Leapfrog Hospital Quality Survey

Q. Where can I get information about the quality of care provided by hospitals in Wyoming?

A. In 2012 11 Wyoming hospitals and two in Montana  responded to the Leapfrog Hospital Quality Survey. You can see their results at www.leapfroggroup.org.

The hospitals that responded are:

  • Banner Health Community Hospital - Torrington
  • Billings Clinic - Billings, MT
  • Campbell County Memorial Hospital - Gillette
  • Memorial Hospital of Carbon County - Rawlins
  • Memorial Hospital of Converse County - Douglas
  • Mountain View Regional Hospital - Casper
  • Platte County Memorial Hospital - Wheatland
  • Sheridan Memorial Hospital - Sheridan
  • Sidney Health Center - Sidney, MT
  • Star Valley Medical Center - Afton
  • Washakie Medical Center - Worland
  • West Park Hospital - Cody
  • Wyoming Medical Center – Casper

Q. Why do we care about healthcare quality/patient safety?

A. We care about higher quality healthcare because we care about the health and welfare of our employees and their family members. We provide health benefits because we know a healthy workforce is the key to our ability to be high-performing businesses.  We also know that higher quality care means better outcomes, fewer complications, reduced readmissions and fewer costly fixes to minor and major medical errors, all of which can impact overall medical costs, productivity and employee well-being. We also know higher quality care usually means better-coordinated care, making the system easier to understand and navigate at a time when our employees could use the extra support. But above all, getting quality healthcare is the difference between life and death, between families sharing their lives together and families being devastated by tragedy, between full lives appreciating our world, and lives of pain and crippling limitations.

 

Q. Why do we want Wyoming hospitals to respond to the Leapfrog Survey?

A. A 1999 report by the Institute of Medicine entitled To Err Is Human, identified glaring gaps in the safety and quality of the care that patients receive in the nation's hospitals. The report found that up to 98,000 Americans die every year from preventable medical errors made in hospitals alone.

Although the IOM report raised awareness of this issue, the unfortunate news is that today patients are actually less safe in hospitals than they were before. The 2008 National Healthcare Quality Report found that patient safety measures have worsened by nearly 1 percent each year for the past 6 years. What's more, central line associated bloodstream infections (i.e. infections that are directly related to the catheter tube that is inserted through a vein of a patient) continue to strike hundreds of thousands of patients each year.[1] The fact is, there are more deaths in hospitals each year from preventable medical mistakes than there are from vehicle accidents, breast cancer, and AIDS.  Medical related harm as a cause of death in the U.S. has gone up from the eighth leading cause in 1999 to the third leading cause currently, according to a more recent report by the National Quality Forum (NQF).  Studies released in April 2011 put the number of medically caused injuries inside and outside hospitals at 1.6 million, responsible for 187,000 hospital deaths.[2]

The National Center for Policy Analysis estimates the cost of medical errors to be between $339 billion and $958 billion, or 18% - 45% of the total dollars spent on healthcare.[3]

As employers we need data on hospital quality to help ourselves, our employees and their family members be informed healthcare purchasers.  Many times our employees believe they can get better care if they travel out of state. We are not convinced that is the case – but in the absence of data we cannot make a case one way or the other.

We believe healthcare quality and safety are issues that will require employers, employees, family members and providers to engage in a conversation significantly different from those we have had to this point.  We would like that conversation to be based on reliable data and we believe the Leapfrog Hospital Survey is the best tool to collect and analyze the necessary information.

 

Q. Why did we pick the Leapfrog Survey?

A. The Leapfrog Hospital Survey is the gold standard for comparing hospitals’ performance on the national standards of safety, quality, and efficiency that are most relevant to consumers and purchasers of care. Consumer Reports uses Leapfrog data in its publication and hospitals that participate in The Leapfrog Hospital Survey achieve hospital-wide improvements that translate into millions of lives and dollars saved.

The Leapfrog Group was founded in November 2000 by the Business Roundtable and is supported by its members, the Robert Wood Johnson Foundation, The Commonwealth Fund, the Agency for Healthcare Research and Quality and other sources. These resources have allowed Leapfrog to assemble a team of leading experts to develop and refine their survey instrument. While better known among large urban hospitals, the instrument has evolved over the last thee years to be more applicable to hospitals in Wyoming. It has served as a trailblazer for other hospital quality reports and has withstood the test of time.

Compared to other public reports, the Leapfrog results are more meaningful to us because:

  • We get the most current published data (one month from submission to publication).  Other sources have data that are 18 – 24 months old.
  • We see results based on all-payer data, which provides a more accurate picture of the local population. The information is not limited to the Medicare database, which primarily covers the population over age 65.
  • We know who is meeting evidence-based standards.
  • We get data on each individual hospital, not by system or by state, allowing for more detailed analysis.
  • We can provide information back to the hospitals via Leapfrogs tools to let them know how they compare to others in the state, region and nation (see the sample report).
  • We know where to begin our quality improvement conversations with local hospitals.
  • We can, over time, see which hospitals are improving, in which areas, and which are not.
  • We can, over time, see which hospitals are maintaining a high standard of excellence.
  • We can distinguish differences in the results – in other reports 85% - 90% of the hospitals fall into a narrow band of performance, making it hard for us to get meaningful information from the data.

 

Q. What does the Leapfrog Survey ask about?

A. The Survey covers four “leaps” in hospital quality and safety. Endorsed by the National Quality Forum (NQF), the practices are: computer physician order entry; evidence-based hospital referral; intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score.

  • Computer Physician Order Entry (CPOE): With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%.
  • Evidence-Based Hospital Referral (EHR): Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria — such as the number of times a hospital performs these procedures each year or other process or outcomes data — research indicates that a patient’s risk of dying could be reduced by 40%.
  • ICU Physician Staffing (IPS): Staffing ICUs with doctors who have special training in critical care medicine, called ‘intensivists’, has been shown to reduce the risk of patients dying in the ICU by 40%.
  • Leapfrog Safe Practices Score: The National Quality Forum-endorsed Safe Practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems or environments of care. Included in the 34 practices are the three leaps above. This fourth leap assesses a hospitals’ progress on a subset the remaining 31 NQF safe practices.

 

These leaps adhere to four primary criteria:

  1. There is overwhelming scientific evidence that these quality and safety leaps will significantly reduce preventable medical mistakes.
  2. Their implementation by the health industry is feasible in the near term.
  3. Consumers can readily appreciate their value.
  4. Purchasers or consumers can easily ascertain their presence or absence in selecting among health care providers.

 

Q. Why should Wyoming hospitals participate?

A. Participation in the survey provides hospitals with many benefits. The Quality Manager at Platte County Memorial Hospital in Wheatland is an enthusiastic supporter of the survey. That facility uses it as a tool in its quality improvement program as do over 2,500 hospitals across the country. It is a checklist of the most current information on quality measurement and improvement. Hospitals could spend significant sums to get this information from consulting companies, but the Leapfrog Survey tool keeps them current at no cost.

Others say it has helped forge a more cooperative working environment among the staff and hospital leadership.

Several hospital administrators report that the data and subsequent dialogue with community members has raised the level of trust and created a more constructive conversation with local employers.

A recent RAND study found that reductions in hospital adverse events translated into lower malpractice premiums for local physicians – a hot topic here in Wyoming as we work to recruit doctors to the state.[4]

Hospitals often pay consulting companies hefty fees ($100K or more) for comparative data, but Leapfrog provides it to those who report at no or low cost.

Finally, while participation in the survey is voluntary, we believe it demonstrates a commitment to being transparent to the community and to quality improvement. 

 

Q. How can employers help?

A. Send a letter - or even better - talk, face-to-face, with your local hospital administrator and board members about the survey. Ask them to participate in the Leapfrog Hospital Quality Survey. Explain why it is important that you, your employees and their family members have access to this healthcare quality information. Remember, you are their customer and you have a right to know whether you are spending your healthcare dollars wisely.

 


[1] Agency for Healthcare Quality and Research, National Healthcare Quality Report, 2008.

[2] Van Den Vos et al, The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors, Health Affairs, April 2011

[3] Goodman, John C., The Social Cost of Adverse Medical Events, and What We Can Do About It, Health Affairs, April 2011

[4] Greenberg, Does Improved Patient Safety Reduce Malpractice Litigation?  RAND Institute for Civil Justice, April 14, 2010