Questions About the Minnesota Hospital Quality Report Expand All 1.   What is the Minnesota Hospital Quality Report? The “Minnesota Hospital Quality Report” is a web resource (www.mnhospitalquality.org) for health care consumers about hospital quality of care that launched in April 2006. This Web site is designed to support and assist consumers, as well as providers, by making information available about the quality and safety of care in Minnesota hospitals. This resource was developed by the Minnesota Hospital Quality Partnership (a partnership with the Minnesota Hospital Association and Stratis Health, Minnesota’s Quality Improvement Organization), and a steering committee comprised of Minnesota hospital representatives. The “Minnesota Hospital Quality Report” site is unique in that it provides information specific to Minnesota hospitals, making it easier for consumers and providers to access. Quality of care information related to hospitals nationwide can be found on the federal “Hospital Compare” Web site (www.hospitalcompare.hhs.gov). 2.   Why are we providing this resource? What is the value? Consumers, employers, health plans, and the government want greater access to hospital performance information. The interest in greater transparency about hospital quality will only grow. By voluntarily releasing quality of care information, hospitals can ensure that the information that is released is meaningful for both the public and the provider community, and that results are interpreted as accurately as possible. 3.   Why are hospitals reporting this information? Minnesota hospitals are committed to sharing meaningful information for consumers regarding performance. MHA and Stratis Health also support giving patients information that will help them make decisions about their medical care. The reporting of this data also provides an incentive for hospitals to continue to improve their use of these best practices. 4.   How have hospitals been involved in this project? MHA and Stratis Health formed a steering committee of hospital representatives including physicians, nurses, and other patient safety and quality management experts. The steering committee’s recommendations form the basis for this project. 5.   Why aren’t all hospitals listed on the Web site? Almost all hospitals are listed on the site, based on their consent to allow Minnesota Hospital Association and Stratis Health to publish this data. Many of the hospitals that are not listed are small rural hospitals with fewer than 25 beds, which are called “Critical Access Hospitals.” Not all of these small hospitals are yet gathering and reporting the initial measures that we are using, based on the federal government’s existing efforts. Also, hospitals that primarily serve children, psychiatric, or rehabilitation patients, or serve a different population of patients than what our report measures are not listed. 6.   What are the measures that are included on the Minnesota Hospital Quality Report? The quality measures reported on the site are tied to four conditions: heart attack, heart failure, pneumonia and surgical care. These are two types of measures on this site — an Appropriate Care Measure and "quality of care" measures. Many of the practices being measured are hard for someone who isn’t a physician or nurse to understand. What’s important is that these are practices that are well accepted nationally as steps that should be taken in the care of the conditions. Heart Attack (Acute Myocardial Infarction) About one million people per year suffer a heart attack, also known as acute myocardial infarction. Heart attacks are among the leading causes of hospital admission for patients 65 and older. The following steps are considered best practices for the treatment of heart attacks. These “quality of care” measures are included on the Web site. They include: Aspirin at arrival Aspirin at discharge Angiotensin-converting Enzyme (ACE) Inhibitor or Angiotensin II Receptor Blockers and (ARBs) for Left Ventricular Systolic Dysfunction (LVSD) Beta Blocker at arrival Beta Blocker at discharge  Thrombolytic agent received within 30 minutes of hospital arrival Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival  Smoking cessation advice/counseling Heart Failure Heart failure is the most common hospital admission diagnosis in patients 65 or older and accounts for more than 700,000 hospitalizations among Medicare beneficiaries every year. The following measures on the Web site represent the best practices for the treatment of heart failure:  Assessment of left ventricular function  ACE Inhibitor or ARB for left ventricular systolic dysfunction  Discharge instructions  Smoking cessation advice/counseling Pneumonia Community-acquired pneumonia causes four million illnesses and nearly one million hospital admissions each year. Best practices include: Oxygenation assessment  Initial antibiotic timing  Appropriate initial antibiotic selection  Blood culture performed prior to first antibiotic received in hospital  Pneumococcal vaccination  Smoking cessation advice/counseling Surgical Care The following measures on the Web site represent the best practices for the treatment of surgical care improvement/surgical infection prevention: Received preventative antibiotic(s) one hour before incision Preventative antibiotics(s) stopped within 24 hours after surgery How Patients Rate Their Care The newest information on the Minnesota Hospital Quality Report is patients’ ratings of their hospital care. The data comes from a national survey called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The survey has 27 questions. Besides the demographic questions, the other questions are combined into eight key areas, including: Communication with doctors Communication with nurses Responsiveness of hospital staff Pain control Communication about medicines Cleanliness of hospital environment Quietness of hospital environment The data will also include patients overall rating of the hospital and their willingness to recommend the hospital to others. 7.   Are these indicators equal to a "rating" of the hospital? Not necessarily. Small differences in the percentages usually don’t show that one hospital is significantly better or worse. Still, these measures have been shown to lead to better outcomes. If a hospital fails to routinely perform the steps, a patient has a right to question their provider. But this data should not be used as the sole basis of making a decision about a hospital. It is intended to be of use as one factor in your decision, not the final verdict. 8. Does the site help users make comparisons? The Web site is about helping patients, families, and caregivers make more informed decisions about the care that’s best for them. All participating hospitals will be listed on the Web site, with detailed results for each reported measure. 9. Where can I view the data in spreadsheet form? To view the Minnesota Hospital Quality Report data in spreadsheet form for research or other purposes, click below. Data Download 10. How recent is the data? What time period does the MHQR cover? The information is as recent as possible, reflecting the same time period used with Hospital Compare. The data is at least nine months old. The data is reported for a one-year period, with updates made quarterly, as hospitals submit new data.  11. How can consumers use this data? Consumers may want to review the available data when considering a hospital visit for a scheduled procedure. The web resource is one tool that can help consumers compare the quality of care in local Minnesota hospitals and allow them to make informed decisions. Consumers should also talk to family and friends, health care professionals, and contact local consumer organizations for references.  12. How is it helpful? The information available on the “Minnesota Hospital Quality Report” is helpful to hospitals and clinicians as they continually work to improve the quality of the care they deliver. By reporting on these areas and increasing public awareness of this information, this report will reinforce the importance of working to address these measures. 13.  Background Launched in early 2006, this site will continue to grow richer with more resources and information. It is being offered through the Minnesota Hospital Quality Partnership, formed by the Minnesota Hospital Association and Stratis Health, the Quality Improvement Organization for Minnesota. We believe that Minnesotans benefit from improved access to meaningful information about hospital quality.  Questions about How Hospitals Perform on Quality Expand All 1. What is the Appropriate Care Measure? The Appropriate Care Measure (ACM) is a patient-focused measure that provides a way of looking at whether a patient received ALL of the “appropriate or right care” (recommended treatments) that he or she should have received, based on his or her clinical condition. Each patient is unique and may not be eligible for every type of care for a condition. The ACM takes patient individuality into consideration, looking at one patient and their episode of care at a time, related to their specific condition. 2. What are the Quality of Care Measures? The quality measures report on the site are "quality of care" measures that describe how often certain practices of care have been followed. Unlike the Appropriate Care Measure, the quality measures illustrate hospitals’ work on each measure by combining all patients treated for a particular condition. The quality measures broadly describe the care provided by a hospital. 3.   How is the information collected? In order to collect the necessary information for this project, hospitals must extract data elements from patients’ medical charts, which is a rather costly method. Fortunately, in order to minimize the collection burden, this project takes advantage of information that is already being collected for other purposes such as for the Centers for Medicare & Medicaid Services, the Joint Commission on Accreditation of Healthcare Organizations, and state requirements. 4.   Why don't all hospitals have data in all the measure sets? Hospitals may phase-in reporting of measures over time as they begin to collect the information. Hospitals must decide which measures apply to them, based on the services that they provide. Not all measures are relevant for the patient population of every hospital. For instance, some patients may enter one hospital’s emergency department and require additional inpatient services at another hospital. Also, the Web site does not include hospitals' statistics about a measure if that hospital handles only a relatively small number of cases involving that measure. For example, a hospital that treats only a few people who have had heart attacks would not provide data on the number of times the hospital had administered aspirin to such patients upon arrival at the hospital, because that statistic would not provide a valid comparison with hospitals that treat large numbers of heart-attack patients. 5. Can hospitals manipulate the data to boost their scores? There are checks and balances to ensure the accuracy of the data. While the data are self-reported, hospitals are subject to audits by the federal government to validate their data. Questions about How Patients Rate their Care Expand All 1. Where does this information come from? The information comes from a national survey called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The survey measures a patient’s experience at a hospital. The survey doesn’t ask patients their level of happiness or satisfaction. Instead, the survey asks patients to identify the frequency by which important elements of care occurred. 2. What kind of information is in the survey? The newest information on the Minnesota Hospital Quality Report is patients’ ratings of their hospital care. The data comes from a national survey called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The survey has 27 questions. Besides the demographic questions, the other questions are combined into eight key areas, including: Communication with doctors Communication with nurses Responsiveness of hospital staff Pain control Communication about medicines Cleanliness of hospital environment Quietness of hospital environment The data will also include patients overall rating of the hospital and their willingness to recommend the hospital to others. 3. How is the information collected? The information comes from the HCAHPS survey, which is administered 48 hours to six weeks after discharge to a random sample of adult patients across medical conditions. Participating hospitals may either use an approved survey vendor, or collect their own HCAHPS data (if approved by CMS to do so). To accommodate hospitals, HCAHPS can be implemented in four different survey modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR). Hospitals can either integrate the HCAHPS survey with their own patient satisfaction survey, or use HCAHPS by itself. Hospitals must survey patients throughout each month of the year. 4. How many hospitals in Minnesota are participating? Nationally, there are 2,700 hospitals (out of more than 5,000 total hospitals) participating in HCAHPS. In Minnesota, hospitals across the state—big and small facilities—are participating. And more facilities will be part of future additions of data to the site.