Hospitals participating in the Leapfrog Group's quality initiative soon may be graded on their adherence to 27 safe practices using a weighted system that values some more than others, depending on the results of a report expected early next month.
The weighting approach would help hospitals prioritize their efforts to instill the more than two dozen safe practices, as well as give consumers a better understanding of their relative importance, said Suzanne Delbanco, Leapfrog's executive director. The Washington-based business coalition expects to expand its survey of hospitals to include those safe practices in late spring or early summer of 2004, Delbanco said.
The National Quality Forum, a not-for-profit organization representing a wide range of healthcare interests, endorsed the practices in May as a starting point for quality oversight efforts by accrediting, consumer and payer organizations (May 26, p. 12).
If the Leapfrog panel cannot come up with a way to weight each practice according to its relative benefit to consumers and the quality of hospital care, Leapfrog still will incorporate the new measures but confine its inquiry to whether or not the measures are in place and, if not, what progress is being made, Delbanco said.
Whatever the Leapfrog Group decides, the initiative would greatly expand the scope of its push for safety practices, which until now has been limited to three standards covering computerized ordering by physicians, deployment of specialists in intensive-care medicine and evidence-based referrals for certain kinds of high-risk care. Those practices are included in the NQF group, for a total of 30 consensus-based safe practices.
A report on the reach of those three currently adopted standards in the hospital industry released last week showed that the number of facilities submitting information on their compliance jumped nearly 60% in a year's time to 1,012 hospitals. But comparisons between that survey and the results of a year ago show that as the size of the hospital pool has grown, the percentage of facilities adhering to those standards has declined.
Last year's Leapfrog survey of 637 responding hospitals reported that 5% had fully implemented physician order-entry systems, and another 25% of the hospitals planned to achieve that standard within a year. The latest survey reported that 3% of 1,008 hospitals responding to the question said they had an operational system, and 13.5% were on target to have one running before 2005.
Delbanco said the trend might demonstrate an initial bias toward hospitals that were well-positioned and not hesitant about reporting because they would look good. The coalition's efforts now are reaching hospitals that haven't made as much progress but are willing to share their results, she said.
The Leapfrog Group's attempt to prioritize its expansion into new standards is similar to an approach the Joint Commission on Accreditation of Healthcare Organizations took with its requirements for hospital safety last year. The accrediting agency established a short list of patient-safety goals for providers to concentrate on from among nearly 50 recommendations identified by a panel of experts (July 29, 2002, p. 8). The approach replaced an aborted attempt to make hospitals responsible for more than 25 patient-safety alerts accumulated over several years. The JCAHO had recognized that the large quantity created confusion about what to focus on first.
The Leapfrog Group also announced it was collaborating with the CMS and the Agency for Healthcare Research and Quality on new standards for physician practices that would gauge the degree to which doctors' offices use information technology tools to guide decisionmaking and manage chronic conditions.
Delbanco said the CMS is looking for an IT component to a pending demonstration project, called Doctors Office Quality, that seeks to define quality measures and develop strategies that improve clinician performance and reward exemplary effort.
The Leapfrog-developed standards, which are expected in draft form by year-end, include computerized physician ordering for the ambulatory setting, electronic access to laboratory results, a registry of patients with key chronic conditions, and the ability to issue reminders about recommended care to physicians when patients on the registry come in.