, et al. Intl J. Quality Health Care. 20(3). 2008. 3 An international review of projects on hospital performance assessment. Groene O, Skau JK, Frolich A. Intl J. Quality Health Care. 20(3). 2008. 4 Hospital performance evaluation: What data do we want, how do we get it, and how should we use it? Mehrotra A, Lee S, RA Dudley. Institute for Health Policy Studies University of California, San Francisco





Lessons Learned

In developing the proposed ranking and benchmarking tool we reviewed and summarized 12 benchmarking systems, focusing particularly on indicators that may be relevant in the Latin American context, challenges to implementation of such a tool and any other relevant lessons that surfaced . The key lessons that emerged from the review of the various hospital benchmarking systems and that were taken into consideration when developing the proposed tool are as follows:

The burden of data collection appears to be one of the greatest impediments to the implementation of a successful performance assessment program. It is important to choose indicators that are relevant but do not require extensive data collection or greatly increased resources to collect them. The PATH project found that the burden of data collection was too high for four of their indicators in particular – antibiotic use, surgical theatre use, expenditure

The PATH project also stated that a lack of personnel, resources, expertise antime for participating hospitals to collect data was an issue. 2

It is essential that clear and very specific definitions of what the indicators mean are established to ensure that all participants collect the same data and are able to interpret it and

The ease and cost of collecting data from structural indicators is considerably better than with process and outcomes of care data; however, the relevance of data is greater with process and outcome of care measures in regards to quality and performance measurement.

The institutional embedding of the performance measurement project at the regional/national level, consideration of various stakeholder interests and technical support during data collection

sited as essential parts of a successful quality indicator program.

atient experience appears to be a good indicator to include as it is measurable, it can be improved and collection of this type of data is inexpensive and most hospitals already gat

It is important to ensure that the selected indicators reflect measurement areas that are relevant to a broad range of institutions.

Different stages of development and organizational structures in institutions, resource and cultural differences between regions and countries may be hurdles that have to be overcome when implementing a benchmarking tool.

The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): An analysis of the pilot implementation in 37 hospitals. Groene O, et al. Intl J. Quality Health

An international review of projects on hospital performance assessment. Groene O, Skau JK, Frolich A.

Hospital performance evaluation: What data do we want, how do we get it, and how should we use it? Institute for Health Policy Studies University of California, San


In developing the proposed ranking and benchmarking tool we reviewed and summarized 12 benchmarking systems, focusing particularly on indicators that may be relevant in the Latin American

elevant lessons that surfaced . The key lessons that emerged from the review of the various hospital benchmarking systems and that were

one of the greatest impediments to the implementation of a successful performance assessment program. It is important to choose indicators that are relevant but do not require extensive data collection or greatly increased

ATH project found that the burden of data collection was too antibiotic use, surgical theatre use, expenditure

The PATH project also stated that a lack of personnel, resources, expertise and

It is essential that clear and very specific definitions of what the indicators mean are established to ensure that all participants collect the same data and are able to interpret it and ultimately

The ease and cost of collecting data from structural indicators is considerably better than with process and outcomes of care data; however, the relevance of data is greater with process and

n regards to quality and performance measurement.

The institutional embedding of the performance measurement project at the regional/national level, consideration of various stakeholder interests and technical support during data collection

sited as essential parts of a successful quality indicator program. 3

atient experience appears to be a good indicator to include as it is measurable, it can be improved and collection of this type of data is inexpensive and most hospitals already gather this

It is important to ensure that the selected indicators reflect measurement areas that are relevant

Different stages of development and organizational structures in institutions, resource availability and cultural differences between regions and countries may be hurdles that have to be overcome

The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): An analysis of the pilot implementation in 37 hospitals. Groene O, et al. Intl J. Quality Health

An international review of projects on hospital performance assessment. Groene O, Skau JK, Frolich A.

Hospital performance evaluation: What data do we want, how do we get it, and how should we use it?

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On the basis of the above review and subsequent lessons learned, it was decided that indicators for the proposed ranking and benchmarking tool would be selected based on the following criteria:

• Measurability of indicator

• Availability of data

• Relevance to Latin American health care setting

• Consistency across other hospital benchmarking tools (see Annex IV for Four thematic indicator areas emerged that fit these criteria and which we considered essential for assessing hospital performance in Latin America: hospital infrastructure and resources; hospital volumes and wait times; hospital clinical effectdescription of the reasoning behind each choice follows: The Hospital Infrastructure and Resources both the technical and human resadequate and appropriate staffing and therefore it is important to take these into account when assessing hospital performance thus hospital staffing and training is the first subFurthermore, it is essential to ascertain the technological resources available to staff to carry out their duties, facilities and technologies available are therefore the second and last subcategory. Overall this component consists of the two subreadiness and ability of a hospital to serve its community. The Hospital Volumes and Wait Times volume of patients attended to as well as These two sub-components will allow for the calculation of staff: patient ratios and provide a sense of whether hospitals are operating under optimal staffing conditions. Finally, wait times in asurgery, diagnostics and the emergency department are considered to determine if services are being received in a timely manner. The Hospital Clinical Effectiveness and Best Practicesthe quality of hospital services provided as clinical care is the defining hallmark of a hospital. Not only are outcomes such as mortality, infection and readmission assessed, process of care measures are also included to determine if hospitals are employing current best practices in their clinical service provision; thus outcomes of care and process of care are the two sub The Hospital Policies and Patient Experience often neglected areas of health care provision: systematic policies reflecting the value a hospital places on patient and staff safety and patient experience and satisfaction with care received. These two areas thus form the sub-components of this category.





On the basis of the above review and subsequent lessons learned, it was decided that indicators for the osed ranking and benchmarking tool would be selected based on the following criteria:

Relevance to Latin American health care setting

Consistency across other hospital benchmarking tools (see Annex IV for matrix)

Four thematic indicator areas emerged that fit these criteria and which we considered essential for assessing hospital performance in Latin America: hospital infrastructure and resources; hospital volumes and wait times; hospital clinical effectiveness and efficiency; hospital policies and patient experience. A description of the reasoning behind each choice follows:

The Hospital Infrastructure and Resources component was selected to capture information outlining both the technical and human resources available to hospitals. Hospitals cannot function without adequate and appropriate staffing and therefore it is important to take these into account when assessing hospital performance thus hospital staffing and training is the first sub-component oFurthermore, it is essential to ascertain the technological resources available to staff to carry out their duties, facilities and technologies available are therefore the second and last sub

ent consists of the two sub-components that attempt to gauge the readiness and ability of a hospital to serve its community.

The Hospital Volumes and Wait Times component seeks to gather information regarding the volume of patients attended to as well as the volume of selected procedures performed in the hospital.

components will allow for the calculation of staff: patient ratios and provide a sense of whether hospitals are operating under optimal staffing conditions. Finally, wait times in asurgery, diagnostics and the emergency department are considered to determine if services are being

The Hospital Clinical Effectiveness and Best Practices component seeks to capture and quantify the quality of hospital services provided as clinical care is the defining hallmark of a hospital. Not only are outcomes such as mortality, infection and readmission assessed, process of care measures are also

ded to determine if hospitals are employing current best practices in their clinical service provision; thus outcomes of care and process of care are the two sub-components of this category.

The Hospital Policies and Patient Experience component attempts to evaluate two important but often neglected areas of health care provision: systematic policies reflecting the value a hospital places on patient and staff safety and patient experience and satisfaction with care received. These two areas thus

components of this category.


On the basis of the above review and subsequent lessons learned, it was decided that indicators for the osed ranking and benchmarking tool would be selected based on the following criteria:

matrix)

Four thematic indicator areas emerged that fit these criteria and which we considered essential for assessing hospital performance in Latin America: hospital infrastructure and resources; hospital volumes

iveness and efficiency; hospital policies and patient experience. A

component was selected to capture information outlining ources available to hospitals. Hospitals cannot function without

adequate and appropriate staffing and therefore it is important to take these into account when assessing component of this category.

Furthermore, it is essential to ascertain the technological resources available to staff to carry out their duties, facilities and technologies available are therefore the second and last sub-dimension of this

components that attempt to gauge the

seeks to gather information regarding the the volume of selected procedures performed in the hospital.

components will allow for the calculation of staff: patient ratios and provide a sense of whether hospitals are operating under optimal staffing conditions. Finally, wait times in areas such as surgery, diagnostics and the emergency department are considered to determine if services are being

component seeks to capture and quantify the quality of hospital services provided as clinical care is the defining hallmark of a hospital. Not only are outcomes such as mortality, infection and readmission assessed, process of care measures are also

ded to determine if hospitals are employing current best practices in their clinical service provision; components of this category.

s to evaluate two important but often neglected areas of health care provision: systematic policies reflecting the value a hospital places on patient and staff safety and patient experience and satisfaction with care received. These two areas thus

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Table 2: Proposed Indicators for Pilot Project by Category

INDICATOR CATEGORY

Hospital Infrastructure and Resources

Hospital Volumes and Wait Times

Hospital Clinical Effectiveness and Best Practices

Hospital Policies and Patient Experience





: Proposed Indicators for Pilot Project by Category

PROPOSED INDICATORS

1. Staff (volumes) 2. Staff (training) 3. Medical Equipment (availability) 4. Medical Facilities (availability) 1. Patient (volumes)

2. Selected Procedures (volumes) 3. Surgery (wait times) 4. Emergency Department (wait times to see physician) 5. Diagnostic Tests (i.e. CT scan, MRI) (wait times from time requested to performance of test) 6. Cancer Treatment Wait Times (wait time from time requested to time of treatment)

Hospital Clinical Effectiveness and Best Practices 1. Outcome of care measures - hospital wide survival/mortality rates - infection rates - length of stay (risk-adjusted discharges) - readmission rates ( i.e. AMI, CHF, elective and emergency surgery) 2. Process of care measures - Acute myocardial infarction (AMI) - Congestive heart failure (CHF) - Pneumonia

Hospital Policies and Patient Experience 1. Hospital Patient’s rights law (present or absent) 2. Patient access to own medical records 3. Hospital Latex-free policy (present or absent) 4. Hospital No-lift policy (present or absent) 5. Hospital Needleless policy (whenever possible) (present or absent) 6. Patient satisfaction survey (overall satisfaction rating)


3. Medical Equipment (availability) 4. Medical Facilities (availability)

2. Selected Procedures (volumes)

4. Emergency Department (wait times to see

5. Diagnostic Tests (i.e. CT scan, MRI) (wait times from time requested to performance of

6. Cancer Treatment Wait Times (wait time equested to time of treatment)

hospital wide survival/mortality rates

adjusted – all

readmission rates ( i.e. AMI, CHF, elective

Acute myocardial infarction (AMI) Congestive heart failure (CHF)

1. Hospital Patient’s rights law (present or

2. Patient access to own medical records free policy (present or absent)

lift policy (present or absent) 5. Hospital Needleless policy (whenever

6. Patient satisfaction survey (overall satisfaction

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Data Analysis and Composite Index

Once data collection is complete and verified, data will be normalized to ensure comparability using the following procedure: individual hospital scores for a particular indicator will be divided by the average indicator score from all hospitals and subnormalized to fall within a range of zero to ten and have a mean of five, thus allowing for easier interpretation and comparison of results. For example a hospital that receives a score of 7.5points or 50% above the index average whereas a hospital that receives a score of 4 will be 1 point or 20% below the average of the index. The normalization process is represented by Equation (1) where NVindicator i for hospital j, OVi,j the observed value for indicator i for hospital j and AVGscore for the indicator across hospitals: Equation (1): NVi,j = OV AVGi

For the sub-components of the index, simple averages will be calculated for all indicators; for example the average for all Volume related indicators in the Hospital Volumes and Wait Times componenbe calculated and then weighted according to the corresponding weight of each subConsequently, this will create a subthen make up the overall benchmarking index (Figure 2





Data Analysis and Composite Index

Once data collection is complete and verified, data will be normalized to ensure comparability using the following procedure: individual hospital scores for a particular indicator will be divided by the average indicator score from all hospitals and subsequently multiplied by five. This will create results that are normalized to fall within a range of zero to ten and have a mean of five, thus allowing for easier interpretation and comparison of results. For example a hospital that receives a score of 7.5points or 50% above the index average whereas a hospital that receives a score of 4 will be 1 point or 20% below the average of the index.

The normalization process is represented by Equation (1) where NVi,j represents the normalized score of the observed value for indicator i for hospital j and AVG

score for the indicator across hospitals:

OVi,j * 5

components of the index, simple averages will be calculated for all indicators; for example the average for all Volume related indicators in the Hospital Volumes and Wait Times componenbe calculated and then weighted according to the corresponding weight of each subConsequently, this will create a sub-index for each of the four components as outlined below that will then make up the overall benchmarking index (Figure 2).


Once data collection is complete and verified, data will be normalized to ensure comparability using the following procedure: individual hospital scores for a particular indicator will be divided by the average

sequently multiplied by five. This will create results that are normalized to fall within a range of zero to ten and have a mean of five, thus allowing for easier interpretation and comparison of results. For example a hospital that receives a score of 7.5 will be 2.5 points or 50% above the index average whereas a hospital that receives a score of 4 will be 1 point or

represents the normalized score of the observed value for indicator i for hospital j and AVGi the average

components of the index, simple averages will be calculated for all indicators; for example the average for all Volume related indicators in the Hospital Volumes and Wait Times component will be calculated and then weighted according to the corresponding weight of each sub-component.

index for each of the four components as outlined below that will

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Figure 1: Structure of the Latin American Hospital Benchmarking Tool

The scale for each indicator will range from zero, indicating no data or no action to 10, indicating optimal performance in regards to achieving the highest standard for that indicator. Reporting no data for an indicator will result in a score of zero to ethe missing information; penalizing hospitals for not reporting data will also ensure fairness in the final standings. The majority of the selected indicators represent continuous data (83%) such thatwill either be percentages or absolute values, while a small percentage of the indicators produce binary data (17%). Binary data will be rescaled to continuous variables using a scale from 0 The four main components that comprise theeach) to reflect the importance, value and interdependence of all components in contributing to hospital performance; the eight sub-components however, will not necessarily be of equal weight. The overcomposite index is therefore represented by the following equation:

Hospital Infrastructure

& Resources

Component

Hospital Volumes

& Wait Times

Component

A. Hospital

Staffing &

Training

B. Facilities &

Technology

Available

C. Volumes

Indicators

A1- A5

Indicators

B1- B8

Indicators

C1- C4

Hospital Infrastructure

& Resources

Index

Hospital Volumes

& Wait Times

Latin American Hospital Performance Composite Index





: Structure of the Latin American Hospital Benchmarking Tool

The scale for each indicator will range from zero, indicating no data or no action to 10, indicating optimal performance in regards to achieving the highest standard for that indicator. Reporting no data for an indicator will result in a score of zero to encourage hospitals to systematically collect and report the missing information; penalizing hospitals for not reporting data will also ensure fairness in the final standings. The majority of the selected indicators represent continuous data (83%) such thatwill either be percentages or absolute values, while a small percentage of the indicators produce binary data (17%). Binary data will be rescaled to continuous variables using a scale from 0 –

The four main components that comprise the composite index will be weighted equally (oneeach) to reflect the importance, value and interdependence of all components in contributing to hospital

components however, will not necessarily be of equal weight. The overcomposite index is therefore represented by the following equation:

Hospital Volumes

& Wait Times

Component

Hospital Clinical

Effectiveness & Best

Practices Component

G. Hospital

Policies

D. Wait Times E. Outcome

of Care

Measures

F. Process

of Care

Measures

Indicators

D1- D5

Indicators Indicators

F1- F10

Indicators

E1- E10

Hospital Volumes

& Wait Times

Index

Hospital Clinical

Effectiveness & Best

Practices Index



: Structure of the Latin American Hospital Benchmarking Tool

The scale for each indicator will range from zero, indicating no data or no action to 10, indicating optimal performance in regards to achieving the highest standard for that indicator. Reporting no data

ncourage hospitals to systematically collect and report the missing information; penalizing hospitals for not reporting data will also ensure fairness in the final standings. The majority of the selected indicators represent continuous data (83%) such that their values will either be percentages or absolute values, while a small percentage of the indicators produce binary

– 10.

composite index will be weighted equally (one-quarter each) to reflect the importance, value and interdependence of all components in contributing to hospital

components however, will not necessarily be of equal weight. The overall

Hospital Policies &

Patient Experience

Component

G. Hospital

Policies

H. Patient

Experience

Indicators

H1

Indicators

G1- G5

Hospital Policies &

Patient Experience

Index


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Equation (2): Composite Index = 1 * HIRI + 4 4 4 4

Hospitals will be separated into peer groups to make for fair comparisons. For example hospitals may be divided into categories of public or private institutions and then further subor teaching status. Once the ranking is carried out, data will be transformed into a visual representation, for easy interpretation of the overall performance index. Indicator specific comparisons and data on the number of hospitals that participated and the number of cases involved will also be m Various methodologies were consulted in developing this composite index including the OECD Handbook for Constructing Composite IndexesIndex.6

Quality Assurance

Background

Assuring the quality of the data submitted by hospitals is very important as the integrity of the results and the conclusions that can be drawn from them are based on this. It is therefore important to ensure that when the data is being collected, processed and warehouseagainst;

• Design or conformation errors (i.e. incompatible units)

• Collection errors ( i.e. incorrectly recorded values, untimely data collection practices)

• Staging errors (i.e. improper translation processes)

• Data integration (i.e. improper data alignment)

• Query errors (i.e. improper query formation)

A quality assurance strategy for healthcare data must assess, monitor, and ultimately prevent these five types of data errors. It has also been shown that the incluscan improve the quality of data collected to perform ranking and benchmarking.

5 Organisation for Economic Co-operation and Development. Handbook on Constructing Composite Indicators: Methodology and User Guide. 2008. 6 World Bank. Composite HIV/AIDS Response Index: Benchmarking Eastern Europe and Central Asia Country Performance in Response to HIV/AIDS7 Berndt DJ, Fisher JW, Hevner AR and Studnicki J. Healthcar





* HIRI + 1 * HVWI + 1 * HCEBPI + 1 * HPPEI 4 4 4 4

Hospitals will be separated into peer groups to make for fair comparisons. For example hospitals may be divided into categories of public or private institutions and then further sub-divided by number of beds

rried out, data will be transformed into a visual representation, for easy interpretation of the overall performance index. Indicator specific comparisons and data on the number of hospitals that participated and the number of cases involved will also be made available.

Various methodologies were consulted in developing this composite index including the OECD Handbook for Constructing Composite Indexes5and the World Bank Composite HIV/AIDS Response

lity of the data submitted by hospitals is very important as the integrity of the results and the conclusions that can be drawn from them are based on this. It is therefore important to ensure that when the data is being collected, processed and warehoused the following five errors are guarded

Design or conformation errors (i.e. incompatible units)

Collection errors ( i.e. incorrectly recorded values, untimely data collection practices)

Staging errors (i.e. improper translation processes)

integration (i.e. improper data alignment)

Query errors (i.e. improper query formation)

A quality assurance strategy for healthcare data must assess, monitor, and ultimately prevent these five types of data errors. It has also been shown that the inclusion of fact, aggregate and dimensions filters can improve the quality of data collected to perform ranking and benchmarking.7

operation and Development. Handbook on Constructing Composite Indicators: Methodology and User Guide. 2008.

World Bank. Composite HIV/AIDS Response Index: Benchmarking Eastern Europe and Central Asia Country Performance in Response to HIV/AIDS

Berndt DJ, Fisher JW, Hevner AR and Studnicki J. Healthcare data warehousing and quality assurance.


Hospitals will be separated into peer groups to make for fair comparisons. For example hospitals may be divided by number of beds

rried out, data will be transformed into a visual representation, for easy interpretation of the overall performance index. Indicator specific comparisons and data on the number

ade available.

Various methodologies were consulted in developing this composite index including the OECD and the World Bank Composite HIV/AIDS Response

lity of the data submitted by hospitals is very important as the integrity of the results and the conclusions that can be drawn from them are based on this. It is therefore important to ensure

d the following five errors are guarded

Collection errors ( i.e. incorrectly recorded values, untimely data collection practices)

A quality assurance strategy for healthcare data must assess, monitor, and ultimately prevent these five ion of fact, aggregate and dimensions filters

operation and Development. Handbook on Constructing Composite

World Bank. Composite HIV/AIDS Response Index: Benchmarking Eastern Europe and Central Asia

e data warehousing and quality assurance.

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There are several examples of quality assurance measures that are employed by other hospital benchmarking systems that attempt to program has a two step system in which hospitals submit their data online where it then goes through a preliminary validation after which the data is reported back to each hospital for verification. Only these processes are complete are data included into the PATH database for further analysis. The Centers for Medicare and Medicaid abstraction and reporting tool (CART) is used as a part of a quality assurance program for The Centers for Medicare and Mcollect data, conduct retrospective analyses and do real time reporting. The application is available at no charge to hospitals or other organizations that seek to improve the quality of care in tclinical areas:

• Acute Myocardial Infarction (AMI)• Heart Failure (HF) • Pneumonia (PN) • Surgical Care Improvement Project (SCIP)

The US Department of Health and Human Services has a Data Integrity Verification Strategy that may prove useful. The health care institution reporting the data is responsible for the submitted, while the US Department of Health anensuring data integrity:

• Source to Target Counts (10% of data)

• Source to Target Data Verification

• Column to Column Verification (for columns undergoing transformations)

• Transformation Verification

• Exception Processing

• Summary and Detailed Results Reporting of Integrity Data


To ensure the accuracy and quality of the data received, measures need to be embedded throughout various steps of the benchmarkindefinitions that will be provided are understood by the participating institutions; as such training will be provided in regards to the indicator set and the standardized data collection proemployed. Once data has been received from institutions and before it is processed, a random sampling of records (1 - 5 %) will be verified with original sources for all participating hospitals. An accuracy score will be assigned to each institution based on the following equation:

Computer. December 2001. 34(12); 56-65.





There are several examples of quality assurance measures that are employed by other hospital benchmarking systems that attempt to address some of these problem areas. The WHO’s PATH program has a two step system in which hospitals submit their data online where it then goes through a preliminary validation after which the data is reported back to each hospital for verification. Only these processes are complete are data included into the PATH database for further analysis. The Centers for Medicare and Medicaid abstraction and reporting tool (CART) is used as a part of a quality assurance program for The Centers for Medicare and Medicaid, as it is a comprehensive tool that enables them to collect data, conduct retrospective analyses and do real time reporting. The application is available at no charge to hospitals or other organizations that seek to improve the quality of care in t

Acute Myocardial Infarction (AMI)

Surgical Care Improvement Project (SCIP)

The US Department of Health and Human Services has a Data Integrity Verification Strategy that may prove useful. The health care institution reporting the data is responsible for the qualitysubmitted, while the US Department of Health and Human Services tests data at the following levels to

Source to Target Counts (10% of data)

Source to Target Data Verification

Column to Column Verification (for columns undergoing transformations)

Transformation Verification

Summary and Detailed Results Reporting of Integrity Data


To ensure the accuracy and quality of the data received, measures need to be embedded throughout various steps of the benchmarking process. First, it is important that the standard measures and definitions that will be provided are understood by the participating institutions; as such training will be provided in regards to the indicator set and the standardized data collection pro

Once data has been received from institutions and before it is processed, a random sampling of records 5 %) will be verified with original sources for all participating hospitals. An accuracy score will be

each institution based on the following equation:

65.


There are several examples of quality assurance measures that are employed by other hospital address some of these problem areas. The WHO’s PATH

program has a two step system in which hospitals submit their data online where it then goes through a preliminary validation after which the data is reported back to each hospital for verification. Only once these processes are complete are data included into the PATH database for further analysis. The Centers for Medicare and Medicaid abstraction and reporting tool (CART) is used as a part of a quality assurance

edicaid, as it is a comprehensive tool that enables them to collect data, conduct retrospective analyses and do real time reporting. The application is available at no charge to hospitals or other organizations that seek to improve the quality of care in the following

The US Department of Health and Human Services has a Data Integrity Verification Strategy that may quality of the data being

d Human Services tests data at the following levels to

To ensure the accuracy and quality of the data received, measures need to be embedded throughout g process. First, it is important that the standard measures and

definitions that will be provided are understood by the participating institutions; as such training will be provided in regards to the indicator set and the standardized data collection procedures that will be

Once data has been received from institutions and before it is processed, a random sampling of records 5 %) will be verified with original sources for all participating hospitals. An accuracy score will be

P a g e | 23


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Equation (3): Accuracy Score = Total # of variables verified Total # of variables verified

The minimally acceptable accuracy score is 80%; values below this cutoff will not be included in the database for processing. Upon passing the data quality assessment, data will be processed into the central database. Automated data edits will be built intdata will be identified. Furthermore, posttarget verification and transformation verification will be employed. The feasibility of conindependent audits of the participating institutions will be considered for future versions of the benchmarking tool.





Total # of variables verified - Number of inaccurate variables * 100 Total # of variables verified

The minimally acceptable accuracy score is 80%; values below this cutoff will not be included in the database for processing. Upon passing the data quality assessment, data will be processed into the central database. Automated data edits will be built into the processing system such that missing or out of range data will be identified. Furthermore, post-processing measures such as source to target counts, source to target verification and transformation verification will be employed. The feasibility of conindependent audits of the participating institutions will be considered for future versions of the


The minimally acceptable accuracy score is 80%; values below this cutoff will not be included in the database for processing. Upon passing the data quality assessment, data will be processed into the central

o the processing system such that missing or out of range processing measures such as source to target counts, source to

target verification and transformation verification will be employed. The feasibility of conducting independent audits of the participating institutions will be considered for future versions of the

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Implementation Strategy

The implementation of the Latin American hospital ranking and benchmarking tool is a dynamic and multi-phase process that will invariably undergo modifications as the project unfolds. The following strategy seeks to establish a preliminary framework in whibe carried out.

• Seek out funders for initial ranking project, potentially health insurers or drug companies, until the project becomes self-sustaining

• Assign project manager to be the contact person for hofurther information or want to become involved. This person will also serve as the liaison between funders and other stakeholders and provide support for implementation of performance measurement within hospitals

• Obtain technical advisor to design data collection templates and test benchmarking tool with simulated data. Web demonstrations and sample reports will be created to show potential participants

• Identify interested hospitals to participate in a pilot test to determine feasibility of collecting proposed indicators

• Review indicator set with pilot hospitals to ensure that they are able to collect/already collect data; adjustments to indicator set w

• Identify steps required to develop required information infrastructure, identify technology and cost implications involved in data collection

• Develop rules and standards for data collection and aggregation

• Establish protocol for data collection (how and by whom), define documentation procedure

• Establish time frame for data collection





Additional Considerations

The implementation of the Latin American hospital ranking and benchmarking tool is a dynamic and phase process that will invariably undergo modifications as the project unfolds. The following

strategy seeks to establish a preliminary framework in which the ranking and benchmarking project will

Seek out funders for initial ranking project, potentially health insurers or drug companies, until sustaining

Assign project manager to be the contact person for hospitals that show interest and want further information or want to become involved. This person will also serve as the liaison between funders and other stakeholders and provide support for implementation of performance measurement within hospitals

technical advisor to design data collection templates and test benchmarking tool with simulated data. Web demonstrations and sample reports will be created to show potential

Identify interested hospitals to participate in a pilot test to determine feasibility of collecting

Review indicator set with pilot hospitals to ensure that they are able to collect/already collect data; adjustments to indicator set will be made based on feedback from hospitals

Identify steps required to develop required information infrastructure, identify technology and cost implications involved in data collection

Develop rules and standards for data collection and aggregation

Establish protocol for data collection (how and by whom), define documentation procedure

Establish time frame for data collection


The implementation of the Latin American hospital ranking and benchmarking tool is a dynamic and phase process that will invariably undergo modifications as the project unfolds. The following

ch the ranking and benchmarking project will

Seek out funders for initial ranking project, potentially health insurers or drug companies, until

spitals that show interest and want further information or want to become involved. This person will also serve as the liaison between funders and other stakeholders and provide support for implementation of

technical advisor to design data collection templates and test benchmarking tool with simulated data. Web demonstrations and sample reports will be created to show potential

Identify interested hospitals to participate in a pilot test to determine feasibility of collecting

Review indicator set with pilot hospitals to ensure that they are able to collect/already collect ill be made based on feedback from hospitals

Identify steps required to develop required information infrastructure, identify technology and

Establish protocol for data collection (how and by whom), define documentation procedure

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Sanigest International

Sanigest International is a healthcare consulting and management firm based out of San Jose, with additional offices in the United States and Europe. For over a decade, Sanigest has worked extensively in the hospital sector providing high quality service and innovative solutions to its clients in the public and private sector as evidencrecent success stories include successfully defining a National Health Insurance basic package of services, a health purchasing plan and implementing a management information system in Belize. Slovakia, Sanigest created a hospital restructuring plan and defined provider payment mechanisms and a health insurance regulatory frame work. Sanigest’s experience spans the globe with extensive experience in the developing nations of Latin America sucand Nicaragua. Sanigest is optimally suited and equipped to design, implement and deliver a high impact hospital ranking and benchmarking tool for Latin America.





Sanigest International is a healthcare consulting and management firm based out of San Jose, with additional offices in the United States and Europe. For over a decade, Sanigest has worked extensively in the hospital sector providing high quality service and innovative solutions to its clients in the public and private sector as evidenced by its ISO 9001:2008 certification. Some of Sanigest’s most recent success stories include successfully defining a National Health Insurance basic package of services, a health purchasing plan and implementing a management information system in Belize. Slovakia, Sanigest created a hospital restructuring plan and defined provider payment mechanisms and a health insurance regulatory frame work. Sanigest’s experience spans the globe with extensive experience in the developing nations of Latin America such as Costa Rica, Belize, Colombia, Ecuador, El Salvador and Nicaragua. Sanigest is optimally suited and equipped to design, implement and deliver a high impact hospital ranking and benchmarking tool for Latin America.


Sanigest International is a healthcare consulting and management firm based out of San Jose, Costa Rica with additional offices in the United States and Europe. For over a decade, Sanigest has worked extensively in the hospital sector providing high quality service and innovative solutions to its clients in

ed by its ISO 9001:2008 certification. Some of Sanigest’s most recent success stories include successfully defining a National Health Insurance basic package of services, a health purchasing plan and implementing a management information system in Belize. In Slovakia, Sanigest created a hospital restructuring plan and defined provider payment mechanisms and a health insurance regulatory frame work. Sanigest’s experience spans the globe with extensive experience

h as Costa Rica, Belize, Colombia, Ecuador, El Salvador and Nicaragua. Sanigest is optimally suited and equipped to design, implement and deliver a high impact

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ANNEX 1: Indicators Used by Various

BENCHMARKING

SYSTEM

INDICATORS INCLUDED

Hospital Compare

Acute Myocardial Infarction

• Aspirin at arrival

• Aspirin at discharge

• ACE Inhibitor or Angiotensin Receptor Blocker for Left Ventricular Systolic Dysfunction

• Beta Blocker at discharge

• Fibrinolytic Medication within 30 min of arrival

• Percutaneous Coronary Intervention (PCI) received within 90 mins of hospital arrival

• Smoking cessation advice/counseling Heart Failure

• Evaluation of left ventricular systolic (LVS) function


• Discharge instructions

• Smoking cessation advice/counseling Pneumonia

• Oxygenation assessment

• Initial antibiotic timing (within 4hrs)

• Pneumococcal vaccination

• Influenza vaccination

• Blood culture performed in Emergency Dept prior to initial antibiotic received in hospital

• Appropriate initial antibiotic selection

• Smoking cessation advice/counseling Surgical Care Improvement Project

• Prophylactic antibiotic received within 1 hr prior to surgical incision

• Prophylactic antibiotic discontinued within 24 hrs after surgery end time

• Prophylactic antibiotic selection

• Surgery patients with recommended venous thromboembolism prophylaxis ordered

• Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hrs prior to surgery to 24 hrs after surgery

• Cardiac surgery patients with controlled 6 AM postoperativ

• Surgery patients with appropriate hair removal Children's Asthma Care

• Use of reliever medication for inpatient asthma

• Use of systemic corticosteroid medication for inpatient asthma 30 day risk-adjusted mortality rate

• Acute Myocardial

• Heart Failure

• Pneumonia Patient Satisfaction

• Patient survey of Hospital Experience

HealthInsight








Indicators Used by Various Hospital Benchmarking Systems

NCLUDED


Aspirin at arrival

Aspirin at discharge

ACE Inhibitor or Angiotensin Receptor Blocker for Left Ventricular Systolic Dysfunction

Beta Blocker at discharge

Fibrinolytic Medication within 30 min of arrival

Percutaneous Coronary Intervention (PCI) received within 90 mins of hospital arrival

cessation advice/counseling

Evaluation of left ventricular systolic (LVS) function


Discharge instructions

Smoking cessation advice/counseling

Oxygenation assessment

Initial antibiotic timing (within 4hrs)

Pneumococcal vaccination

Influenza vaccination

Blood culture performed in Emergency Dept prior to initial antibiotic received in hospital

Appropriate initial antibiotic selection

cessation advice/counseling

Surgical Care Improvement Project

Prophylactic antibiotic received within 1 hr prior to surgical incision

Prophylactic antibiotic discontinued within 24 hrs after surgery end time

Prophylactic antibiotic selection

ients with recommended venous thromboembolism prophylaxis ordered

Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hrs prior to surgery to 24 hrs after

Cardiac surgery patients with controlled 6 AM postoperative blood glucose

Surgery patients with appropriate hair removal

Children's Asthma Care

Use of reliever medication for inpatient asthma

Use of systemic corticosteroid medication for inpatient asthma

adjusted mortality rate


Patient survey of Hospital Experience


Aspirin at arrival



Hospital Benchmarking Systems





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BENCHMARKING

SYSTEM

INDICATORS INCLUDED


• Beta Blocker at arrival



• Percutaneous Coronary Intervention (PCI) received within 90 mins of





• Smoking cessation Pneumonia






• Appropriate initial antib





• Surgery patients with recommended venous thromboembolism prophylaxis ordered


• Cardiac surgery patients with controlled 6 AM postoperative blood glucose

• Surgery patients with appropriate hair removal

Leapfrog Group

Structural indicators

• Computerized physician order entry (CPOE) system

• ICU staffing

• High risk treatments (evidence based hospital referral)

• Safe practice scores

Michigan Manufacturing Technology Centre (MMTC)

Hospital Policies

• No lift policy (use lifts to raise patients to avoid staff and patient injury)

• Latex-free policy

• Needleless policy (administer







Heart Failure







NCLUDED


Beta Blocker at arrival




















Surgery patients with recommended venous thromboembolism prophylaxis ordered


ery patients with controlled 6 AM postoperative blood glucose

Surgery patients with appropriate hair removal

Computerized physician order entry (CPOE) system

High risk treatments (evidence based hospital referral)

practice scores

No lift policy (use lifts to raise patients to avoid staff and patient injury)

free policy

Needleless policy (administer medications without needles whenever possible)


Aspirin at arrival




Blocker at discharge










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BENCHMARKING

SYSTEM

INDICATORS INCLUDED

Pneumonia


• Initial antibiotic


• Hospital-wide Mortality Index

• % of cardiac patients with acute readmission within 31 days

• % of patients with unscheduled Inpatient returns to OR within same stay

• % of Inpatient admissions following unscheduled returns to Emergency Dept within 72 hrs

Business, Productivity, Asset Utilization and Throughput

• Operating (profit) margin

• Dollars of Expenses per Case Mix

• Bad Debt Expenses as a % of net Patient Service Revenue

• Value added per FTE Employee/Contractor

• Value added per Case Mix

• FTE Employees/Contractors per CMAED

• Net Patient Service Revenue per FTE Employee/Contractor

• Operating Room 'Cut & Sew' Time as % of booked time

• Cost per unit of production (adjusted)

• Avg length of stay (days), Case

• % of discharges made before noon

• Mean outpatient door

• Mean Emergency Dept Door

• Mean Troponin Lab test turnaround time (min)

• Mean radiology order


• Risk adjusted mortality

• Reputation

• Number of discharges

• Nurse staffing

• Nurse Magnet

• Advanced technologies

• Patient services









• Percutaneous Coronary Intervention (PCI) received within 90 mins of









NCLUDED



Pneumococcal vaccination Clinical outcomes

wide Mortality Index

% of cardiac patients with acute readmission within 31 days

patients with unscheduled Inpatient returns to OR within same stay

% of Inpatient admissions following unscheduled returns to Emergency Dept within 72 hrs

Business, Productivity, Asset Utilization and Throughput

Operating (profit) margin

Dollars of Expenses per Case Mix-Adjusted Equivalent Discharge (and wage-adjusted)

Bad Debt Expenses as a % of net Patient Service Revenue

Value added per FTE Employee/Contractor

Value added per Case Mix-Adjusted Equivalent Discharge (CMAED)

FTE Employees/Contractors per CMAED

Net Patient Service Revenue per FTE Employee/Contractor

Operating Room 'Cut & Sew' Time as % of booked time

Cost per unit of production (adjusted)

Avg length of stay (days), Case-Mix adjusted

discharges made before noon

Mean outpatient door-to-door time (min)

Mean Emergency Dept Door-to-Physician time (min)

Mean Troponin Lab test turnaround time (min)

Mean radiology order-to transcription time (hrs)

Clinical Outcomes and Services

Risk adjusted mortality

Number of discharges

Nurse Magnet hospital

Advanced technologies

Patient services


Aspirin at arrival













adjusted)



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BENCHMARKING

SYSTEM

INDICATORS INCLUDED

• Smoking cessation Pneumonia






• Appropriate initial antibiotic selection


• Prophylactic antibiotic received within 1 hr prior to surg



• Risk adjusted mortality

• Risk adjusted complications index

• Risk adjusted patient safety index

• Severity adjusted length of stay

•

• Operating(profit margin

• Expenses per Adjusted Discharge (case

• Cash to total debt ratio


• Patients’ rights law

• Patient organizations involved in decision making

• No fault malpractice

• Right to second opinion

• Access to own medical record

• Readily accessible register of legit doctors

• Electronic patient record (EPR) penetration in primary care

• Provider catalogue with quality ranking

• Web or 24/7 telephone healthcare info Waiting Times

• Family doctor same day service

• Direct access to specialist care

• Major non-

• Cancer, radiation/chemotherapy

• MRI scan examination Clinical Outcomes

• Heart infarct mortality <

• Infant deaths/ 1000 live births

• Cancer 5-yr survival rates





NCLUDED






culture performed in Emergency Dept prior to initial antibiotic received in hospital







Clinical Outcomes


Risk adjusted complications index

Risk adjusted patient safety index

Severity adjusted length of stay

Business

Operating(profit margin

Expenses per Adjusted Discharge (case-mix and wage-adjusted)

Cash to total debt ratio

Patients rights & Information

Patients’ rights law

Patient organizations involved in decision making

No fault malpractice insurance

Right to second opinion

Access to own medical record

Readily accessible register of legit doctors

Electronic patient record (EPR) penetration in primary care

Provider catalogue with quality ranking

Web or 24/7 telephone healthcare info

Family doctor same day service

Direct access to specialist care

-acute operations

Cancer, radiation/chemotherapy

MRI scan examination

Heart infarct mortality < 28 days after getting to hospital

Infant deaths/ 1000 live births

yr survival rates


culture performed in Emergency Dept prior to initial antibiotic received in hospital

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BENCHMARKING

SYSTEM

INDICATORS INCLUDED

• Avoidable deaths

• MRSA Generosity of Public Healthcare Systems

• Cataract operation rates per 100,000 citizens (age

• Infant 4-disease vaccination

• Kidney transplants per million population

• Is dental care a part of the offering from public healthcare system Pharmaceuticals

• Prescription subsidy %

• Layman-adapted pharmacopoeia

• Speed of deployment of novel cancer drugs

• Access to new drugs

National Health Services Choices Hospital Scorecard

Clinical Effectiveness and Safety

• Readmission

• Length of Stay

• Survival rate (elective and emergency surgeries)

• Rate of MRSA

• Time from referral to treatment

• # times surgical department performs operation/yr

• Standardized admission ratio (SAR)

• Patient rating of overall care

• Cleanliness of hospital


Clinical effectiveness and safety

• Risk adjusted mortality (or mortality index)

• Rate of emergency readmission to hospital

• Rate of emergency readmission to hospital following treatment for fractured hip

• Rate of emergency readmission to hospital following AMI (within 28 dys)

• Rate of emergency readmissions to hospital within 14 days for COPD

• Rate of MRSA

• Rate of C. difficile

• Risk adjusted length of stay

• Day Case rate for target procedures (case mix adjusted)

• Day Case conversion rate (case mix adjusted)

• % of elective inpatients admitted on

• Pre-op length of stay for fractured neck of femur

• Pre-op length of stay for elective surgery

• % elective in

• Missed out

• Overall data quality

• Procedures not carried o

• Waiting times for common diagnostic procedures





NCLUDED

Avoidable deaths – potential years of life lost (PYLL)/ 100,000

Generosity of Public Healthcare Systems

Cataract operation rates per 100,000 citizens (age adjusted)

disease vaccination

Kidney transplants per million population

Is dental care a part of the offering from public healthcare system

escription subsidy %

adapted pharmacopoeia

Speed of deployment of novel cancer drugs

Access to new drugs


Length of Stay

Survival rate (elective and emergency surgeries)

Rate of MRSA

Time from referral to treatment

# times surgical department performs operation/yr

Standardized admission ratio (SAR)

Patient rating of overall care

Cleanliness of hospital

Clinical effectiveness and safety

Risk adjusted mortality (or mortality index)

Rate of emergency readmission to hospital - 28 days

Rate of emergency readmission to hospital following treatment for fractured hip

emergency readmission to hospital following AMI (within 28

Rate of emergency readmissions to hospital within 14 days for COPD

Rate of MRSA

C. difficile for patients ≥ 65 yrs

Throughput

Risk adjusted length of stay

Day Case rate for target procedures (case mix adjusted)

Day Case conversion rate (case mix adjusted)

% of elective inpatients admitted on day of surgery

op length of stay for fractured neck of femur

op length of stay for elective surgery

% elective in-patient admission with no procedure

Missed out-patient appointments (1st attendance)

Overall data quality

Procedures not carried out (hospital decision)

Waiting times for common diagnostic procedures Clinical Effectiveness and Safety


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BENCHMARKING

SYSTEM

INDICATORS INCLUDED

IASIST Top 20 Hospitals • Risk adjusted mortality

• Risk adjusted complications index

• Risk adjusted length of stay

• Readmissions index (risk

• Surgery index (without adjust

• Cost per unit of production

World Health Organization - Performance Assessment Tool for Quality Improvement in Hospitals (PATH )

• Caesarean Section

• Prophylactic Antibiotic Use (surgery)

• Mortality (Acute myocardial infarction, stroke, community acquired pneumonia, hip fracture, coronary artery b

• Readmission

• Day surgery for 8 tracers

• Admission after day surgery (same

• Return to ICU

Efficiency

• Length of stay

• Surgical theatre use Staff Orientation & Safety

• Training expenditure

• Absenteeism

• Working excessive hours

• Needle injuries

• Staff smoking prevalence

Responsive Governance

• Breastfeeding at discharge

• Health care transitions

• Patient Centeredness

• Patient expectations

International Quality Indicator Program (IQIP)



• Prophylactic antibiotic






NCLUDED




Readmissions index (risk-adjusted)

Surgery index (without adjusted incomes) Cost per unit of production


Caesarean Section

Prophylactic Antibiotic Use (surgery)

Mortality (Acute myocardial infarction, stroke, community acquired pneumonia, hip fracture, coronary artery bypass graft)

Day surgery for 8 tracers

Admission after day surgery (same 8 tracers)

Return to ICU

Length of stay

Surgical theatre use Staff Orientation & Safety

Training expenditure

Absenteeism

Working excessive hours

Needle injuries

Staff smoking prevalence


Breastfeeding at discharge

Health care transitions

Patient Centeredness

Patient expectations






Mortality (Acute myocardial infarction, stroke, community acquired pneumonia, hip fracture, ypass graft)


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BENCHMARKING

SYSTEM

INDICATORS INCLUDED

Use of Devices in ICU

• Central line use

• Ventilator use

• Indwelling urinary

Management of Labour

• Primary C-

• Repeat C-sections

• Total C-sections

• Vaginal births after C Process of Care Measures

• Active surveillance cultures for MRSA Clinical Effectiveness and Safety

• Device-associated

• Device-associated infections in ICU due to MRSA

• Surgical site infections

• Inpatient mortality

• Neonatal mortality

• Perioperative mortality

• Total unscheduled readmissions within 15 and 31 days

• Unscheduled admissions following ambulatory

• Unscheduled returns to ICU

• Unscheduled returns to OR

• Unscheduled returns to ER

• Physical restraint events

• Documented falls

• Documented falls in ambulatory care

• Complications following sedation and analgesia in ICU

• Complications following sedation

• Complications following sedation and analgesia in Cardiac Catherization lab

• Complications following sedation and analgesia in Radiology Suites

• Pressure ulcers in acute inpatient care

• Deep vein thrombosis and pulmonary throm

• Multi-drug resistant organisms





NCLUDED


Central line use

Ventilator use

Indwelling urinary catheter use


-sections

sections

sections

Vaginal births after C-sections

Process of Care Measures

Active surveillance cultures for MRSA


associated infections in ICU

associated infections in ICU due to MRSA

Surgical site infections

Inpatient mortality

Neonatal mortality

Perioperative mortality

Total unscheduled readmissions within 15 and 31 days

Unscheduled admissions following ambulatory procedures

Unscheduled returns to ICU

Unscheduled returns to OR

Unscheduled returns to ER

Physical restraint events

Documented falls

Documented falls in ambulatory care

Complications following sedation and analgesia in ICU

Complications following sedation and analgesia in Emergency Dept

Complications following sedation and analgesia in Cardiac Catherization lab

Complications following sedation and analgesia in Radiology Suites

Pressure ulcers in acute inpatient care

Deep vein thrombosis and pulmonary thromboembolism following surgery

drug resistant organisms


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HOSPITAL PERFORMANCE DIMENSION

APPENDIX IV: MATRIX OF INDICATORS FROM REVIEWD HOSPITAL BENHCMAKRING SYSTEMS BENCHMARKING SYSTEMS

Clinical Effectiveness & Safety

WHO PATH


Leapfrog Group

Hospital Compare

Caesarean Section � Prophylactic Antibiotic Use (surgery) � Mortality (Acute myocardial infarction, stroke, community acquired pneumonia, hip fracture, coronary artery bypass graft) �

Readmission � Day surgery for 8 tracers � Admission after day surgery (same 8 tracers) �

Return to ICU �

Efficiency

Length of stay �

Surgical theatre use �

Staff Orientation & Safety

Training expenditure �

Absenteeism � Working excessive hours �



((550066)) 22229911--11220000 || UUnniitteedd SSttaatteess TTeell:: ++11 ((330055)) 660000--44441166

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APPENDIX IV: MATRIX OF INDICATORS FROM REVIEWD HOSPITAL BENHCMAKRING SYSTEMS

MMTC Community Hospital Benchmarking Survey

International Quality Indicator Project HealthInsight

National Health Service ScoreCard (UK)

CHKS 40 Top Hospitals (UK)


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APPENDIX IV: MATRIX OF INDICATORS FROM REVIEWD HOSPITAL BENHCMAKRING SYSTEMS

News

World Report

Thomson & Reuters Top 100

IASIST Top 20 Hospitals (Spain)

Total Counts for Indicator

% of systems with indicator

1 8.3

1 8.3

1 8.3

2 16.7

1 8.3

1 8.3

1 8.3

2 16.7

1 8.3

1 8.3

1 8.3

1 8.3

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HOSPITAL PERFORMANCE DIMENSION BENCHMARKING SYSTEMS

WHO PATH


Leapfrog Group

Hospital Compare

Needle injuries �

Staff smoking prevalence �

No lift policy (use lifts to raise patients to avoid staff and patient injury)

Latex-free policy

Needleless policy (administer medications without needles whenever possible)


Breastfeeding at discharge �

Health care transitions �

Patient Centeredness

Patient expectations �

Patient rights & information










�

�

�


News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

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WHO PATH


Leapfrog Group

Hospital Compare

Direct access to specialist care �

Major non-acute operations �

Cancer, radiation/chemotherapy �

MRI scan examination �

Outcomes

Heart infarct mortality < 28 days after getting to hospital

�

Infant deaths/ 1000 live births

�

Cancer 5-yr survival rates

�

Avoidable deaths - potential years of life lost (PYLL)/ 100,000

�

MRSA

�

Generosity of public healthcare systems

Cataract operation rates per 100,000 citizens (age adjusted) �





Hospital Compare


International Quality Indicator Project

HealthInsight





News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 36


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WHO PATH


Leapfrog Group

Hospital Compare

Cataract operation rates per 100,000 citizens (age adjusted) �

Infant 4-disease vaccination �

Kidney transplants per million population �

Is dental care a part of the offering from public healthcare system �

Pharmaceuticals

Prescription subsidy % �

Layman-adapted pharmacopoeia �

Speed of deployment of novel cancer drugs �

Access to new drugs �

Structural Indicators

Computerized physician order entry (CPOE) system �

ICU staffing �

High risk treatments (evidence based hospital referral) �











News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

2 16.7

1 8.3

1 8.3

1 8.3

1 8.3

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WHO PATH


Leapfrog Group

Hospital Compare

Safe practice scores �

Process of Care Measures


Aspirin at arrival �

Aspirin at discharge �

ACE Inhibitor or Angiotensin Receptor Blocker for Left Ventricular Systolic Dysfunction �

Beta Blocker at discharge �

Fibrinolytic Medication within 30 min of arrival �

Percutaneous Coronary Intervention (PCI) received within 90 mins of hospital arrival �

Smoking cessation advice/counseling �











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� �

� �

� �

�

�

�

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News

World Report





1 8.3

� 4 33.3

� 4 33.3

� 4 33.3

� 4 33.3

� 3 25.0

� 3 25.0

� 3 25.0

� 3 25.0

P a g e | 38


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Heart Failure

Evaluation of left ventricular systolic (LVS) function �

ACE Inhibitor or Angiotensin Receptor Blocker for Left Ventricular Systolic Dysfunction �

Discharge instructions �


Pneumonia

Oxygenation assessment �

Initial antibiotic timing (within 4hrs) �

Pneumococcal vaccination �

Influenza vaccination �

Blood culture performed in Emergency Dept prior to initial antibiotic received in hospital �










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News

World Report





� 4 33.3

� 4 33.3

� 3 25.0

� 3 25.0

� 4 33.3

� 4 33.3

� 4 33.3

� 3 25.0

� 3 25.0

P a g e | 39


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Appropriate initial antibiotic selection �



Prophylactic antibiotic received within 1 hr prior to surgical incision �

Prophylactic antibiotic discontinued within 24 hrs after surgery end time �

Prophylactic antibiotic selection �

Surgery patients with recommended venous thromboembolism prophylaxis ordered �

Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hrs prior to surgery to 24 hrs after surgery �

Cardiac surgery patients with controlled 6 AM postoperative blood glucose �

Surgery patients with appropriate hair removal �





Hospital Compare






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� �

� �

�

�

� �

�

�


News

World Report





� 3 25.0

� 3 25.0

� 4 33.3

� 4 33.3

� 3 25.0

2 16.7

3 25.0

2 16.7

2 16.7

P a g e | 40


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Children's Asthma Care

Use of reliever medication for inpatient asthma �

Use of systemic corticosteroid medication for inpatient asthma �


Central line use

Ventilator use

Indwelling urinary catheter use


Primary C-sections

Repeat C-sections

Total C-sections

Vaginal births after C-sections





Hospital Compare






�

�

�

�

�

�

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News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 41


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Other Process of Care Measures

Active surveillance cultures for MRSA

Outcome of Care Measures

30 day risk-adjusted mortality rate

Acute Myocardial Infarction �

Heart Failure �

Pneumonia �

Patient survey of hospital experience (i.e. Consumer Assessment of Healthcare Providers & Systems (CHAPS)) �

Other clinical outcomes

Hospital-wide Mortality Index

% of cardiac patients with acute readmission within 31 days










�

�

�


News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 42


iinn


WHO PATH


Leapfrog Group

Hospital Compare

% of patients with unscheduled Inpatient returns to OR within same stay


Device-associated infections in ICU

Device-associated infections in ICU due to MRSA

Surgical site infections

Inpatient mortality

Neonatal mortality

Perioperative mortality

Total unscheduled readmissions within 15 and 31 days

Unscheduled admissions following ambulatory procedures

Unscheduled returns to ICU










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News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 43


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Unscheduled returns to OR

Unscheduled returns to ER

Physical restraint events

Documented falls

Documented falls in ambulatory care

Complications following sedation and analgesia in ICU

Complications following sedation and analgesia in Emergency Dept

Complications following sedation and analgesia in Cardiac Catherization lab

Complications following sedation and analgesia in Radiology Suites

Pressure ulcers in acute inpatient care

Deep vein thrombosis and pulmonary thromboembolism following surgery

Multi-drug resistant organisms





Hospital Compare






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�

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News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 44


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Risk adjusted mortality (or mortality index)

Rate of emergency readmission to hospital - 28 days

Rate of emergency readmission to hospital following treatment for fractured hip

Rate of emergency readmission to hospital following AMI (within 28 dys)

Rate of emergency readmissions to hospital within 14 days for COPD

Survival rate (elective surgery)

Survival rate (emergency surgery)

Rate of MRSA

Reported rate of C-difficile for patients ≥ 65 yrs


Risk adjusted patient safety index

Readmissions index (risk adjusted)





Hospital Compare






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News

World Report





� � 4 33.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

2 16.7

1 8.3

� � 2 16.7

� 1 8.3

� 1 8.3

P a g e | 45


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Surgery index (without adjusted incomes)

Business

Operating (profit) margin

Dollars of Expenses per Case Mix-Adjusted Equivalent Discharge (and wage-adjusted)

Bad Debt Expenses as a % of net Patient Service Revenue

Cash to total debt ratio

Productivity

Value added per FTE Employee/Contractor

Value added per Case Mix-Adjusted Equivalent Discharge (CMAED)

FTE Employees/Contractors per CMAED

Net Patient Service Revenue per FTE Employee/Contractor

Operating Room 'Cut & Sew' Time as % of booked time





Hospital Compare






�

�

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�

�

�

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�


News

World Report





� 1 8.3

� 2 16.7

� 2 16.7

1 8.3

� 1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 46


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Occupancy rate, staffed beds

Avg days of receivables

Avg days of on-hand inventory

Throughput

Avg length of stay (days), Case-Mix adjusted

% of discharges made before noon

Mean outpatient door-to-door time (min)

Mean Emergency Dept Door-to-Physician time (min)

Mean Troponin Lab test turnaround time (min)

Mean radiology order-to transcription time (hrs)

Length of stay in Emergency department (hrs)

Cancellation of scheduled ambulatory procedures

Patients leaving Emergency room prior to completion of treatment





Hospital Compare






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News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

P a g e | 47


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Patients leaving Emergency room prior to completion of treatment

Time from referral to treatment


Day Case rate for target procedures (case mix adjusted)

Day Case conversion rate (case mix adjusted)

% of elective inpatients admitted on day of surgery

Pre-op length of stay for fractured neck of femur

Pre-op length of stay for elective surgery

% elective in-patient admission with no procedure

Missed out-patient appointments (1st attendance)

Severity adjusted average length of stay

# times surgical department performs operation/yr





Hospital Compare






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News

World Report





1 8.3

1 8.3

� 2 16.7

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

� 1 8.3

1 8.3

P a g e | 48


iinn


WHO PATH


Leapfrog Group

Hospital Compare

Standardized admission ratio (SAR)

Patient rating of overall care

Cleanliness of hospital

Overall data quality

Procedures not carried out - hospital decision

Waiting times for common diagnostic procedures

Reputation

Number of discharges

Nurse staffing

Nurse Magnet hospital

Advanced technologies

Patient services










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News

World Report





1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

1 8.3

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