MHA Hospital Performance Project
The MHA Hospital Performance Project is a cooperative health data effort between the Missouri Hospital Association and Missouri hospitals to provide individual, aggregate and comparative hospital data on selected, nationally defined indicators of inpatient health care quality and patient safety to assist participating hospitals in the evaluation of quality of care.
The MHA Hospital Performance Project replaces the MHA BENCHMARK Project, which provided hospital-specific and Missouri comparative data on a set of MHA-developed quality indicators from 1994 through 2003.
MHA has adopted a subset of indicators developed by the Agency for Healthcare Research and Quality (AHRQ) for the MHA Hospital Performance Project. The AHRQ developed these indicators, called Quality Indicators (QIs), in response to a need for nationally defined, multidimensional, accessible quality indicators. The AHRQ QIs are a family of measures that can be used with hospital inpatient administrative billing data to identify apparent variations in the quality of inpatient or outpatient care. The AHRQ’s Evidence-Based Practice Center at the University of California San Francisco and Stanford University adapted, expanded and refined the indicators based on the original Healthcare Cost and Utilization Project Quality Indicators developed in the early 1990s. 1
The measure sets are used by the AHRQ to report on national health care quality issues, including annual reports mandated by Congress on health care quality, the National Healthcare Quality Report and the National Healthcare Disparities Report. To learn more about these reports, visit www.ahrq.gov.
The AHRQ QIs adopted for use in the MHA Hospital Performance Project measure certain aspects of the quality of patient care that reflect internal hospital activities. The indicators serve as a starting point to assist hospitals in assessing the quality of care provided to patients. The indicators are expected to be used in conjunction with other hospital performance improvement activities and to supplement continuous quality improvement efforts.
The AHRQ QIs are organized into three modules: Prevention Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs) and Patient Safety Indicators (PSIs). Details on each of the measure sets are available online at www.qualityindicators.ahrq.gov. Each of the modules includes area-level indicators that report performance throughout a geographic area, such as a county or metropolitan statistical area. These area-level indicators are not included in the MHA Hospital Performance Project because the focus of this project is to report indicators pertinent to individual hospital-specific inpatient quality of care. The IQIs and PSIs also include
provider-level indicators that reflect care provided within the hospital setting.
The IQIs focus on health care provided within the inpatient hospital setting and include volume, mortality and utilization indicators.
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The volume indicators are in areas for which a link has been demonstrated between the number of procedures performed and outcomes. The volume indicators are not reported as part of the MHA Hospital Performance Project.
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The mortality measures examine outcomes following procedures and for common medical conditions. The mortality measures are reported as part of the MHA Hospital Performance Project, with the exception of esophageal resection mortality, pancreatic resection mortality, abdominal aortic aneurysm mortality and pediatric heart surgery mortality because of the low volume of such procedures performed in the state, which limits adequate analysis.
- The utilization measures examine procedures for which questions have been raised about overuse, underuse and misuse and are included in the MHA Hospital Performance Project.1
- coronary artery bypass graft (CABG) mortality rate (IQI 12)
- percutaneous transluminal coronary angioplasty (PTCA) mortality rate (IQI 30)
- carotid endarterectomy mortality rate (IQI 31)
- craniotomy mortality rate (IQI 13)
- hip replacement mortality rate (IQI 14)
- acute myocardial infarction (AMI) mortality rate (IQI 15)
- congestive heart failure (CHF) mortality rate (IQI 16)
- acute stroke mortality rate (IQI 17)
- gastrointestinal (GI) hemorrhage mortality rate (IQI 18)
- hip fracture mortality rate (IQI 19)
- pneumonia mortality rate (IQI 20)
- Cesarean section delivery rate (IQI 21)
- vaginal birth after Cesarean (VBAC) rate (IQI 22)
- laparoscopic cholecystectomy rate (IQI 23)
- incidental appendectomy among the elderly rate (IQI 24)
- bilateral cardiac catheterization rate (IQI 25)
The PSIs are a set of measures that can be used to screen for adverse events and complications that patients may experience as a result of exposure to the health care system. The PSIs provide a focus for further analysis to reduce potentially preventable errors through system or process changes.2
- complications of anesthesia (PSI 1)
- death in low mortality DRGs (PSI 2)
- decubitus ulcer (PSI 3)
- failure to rescue (PSI 4)
- foreign body left in during procedure (PSI 5)
- iatrogenic pneumothorax (PSI 6)
- infection due to medical care (PSI 7)
- postoperative hip fracture (PSI 8)
- postoperative hemorrhage or hematoma (PSI 9)
- postoperative physiologic metabolic derangement (PSI 10)
- postoperative respiratory failure (PSI 11)
- postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) (PSI 12)
- postoperative sepsis (PSI 13)
- postoperative wound dehiscence (PSI 14)
- accidental puncture/laceration (PSI 15)
- transfusion reaction (PSI 16)
- birth trauma (PSI 17)
- OB trauma – vaginal with instrument (PSI 18)
- OB trauma – vaginal without instrument (PSI 19)
- OB trauma – Cesarean (PSI 20)
The data source for the indicators in the MHA Hospital Performance Project is uniform billing (UB) data submitted by participating hospitals to the Hospital Industry Data Institute. HIDI collects the uniform billing information from MHA-member hospitals that voluntarily participate in HIDI via their association membership. Because HIDI has the data required for reporting project indicators, no duplicate collection or reporting of data by participating hospitals is necessary. The UB data also are submitted by HIDI to the Missouri Department of Health and Senior Services on behalf of participating hospitals to meet state law requirements for reporting hospital UB data to the state of Missouri.
The MHA Hospital Performance Project reports are hospital-specific reports provided for internal use by participating hospitals only. The hospital-specific data contained in the reports is considered confidential and should not be shared with outside sources. MHA staff will not publicly release the hospital-specific data contained within the project and asks hospitals to not release the data publicly. Aggregate statewide data results may be released as part of periodic reports on the state of health care quality in Missouri.
The MHA Hospital Performance Project reports are distributed quarterly on CD-ROM to participating MHA-member hospitals. Each report provides individual hospitals with
hospital-specific and comparative data for the previous eight quarters. In addition, hospitals receive their data as comma delimited ASCII files to allow for additional data analysis and reporting, if desired.
In addition to the reports, updates to the manual material also will be provided on the quarterly CD-ROM. Participating hospitals have been provided one hard copy of the manual, which may be maintained by printing manual updates and reports from the quarterly CD-ROM, if desired.
The accuracy of coding and quality of data submitted by each hospital on the UB form is imperative to the success of the MHA Hospital Performance Project and should be monitored internally by each participating hospital. Hospitals are expected to comply with requirements and instructions for completing the UB claim forms as defined by the National Uniform Billing Committee, as well as complying with ICD- 9-CM coding guidelines and subsequent versions of coding guidelines that may be implemented in the future.
HIDI performs an editing and verification process on the UB data received from participating hospitals to ensure the data’s reliability and validity. HIDI provides three types of edit and validation reports to respective hospital information management contacts after each submission of discharge data. The first report provides summary statistics on the count and percent of each error; the second report provides details on each patient and error for correction purposes; and the third report provides summary statistics on data variables for validation by the hospital. These reports are available on HIDI’s Web site after submission of data for each quarter. Copies of the reports are mailed to hospitals that have not established access to the Web site. Although the Missouri Department of Health and Senior Services’ regulations require a less than 1 percent error level, HIDI requests that hospitals establish a goal of zero errors.
Additional and detailed information about the AHRQ and the QIs is available online at www.qualityindicators.ahrq.gov. This site includes detailed information about the development of the QIs, including scientific evidence supporting and rationale for each.
If you have questions about the MHA Hospital Performance Project, contact Wanda Marvel.
1 “AHRQ Quality Indicators — Guide to Inpatient Quality Indicators: Quality of Care in Hospitals — Volume, Mortality, and Utilization.” Rockville, MD: Agency for Healthcare Research and Quality, 2002. Revision 2 ( September 4, 2003). AHRQ Pub. No. 02-RO 204.
2 “AHRQ Quality Indicators — Guide to Patient Safety Indicators.” Rockville , MD : Agency for Healthcare Research and Quality, 2003 . AHRQ Pub .03 -R 203.
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