Lat­est Leapfrog re­port card hits ur­ban hos­pi­tals hard

Modern Healthcare - - Quality - By Maria Castel­lucci

The ma­jor­ity of ur­ban hos­pi­tals don’t per­form well on pa­tient safety mea­sures, ac­cord­ing to the Leapfrog Group’s lat­est re­port card.

Of the 11 hos­pi­tals in New York City in­cluded in the spring 2018 Hospi­tal Safety Grade re­port, only one—NYC Health & Hos­pi­tals/Met­ro­pol­i­tan—re­ceived an

“A” grade, while the rest re­ceived a “C” or “D.” Ad­di­tion­ally, just three of Los Angeles’ 12 hos­pi­tals in the re­port earned an “A” while six of them got a “C” or lower. One-third of Chicago’s 18 hos­pi­tals re­ceived an “A” grade, while 11 were rated “C” or lower.

Even though hos­pi­tals in large cities treat pa­tients with an ar­ray of so­cial risk fac­tors, the lo­ca­tion of a hospi­tal is no ex­cuse for poor per­for­mance on safety, said Leah Bin­der, CEO of the Leapfrog Group. “Pa­tient safety doesn’t de­pend on the pa­tient pop­u­la­tion.”

While groups like Leapfrog con­tinue to ad­vo­cate for greater trans­parency in qual­ity and safety met­rics, there are dis­crep­an­cies when com­par­ing rat­ings. Some of the hos­pi­tals that re­ceived low grades from Leapfrog have been rec­og­nized for strong qual­ity per­for­mance by other or­ga­ni­za­tions. For ex­am­ple, Cedars-Si­nai Med­i­cal Cen­ter in Los Angeles and Mount Si­nai Hospi­tal in New York City both re­ceived “C” grades from Leapfrog even though they were re­cently rec­og­nized by U.S. News & World Re­port as “Best Hos­pi­tals.”

Such in­con­sis­ten­cies point to a fre­quent crit­i­cism of rank­ings and lists among in­dus­try ex­perts.

With so many dif­fer­ent qual­ity rank­ings, it’s dif­fi­cult for pa­tients to de­cide which they should rely on.

Hos­pi­tals have also ques­tioned the va­lid­ity of Leapfrog’s method­ol­ogy. Cedars-Si­nai said in a state­ment that it doesn’t par­tic­i­pate in Leapfrog’s hospi­tal sur­vey be­cause it doesn’t sup­port the method. The hospi­tal claimed it was pe­nal­ized with a low grade as a re­sult.

“A more re­li­able and accurate mea­sure of Cedars-Si­nai’s qual­ity can be found through rep­utable sources such as the CMS’ Hospi­tal Com­pare,” a spokes­woman said.

Sim­i­lar to its fall re­port, Leapfrog’s lat­est anal­y­sis shows wide vari­a­tion in pa­tient safety per­for­mance across hos­pi­tals. Leapfrog graded 2,479 hos­pi­tals this spring, of which 750 earned A’s, 683 scored B’s, 879 re­ceived C’s, 145 got D’s, and 22 were given F’s.

Hos­pi­tals na­tion­wide can tackle per­sis­tent pa­tient safety is­sues by con­sid­er­ing them more in value-based pur­chas­ing pro­grams, Bin­der said.

“A lot of the value move­ment has been aimed at qual­ity out­comes and pric­ing, and they have over­looked the third leg of the stool, which is safety,” she said.

Leapfrog is work­ing with the CMS to in­te­grate pa­tient safety mea­sures into value-based pur­chas­ing pro­grams so hos­pi­tals will have ad­di­tional in­cen­tives to fo­cus on pa­tient safety.

Leapfrog cal­cu­lates the grades us­ing 27 mea­sures, in­clud­ing hand hy­giene, falls and pres­sure ul­cers. The data are de­rived from the CMS, Leapfrog’s own hospi­tal sur­vey, and sec­ondary data sources such as the Amer­i­can Hospi­tal As­so­ci­a­tion.

Leapfrog also an­nounced last week that it’s ac­cept­ing pub­lic com­ments on two pro­posed changes to its method­ol­ogy. The not-for-profit or­ga­ni­za­tion has sug­gested low­er­ing the num­ber of points that hos­pi­tals will earn for the com­put­er­ized physi­cian or­der-en­try mea­sure if the data are de­rived from the AHA, which it con­sid­ers a sec­ondary source that of­fers less de­tail than if the in­for­ma­tion is from the Leapfrog hospi­tal sur­vey.

Leapfrog has also pro­posed adding a bar-code med­i­ca­tion ad­min­is­tra­tion mea­sure. Most hos­pi­tals have a process in place where a clin­i­cian scans the bar code on a med­i­ca­tion and the pa­tient’s iden­ti­fi­ca­tion badge to en­sure the pa­tient is get­ting the cor­rect medicine. While this should be done at a pa­tient’s bed­side, that doesn’t al­ways hap­pen, Bin­der said.

The Leapfrog sur­vey would ask hos­pi­tals if they have a process to en­sure bar code med­i­ca­tion ad­min­is­tra­tion is done in front of the pa­tient.

Bin­der said med­i­ca­tion ad­min­is­tra­tion er­rors are the most fre­quent pa­tient safety mis­takes in hos­pi­tals, but they are dif­fi­cult to track and mon­i­tor.

The pro­posed changes—if ap­proved—would be im­ple­mented in the next Hospi­tal Safety Grade re­port in fall 2018.

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