The Leapfrog Group coalition of healthcare buyers is making the first significant alterations to its survey of hospital quality efforts by broadening its definition of "intensivist," pushing back its date for hospitals to achieve full implementation of computerized physician order entry and tweaking its benchmarks for high-risk procedures.
During a nationwide teleconference with journalists on Wednesday, Leapfrog officials also announced they are expanding the geographic base of its survey by inviting 150 hospitals in Maine, the Hampton Roads area of southeast Virginia, and Chicago and other Illinois cities to participate.
The survey pool now includes 1,100 hospitals in 22 regions of the country, serving up to 48% of the population, Executive Director Suzanne Delbanco says.
In what Delbanco calls an "important evolution in our work," the patient-safety advocacy group now will classify as intensivist physicians who were trained in critical care medicine before board certification of intensivists began in 1987 and who have worked full-time in intensive care units for at least six weeks a year since then.
"As we interacted with America's provider community over the past year, we learned that a lot of qualified physicians were not recognized," explains Leapfrog Group board member Arnold Milstein, M.D., medical director for the Pacific Business Group on Health, a major Leapfrog participant.
The organization on Wednesday made the first change to its list of seven high-risk surgeries and neonatal conditions that it is using to promote evidence-based hospital referral by replacing carotid endarterectomy with pancreatic cancer resection. Milstein says the change reflects the group's belief that successful pancreatectomy surgery "can save more lives."
Leapfrog officials also changed some of the volume-based benchmarks for the other six procedures that had been targets for criticism from the medical community. To qualify for a Leapfrog rating, a hospital now must perform 450 coronary artery bypass graft surgeries annually, down from 500; facilities also may qualify with 350 CABGs annually if they meet certain risk-adjusted outcomes targets.
Milstein notes that the proliferation of specialized heart hospitals "has watered down the volume available at existing hospitals."
The treatment category of coronary angioplasty now includes stenting and other percutaneous coronary interventions to reflect technologies that have proliferated since the Leapfrog Group formed in 2000.
In its third area of focus, CPOE, the Leapfrog Group is giving hospitals an extra year, until January 2005, to achieve full implementation.
"Implementing these systems were a significant budget line item that required board approval," Milstein says. He also says that hospitals have not had a whole lot of success with "off-the-shelf" implementation of vendor CPOE systems without extensive customization.