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Quality Health Indicators
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• About QHi• The PiHQ Portal• Defining your facility• Selecting Measures• Entering Data• Dashboards• Reports• How we use the data
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Quality Health Indicators
The Quality Health Indicator (QHi) web site was developed through the Kansas Hospital Association (KHA) and the Kansas Rural Health Options Project (KRHOP) to facilitate a benchmarking project for rural Kansas hospitals.
The goal of QHi is to provide hospitals an economical instrument to evaluate internal processes of care and to seek ways to improve practices by comparing specific measures of quality with like hospitals.
Using QHi as a tool, regional networks of hospitals and individual facilities can select from a library of indicators to determine which measures meet their unique needs.
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Quality Health Indicators
More than 1000 users in over 295 Critical Access and other small rural hospitals in Arizona, California, Colorado, Illinois, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Mexico, Oklahoma, Oregon and Wyoming use QHi as a data collection and benchmarking tool.
As a user-driven multi-state project, QHi is well-positioned to serve as a significant repository of information on quality of care and performance in rural hospitals nationwide.
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Four Pillars Of Measurement
Quality Health Indicators
Clinical
Quality
Employee
Contribution
Patient
Satisfaction
Financial
Operational
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QHi Core Measures Set
Clinical Quality• Healthcare Associated Infections per 100 inpatient days• Unassisted Patient Falls per 100 inpatient days• Pneumococcal Immunization – Age 65 and Older (CMS IMM-1b)• Discharge Instructions (CMS HF-1)
Employee Contribution• Benefits as a Percentage of Salary• Staff Turnover
All participating hospitals are asked to collect and report the 8 QHi Core Measures:
Financial Operational• Days Cash on Hand • Gross Days in AR
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Clinical Quality Measures Inpatients Screened for Pneumonia Vaccine Status (not a CMS measure) Medication Omissions Resulting in Medication Errors per 100 inpatient days Medication Errors Resulting from Transcription Errors per 100 inpatient days Percentage of ER Provider Response Times Percentage of Return ER Visits within 72 hours with same/similar diagnosis Percentage of Readmissions Within 30 Days with Same or Similar Diagnosis Healthcare Associated Infections per 100 inpatient days* Unassisted Patient Falls per 100 inpatient days* Long Term Care Patient Falls per 100 Long Term Care patient days
CMS Pneumonia Measures: Inpatients Receiving O2 Assessment within 24 hours of admission - CMS PN-1 (retired) Inpatients Receiving Pneumococcal Vaccination - CMS PN-2 (retired) Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital - CMS PN-3b Adult Smoking Cessation Advice/Counseling - CMS PN-4 (retired) Pneumonia Patients Receiving Initial Antibiotic Within 6 Hours of Hospital Arrival - CMS PN-5c (retired) Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients - CMS-PN6 Influenza Vaccination - CMS PN-7 (retired)
*Part of the 8 Core Measure Set
Additionally, facilities can select from over 100 measures
in the QHi library of indicators:
Clinical Quality Measures (continued)
CMS OP Transfer Measures: Median Time to Fibrinolysis in the Emergency Department - CMS OP-1 Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival in the Emergency Department - CMS OP-2 Median Time to Transfer to Another Facility for Acute Coronary Intervention in the Emergency Department - CMS
OP-3 Aspirin at Arrival in the Emergency Department - CMS OP-4 Median Time to ECG in the Emergency Department - CMS OP-5 Timing of Antibiotic Prophylaxis in Hospital Outpatient Surgery - CMS OP-6 Prophylactic Antibiotic Selection for Surgical Patients in Hospital Outpatient Surgery - CMS OP-7
CMS Immunization Measures: Pneumococcal Immunization – Overall Rate - CMS IMM-1a Pneumococcal Immunization – Age 65 and Older* - CMS IMM-1b Pneumococcal Immunization – High Risk Populations (Age 5 through 64 years) - CMS IMM-1c Influenza Immunization - CMS IMM-2
*Part of the 8 Core Measure Set8
Clinical Quality Measures (continued) CMS HF Measures: Discharge Instructions* – CMS HF-1 Evaluation of LVS Function – CMS HF-2 ACEI or ARB for LVSD – CMS HF-3 Adult Smoking Cessation Advice/Counseling – CMS HF-4 (retired)
CMS SCIP Measures: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision – Overall Rate CMS SCIP-Inf-1a Prophylactic Antibiotic Selection for Surgical Patients – Overall Rate CMS SCIP-Inf-2a Prophylactic Antibiotics Discontinued Within 24 Hours after Surgery End Time – Overall Rate CMS SCIP-Inf-3a Surgery Patients with Appropriate Hair Removal – CMS SCIP-Inf-6 Urinary Catheter Removed on Postop Day 1 or Postop Day 2 with Day of Surgery being Day 0 – CMS SCIP-Inf-9 Surgery Patients with Perioperative Temperature Management – CMS SCIP-Inf-10 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative
Period – CMS SCIP-Card-2 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered – CMS SCIP-VTE-1 (retired) Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery
to 24 Hours After Surgery – CMS SCIP-VTE-2
*Part of the 8 Core Measure Set 9
Clinical Quality Measures (continued)
MBQIP Phase 3 Measures: Pharmacist CPOE/Verification of Medication Orders Within 24 Hours Outpatient Emergency Department Transfer Communication (Pre-Transfer Communication Information) Outpatient Emergency Department Transfer Communication (Patient Identification) Outpatient Emergency Department Transfer Communication (Vital Signs) Outpatient Emergency Department Transfer Communication (Medication-related Information) Outpatient Emergency Department Transfer Communication (Practitioner generated information) Outpatient Emergency Department Transfer Communication (Nurse generated information) Outpatient Emergency Department Transfer Communication (Procedures and Tests)
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Employee Contribution Measures Non-Nursing Staff Turnover Average Time to Hire (All Staff) Nursing Staff Turnover Average Time to Hire (Nursing) Average Time to Hire (Non-Nursing) Salary to Operating Expenses Comparison Benefits as a Percentage of Salary* Staff Turnover*
Patient Satisfaction Measures
How well staff worked together to care for the patient (QHi1) The extent to which the patient felt ready for discharge (QHi2)
In addition to these two original QHi patient satisfaction measures, 25 HCAHPS measures are now in the library of indicators.
*Part of the 8 Core Measure Set
Hospital Characteristics Measures Average Inpatient Days
ALOS (in hours) Comparison
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Financial:
Days Cash on Hand*
Gross Days in AR*
Net Days in Accounts Receivable
Bad Debt as a % of Gross Patient Revenue
Charity Care as a % of Gross Patient
Revenue
Bad Debt and Charity Care as a % of Gross
Patient Revenue
Cost per Adjusted Patient Day
Labor Hours per Adjusted Patient Day
Labor Cost per Adjusted Patient Day
Labor Cost as a % of Net Patient Revenue
Net Patient Revenue as a % of Gross
Patient Revenue
Financial & Operational Measures
Bad Debt Expense
Charity Care
Cost per Patient Day
Labor Hours per Patient Day
Operating Profit Margin
Total Margin
Total Margin %
Debt Service Coverage Ratio
Current Ratio
Net Patient Revenue per Adjusted Patient Day
Net Patient Revenue per Patient Days
*Part of the 8 Core Measure Set
Financial & Operational Measures (continued)
Operational:
Physical Therapy Paid Labor Hours per UOS
Laboratory Paid Labor Hours per UOS
X-ray Paid Labor Hours per UOS
Mammogram Paid Labor Hours per UOS
Ultrasound Paid Labor Hours per UOS
CT Paid Labor Hours per UOS
MRI Paid Labor Hours per UOS
Pharmacy Paid Labor Hours per UOS
Nursing Hours per Acute Inpatient Day
Nursing Hours per Patient Day
Rural Health Clinic Encounters per FTE
Long Term Care Hours per LTC Patient Day
Laboratory Hours per Billed Service
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Financial (continued):
Payer Mix – Commercial
Payer Mix – Medicaid
Payer Mix – Medicare
Payer Mix – Other
Payer Mix – Other Government
Payer Mix – Self/Private Pay
Acute Occupancy per Day
Swing Bed Occupancy per Day
F Financial & Operational Measures (continued)
Operational (continued):
Lab – Blood Utilization Rate
Lab – Single Unit Transfusions
Lab – Blood Culture Contamination Rate
Lab – Total Billables per Month
Lab – Worked Productivity (24/7 Service)
Lab – Worked Productivity (Non 24/7 Service)
Lab – Paid Productivity (24/7 Service)
Lab – Paid Productivity (Non 24/7 Service)
Lab – Corrected Reports
Lab – Specimen Rejection Rate
Lab – Tests per hour worked
Lab – Total direct cost per test
Radiology – Tests per hour worked
Radiology – Total direct cost per test
Acute Care – Worked Hours per days of care
Acute Care – Total direct cost per days of care
Acute Care – Hospitalist or Other Provider cost
per visit
Acute Care – Hospitalist Cost per Acute Inpatient
Day
OR – Procedures per patient
OR – Worked Hours per procedure
OR – Total direct cost per procedure
OR – Provider cost associated with CRNA or
Anesthesiologist per visit
ED – Hours worked per visit
ED – Total direct cost per visit
ED – Physician/PA/NP cost per visit
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Financial & Operational Measures (continued)
Operational (continued):
Skilled Nursing Facility – Average daily census
to clinical staffing ratio Skilled Nursing Facility – Base cost per patient
day Skilled Nursing Facility – Support cost per
patient day Skilled Nursing Facility – Support cost to base
cost ratio Skilled Nursing Facility – Related support to
base cost ratio limit Skilled Nursing Facility – Patient days
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Web Site AccessAn email address and password are required to enter this secure web site.
The level of access is determined by the User type:
System Administrator – maintains the site – KHA/KHERF
State Administrator –provides support to Provider Contacts in their State
Network Administrator – maintains Network profiles & provides support
Provider Contact – maintains Provider profiles , adds users & enters data
Provider User – enters data and runs reports
View Only – views data and runs reports
Report Recipient – no access to QHi, only receives reports
Quality Health Indicators
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Defining
Your
HospitalReturn to Main Menu
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Users navigate through the suite of resources in the PiHQ Portal by clicking
on the blue-lettered links in the whitemenu bar
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Hover text provides a briefdescription of each resource
All QHi, HSI and SQSS users have access to the
PiHQ search engine.
Users type in search topic here
…or on any page throughout the portal
Results are pulled from all Portal resources.
Future enhancements will allow users to pull from resources outside of PiHQ as well.
The Resource Library holds all resource materials developed for PiHQ.
All users have access to the Resource Library
Results are pulled from all Portal resources.
Icons identify the source of the information.
All users have access to the Calendar
The Calendar provides registration information for upcoming Quality Training Sessions
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Users with access to this application are directed to the home page,
without additional log in.
All HCAHPS measures can be automatically pulled from HSI and uploaded directly into QHi, eliminating duplicate entry.
Future enhancements will allow any HSI measure to be uploaded into QHi.
Users with access to this application are directed to their customized home page, without additional log in.
Partners in Healthcare Quality are working with two notable Risk Management vendors to pull aggregate data directly into QHi, further reducing data entry, and enhancing comparative analysis and benchmarking opportunities.
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Defining
Your
HospitalReturn to Main Menu
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Users navigate through QHi by selecting options from
the red main-menu bar andthe blue sub-menu bar
Click Administration to viewHospital Profile page
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Provider Contacts are responsible forcompleting and maintaining the
Hospital Profile page for their facility
All fields with a redasterisk are required
fields
Hospital Characteristicsdefine each facility for
creation of peer groupswhen running reports
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Click drop-down to select Level of
Measurement . This applies only to
Financial/Operational measures
Question mark icons provide pop-up
definitions throughout the QHi site
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Selecting
Measures
Return to Main Menu
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Click here or here to go to the Measure Selection page
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Measure Sets lists the pre-determined sets of
measures selected by astate or network for their
hospitals to collect
Click on questionmark icon to display
the measures includedin each measure set
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Individual measurescan be selected from the list of measures ineach category group.
A measure or type ofmeasure can be located
by typing in a word identifier or descriptor
Measure information is available byclicking on the question icon.
The number of hospitals collectingeach measure is also provided.
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Entering
Data
Return to Main Menu
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Click Data Submissions to accessthe Data Submission page
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Click drop-down arrow toselect prior months’ data
submissions
To create a new month’s DataSubmission page, select
month and year and click onAdd New Submission
IMPORTANT: You must checkActivate data for reporting
box and then Save All and Stayfor the data entered this month
to be displayed ondashboards and in reports
Save All and Stay will onlysave data entered on this
Data Submission page andwill not forward data to dashboards and reports
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If data for the month is entered andsaved, but not activated, this
message will appear to remindthe user to activate the data for
reporting
Click here to import CMS datafrom your CART report
Click on question icon to viewinformation about the
measure calculation andelement definitions
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Measures and their dataelements automatically
populate this page whenmeasures are selected andand saved in the Measure
Selection page
Prior months’ datais displayed for easy reference
Click to immediately calculateand display data results
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The
Dashboard
Return to Main Menu
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The Core Measures Dashboarddisplays comparison data for the
eight Core Measures
Roll mouse over anyDashboard graph to
view the pop-up calculationfor that measure
The Dashboard can bedisplayed in graph,table, graph/table or
PDF views
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Table View
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Graph and Table View
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Dashboard data is calculated using aconsecutive three-month summing average
State Avg values reflect data fromhospitals in the same state asMy Hospital and reported in
the same time interval
QHi Avg values reflect data from allhospitals in QHi reporting the samemeasure in the same time interval
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A hospital must have activated data for at least one of the three
months in the Date Range in order for the measure to be
displayed on the Dashboard
My Hospital data for some clinical measures will not
display on the Dashboard if the hospital had no
occurrences during the Date Range period
Financial measures on the Dashboard default to peer groups determined by
the hospital’s selection of level ofreporting (Hospital Only or EntireEnterprise) in the Hospital Profile
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The three months in the Date Range canbe changed by clicking the drop-down to
select the start month for the desiredthree-month period
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Click here to view theDashboard as a PDF
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PDF view
The PDF format allows the user to save, print
or email the Dashboard in graph, table or
graph/table views
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Users can email the Dashboard in PDF tothemselves by clicking To Myself
…or choose another recipient
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User selects from a list ofexisting registered users
…or choose to add a new recipient
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Enter the name and Emailaddress of the new recipient
…and click Add New
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Click Create Schedule to establish apre-determined schedule for mailing
Dashboard reports to selected recipients
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1. Select run date by clicking on calendar2. Select frequency (monthly, quarterly, annually)3. Select recipients4. Click on Save Schedule5. Report is sent through email as a PDF attachment
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Click View My Dashboard tocreate a customized Dashboard
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Only those measures being collected by the
hospital will be available in the list
Click drop-down to select a measure to display on
Dashboard
Selected measures are retained and are
user specific
Notes section available to add comments or
additional information
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Click At A Glance Dashboard toview a twelve-month trending
graph/table view of each of theeight Dashboard core measures
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At A Glance twelve-monthtrending graphs for each
Core measure withtimeline and view options
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Reports
Return to Main Menu
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Reports is still available tousers to create peer reports.
However, its function hasbeen replaced by the
enhanced and upgradedNew Reports
Click New Reports to view measures andcreate peer reports
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Select report start and end dates
Select peer groups
Select data grouping
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Users can select up to five additional peer groups
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Available criteria selections for each peer group
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Users can only create a reporton measures that are being
collected by their hospital
Click on the blue measurescategory bar to display the
list of measures (beingcollected by that hospital)
in that category
Users can select more thanone measure from more
than one category
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Select output format
Select how wish to view report
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Webpage At A Glance view
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Webpage Line Graph view
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Webpage Bar Graph view
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Webpage Table view
The user’s facility isidentified as Hospital
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Webpage Table with detail view
Note that peer hospitals arenot identified by name but
have been assignedrandom numbers
Click on the envelope icon tocontact a peer hospital forbest practice information
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The Hospital Contact at theselected peer hospital will receive the email message
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Export format applies toTable and Table with detail
views
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From the Excel reportusers can create
customized graphs to meet their needs
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Gray Scale format displaysgraphs in black and white
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Click on Best Practice Reportto view and create reports that
list the top five performersfor any measure in QHi
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Hospitals can create a customizedBest Practice report by selecting:
1. Comparison quarter2. Sorting and display options3. Criteria4. Measures5. Clicking on Run Report
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Top performers aredefined by the summed
average of the mostrecent or selected
quarter’s data
Previous two quartersare displayed forreference only
If your hospital is not in the top 5 performers, it will be shown at the end of the list with the ranking identified
If your hospital is in the top 5performers of a core measure,
it will be identified on theDashboard with green stars and
the message: “Best PracticeTop Performer”
Click on the envelope iconto contact a top performerhospital for best practice
information
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Training, educational materialsand QHi documents are availablefor download on the Help page
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How we use the data
Return to Main Menu
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I print a copy of the graphs and take it to the board for discussion. They appreciate seeing in color how we compare to other CAHs in KS as well as others in the USA.
On a quarterly basis I am giving a copy of the bar graphs to our Board Members at their meeting.
I give the Quality Committee a copy of the quality reports on a quarterly basis.
We track and present our indicators monthly and are usually above the norm. On the occasions when we fall below, it prompts us to review processes to seek improvements.
If we fall below expectations, we look for ways to improve and then report back to the board in the next quarter.
We like the Days in AR report. This is our only source for comparative information on this measure.
Quality Health Indicators
What do we do with the data? A few comments from our hospitals…
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Thank you for viewing this demonstration.
If you have any questions or would like additional information on the QHi project, please contact:
Sally Perkins, QHi System Administrator [email protected]
785-276-3118or
Stuart Moore, QHi [email protected]
785-276-3104
Quality Health Indicators
