Here are the main changes to the Leapfrog Group’s hospital survey this year.
Scoring and public reporting of health equity standards
For the past three years, both hospitals and ambulatory surgery centers have answered survey questions about how they collect data on patients’ race, ethnicity and preferred language. This year the facilities’ responses will be scored and publicly reported.
To perform well on the 2024 survey, healthcare organizations will also be required to stratify at least one Leapfrog Group quality measure by demographic data to identify disparities and implement plans to close care gaps.
Facility administrators and clinicians have largely been supportive of these changes since most organizations are already moving toward the stratification of patient data by race, said Missy Danforth, senior vice president of healthcare ratings at the Leapfrog Group.
The organization's healthcare equity reporting also overlaps with a lot of best practices included in the Joint Commission's accreditation standards, as well as the Centers for Medicare and Medicaid Services' advancing equity framework, she said.
“The issue of healthcare inequities significantly impacting patient outcomes is one that we really need to turn our focus on now in order to ensure that we're achieving our mission of safe patient care for everyone,” Danforth said.
Removing an elective deliveries measure
As part of this year’s survey, hospitals will no longer be required to report data on their number of scheduled C-sections or medical inductions prior to 39 weeks of pregnancy.
Reporting on elective deliveries was first dropped as an accreditation program requirement by the Joint Commission in January, and subsequently the measure was removed from CMS’ Hospital Inpatient Quality Reporting Program.
Though Leapfrog Group believes the metric is important in reducing maternal health complications and neonatal intensive care units admissions, feedback from health systems made the organization decide to cut the measure, as well, Danforth said.
“What we were hearing from hospitals is that they were going to lose support from their electronic health record vendors to do the data abstraction needed for them to report on the measure,” she said. “Without that support, reporting on the measure is quite cumbersome.”
The Leapfrog Group added a question to the 2024 survey that asks if hospitals have a policy in place to prevent elective deliveries. The organization is also considering whether to include two measures on next year’s survey on unexpected complications in newborns and severe obstetric complications.
Collecting nurse staffing data from mixed patient units
Starting with the 2024 survey, the Leapfrog Group is scoring and reporting data on nurse staffing in hospital units with patients at different severity levels.
The organization previously collected workforce data only from single acuity medical, surgical or medical-surgical units, where all patients are generally in similar conditions. However, that data didn't include all facilities.
“Some hospitals, like the Kaiser Permanente hospitals in California, have moved to operating units that have a mix of low-acuity patients, mid-acuity patients like telemetry patients and high-acuity patients like critical care patients,” Danforth said.
To accommodate hospitals with mixed acuity units — and account for the prospect that they might require a different number of total nursing hours per patient day or percentage of registered nurses, nursing assistants and licensed practical nurses — the Leapfrog Group will compare these hospitals to each other when scoring and publicly reporting nurse staffing data.
Adding questions on diagnostic error prevention
In response to hospitals’ difficulties with reducing diagnostic errors, the Leapfrog Group added questions that will assess facilities’ implementation of five evidence-based practices intended to prevent delayed, missed and incorrect diagnoses.
The questions, which will not be scored or publicly reported this year, focus on how hospitals make sure CEOs are committed to diagnostic accuracy, engage patients, conduct risk assessments, convene a multidisciplinary team and train staff.
The survey also includes a process measure on closed loop communication.
“We're going to be asking hospitals to report on the number of first-time cancer diagnoses where both the ordering physician and the patient were notified within five business days, which we think is appropriate for such a serious diagnosis,” Danforth said.
Expanding the bar code medication administration standard
For the first time, the Leapfrog Group’s standard on bar code medication administration, which requires hospitals to report how often clinicians use handheld scanners to ensure the right medication goes to the right patient, will be tracked in both inpatient and outpatient care settings.
“Historically we've only measured the use of bar code medication administration in adult and pediatric med-surg units, labor and delivery units and critical care units,” Danforth said. “But more and more research is indicating that the use of the technology is highly important in pre-operative and post-operative care units.”
Though the updated measure won’t be publicly reported in 2024, it is crucial that more facilities start taking note of this data as medication errors are the most common type of patient care error, she said.
