Hospital Metrics TAG August 09, 2016 PLEASE DO NOT PUT YOUR PHONE - - PowerPoint PPT Presentation

Hospital Metrics TAG

August 09, 2016 PLEASE DO NOT PUT YOUR PHONE ON HOLD: IT IS BETTER TO HANG UP AND CALL BACK IN IF NEEDED

Welcome and Introductions

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Agenda Overview

• Updates
• Opioid Metric Test Group
• Opioid-related Discharge Data
• Presentation: Public Health Home Visiting

Program (re: Year 5 maternal/child health measure)

• Year 4 EDIE Report
• Best Practice Collaboration Discussion

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Updates

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Committee Meeting Debrief

• Orientation for new members was held in July
• No meeting was held in July
• The next meeting will be scheduled for September with

new committee membership. Agenda items include:

– Discussing Year 4 benchmarks – Discussing challenge pool metric(s) – Beginning discussion of Year 5 core / menu set

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HTPP 4: CMS Discussions

• Years 4+ (2017 on) are part of OHA’s Medicaid

waiver renewal proposal; OHA continues working with CMS

• Proposal has been submitted

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HTPP Year 3 Improvement Target Reports

• Sent to all hospitals on 29 July
• Includes final Year 2 performance and Year 3

improvement targets

• Exception is follow-up after hospitalization for mental

illness – To ensure equitable year-to-year comparison, OHA is rerunning Year 2 for both hospitals and CCOs. – These revised data will be used in calculating Year 3 benchmarks and improvement targets. – OHA anticipates that the Year 3 benchmark, improvement targets, and progress reports will be available by mid-August.

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Final Year 3 Benchmarks

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Measure Year 3 Benchmark

CLABSI Improvement target only CAUTI Improvement target only Adverse drug events due to Opioids 3% Excessive anticoagulation due to Warfarin 3% Hypoglycemia in inpatients receiving insulin 5% HCAHPS – discharge National 90th percentile (91.0%) Shriners, 92.6% HCAHPS – medication National 90th percentile (73.0%) All-cause readmissions 90th percentile HTPP Year 2 (8.4%) EDIE 90th percentile HTPP baseline, Year 1 (84.4%) Follow-up after hospitalization 90th percentile HTPP Year 2, hosp only rate (TBD) SBIRT – brief screen 90th percentile HTPP Year 2, brief (83.5%) SBIRT – full screen 90th percentile HTPP Year 2, full (71.3%)

Questions?

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Opioid Reporting Test Group and Opioid-related Discharge Data

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Opioid Related Inpatient Discharges

• We wanted to provide some additional context to the hospitals as we

develop specification around opioid related metrics.

• We want to provide information to help hospitals to assess their own

individual opioid related impacts.

Analysis Methods

• Followed CDC guidelines for assessing opioid poisonings:
• https://www.cdc.gov/drugoverdose/pdf/pdo_guide_to_icd-9-

cm_and_icd-10_codes-a.pdf

• Selected ICD codes for prescription opioid poisoning (overdose)

including diagnosis codes 965.00, 965.02, 965.09 and ecodes E850.1 and E850.2

• Selected ICD codes for opioid dependency including 304.0, 304.00,

304.01, 304.02, 304.03

• Calculated rate per 1,000 discharges for both prescription opioid

poisonings and for opioid dependency as a complicating condition

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Findings: Prescription Poisonings

• Includes prescription use of opioid (methadone, oxycotin, vicodin,

etc) and excludes heroin.

• DRG hospitals have remain consistent 2008-2015 in the rate of

prescription opioid poisoning discharges. DRG mean is 2.65 discharges per 1,000.

• DRG’s range of rates from 0 – 6.56 per 1,000.

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2015 Values Total DRG Hospitals 2.65 Total Type B 2.15 Total Type A 2.57 Total Statewide 2.61

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Prescription Poisonings Date Range: 2008-Q3 2015

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Prescription Poisonings Date Range: 2008-Q3 2015

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Prescription Poisonings Date Range: 2008-Q3 2015

Findings: Opioid Dependency

• Includes secondary diagnosis codes indicating opioid dependency

as a complication to the principle condition

• Includes heroin use
• Rates have more than doubled in past 5 years
• DRG hospitals average 20.54 discharges per 1,000 with a range of

0-75.

• Most common principle diagnoses associated with opioid

dependency are drug withdrawal, septicemia, and cellulitis.

• Evidence for high levels of detox boarding.

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2015 Values Total DRG Hospitals 20.54 Total Type B 12.59 Total Type A 11.02 Total Statewide 19.60

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Opioid Dependency Date Range: 2008-Q3 2015

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Opioid Dependency Date Range: 2008-Q3 2015

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Opioid Dependency Date Range: 2008-Q3 2015

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Opioid Dependency Date Range: 2008-Q3 2015

Additional notes

• There is some overlap between patients counted as an opioid

poisoning and as opioid dependency due to coding issues, but generally the categories are exclusive.

• Ecode use is inconsistent, and missing for about half of diagnosed
• verdose/poisonings

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Conclusions

• While specific prescription overdoses have remained consistent, the

rate of opioid dependency seen in hospitals has significantly increased

• The majority of these cases represent avoidable hospitalizations

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Opioid Metric Development – Next Steps

• OHA is still awaiting clarification from WA State on how

they utilize the ‘days/supply’ metric’

• OHA is developing a master list of opioid products to

help in report development

• Run test reports
• Go!

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Year 4 Baseline / Reporting Clarification

• OHA’s proposal to CMS requests that new measures be

pay-for-reporting, rather than pay-for-performance

• However, given that Year 4 reporting may need to start

as early as October (pending new waiver negotiations with CMS), hospitals should plan that new measures will be pay-for-performance in Year 4

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Opioid Metric – Baseline / reporting clarification

• Assuming pay-for-performance in Year 4:

– Baseline period will be through March 31, 2017 (regardless of start date for Year 4) – Hospitals must have a minimum of 30 consecutive days of baseline data within this period in order to be eligible to participate in the measure (i.e., must be able to begin reporting by March 2, 2017) – The performance period will be from April 1, 2017 through the last day of Year 4 (date TBD per CMS)

• Assuming pay-for-reporting in Year 4:
• Hospitals must still be able to begin reporting by March 2, 2017

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Opioid Metric – Baseline / reporting clarification

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Opioid Measure Test Group

• OHA strongly recommends hospitals begin running test

reports now

• Recruiting hospitals to be involved in subgroup of H-TAG

to run test reports, learn from one another, and provide input for any changes / clarifications needed to the specifications

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Opioid Measure Test Group

• Scope:

– Provide input on any technical problems in running reports per the measure specifications – Provide feedback on needed technical clarifications needed to specifications – Chance to trouble shoot report writing issues related to this measure with other hospitals

• Participants:

– Report writers / technical experts and QI leads

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Opioid Measure Test Group

• Commitment (2-3 meetings lasting 60 minutes

each):

– Meeting 1: 23-25 August (specific date/time TBD when

group identified)

• Review specifications, talk through details together
• Ensure report writers have what they need to write

report

– Meeting 2, 19-23 September (specific date/time TBD when group identified)

• Discuss issues encountered in running reports
• Review data, assess validity together

– Meeting 3, scheduled if needed

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Opioid Measure Test Group

If interested in participating, please email metrics.questions@state.or.us by 15 August.

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PUBLIC HEALTH DIVISION Maternal and Child Health Section

Public Health Nurse Home Visiting Programs

Hospital Technical Advisory Group Meeting August 9, 2016

Anna Stiefvater, Perinatal Nurse Consultant Cate Wilcox, Maternal and Child Health Manager Public Health Division

Background: Proposed Metric

• Proportion of hospital births

screened for eligibility for home visiting programs other types of parenting support

– Hospitals would check to see if this screening was done prenatally (which is preferred) – Hospitals would conduct the screening if it was not done prenatally

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Background: Oregon’s Home Visiting System

• Work to develop the system happening since 2010
• More need than capacity
• Programs include

– Healthy Families Oregon – Public Health Nurse Home Visiting Programs – Early Head Start – Children’s Relief Nurseries – Family Support and Connections – Local initiatives

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Public Health Nurse (PHN) Home Visiting Programs

• Implemented by Local Health Departments with support and

technical assistance from the State Public Health Division and the Oregon Center for Children & Youth with Special Health Needs

• Referrals from clinical providers, WIC, hospitals
• Services are voluntary
• Programs include: Maternity Case Management, Nurse Family

Partnership, Babies First, CaCoon

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Maternity Case Management (MCM)

• Primary goal is to optimize pregnancy outcomes, including reducing

the incidence of low birth weight babies.

• Must be initiated during the pregnancy and before delivery.
• Expands perinatal services to include management of health,

economic, social and nutritional factors through the end of pregnancy and a two-month postpartum period.

• Requires communication of pertinent information to the prenatal

care provider and others participating in the client's medical and social care.

• Provided in different settings by different types of providers.
• Requirements in Oregon Rule, reimbursement from Medicaid.

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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PHN MCM Clients

• 2,244 pregnant and postpartum women

served in 2014

• Receive an average of 6 home visits
• PHN MCM clients are more likely to be:

– younger than 18 – lower income – Hispanic, Asian, Black/African American and Native American – Diagnosed with a mental health disorder – Tobacco users – Alcohol/Drug abusers

• Improved timeliness and adequacy of

prenatal care

• Reduced early preterm delivery

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Nurse Family Partnership (NFP)

• Nationally recognized, evidence-based

model

• Serves low-income, first-time moms

and their infants (up to age 2)

• Services must be initiated prior to 28

weeks gestation

• Randomized, controlled trials

demonstrate better pregnancy

• utcomes, improved child health and

development, and increased economic self-sufficiency. These outcomes contribute to preventing child abuse, reducing juvenile crime, and increasing school readiness

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Oregon NFP

• 8 Counties (Multnomah, Washington, Deschutes, Umatilla, Morrow,

Lincoln, Lane and Jackson)

• In 2015, Oregon NFP served 971 women and 682 infants.
• NFP Outcomes

– 91% of NFP babies were born full-term in 2014 – 93% of NFP babies were born at a healthy weight (=>2500 g) in 2014 – 14% reduction in cigarette smoking among NFP moms during pregnancy in 2014 – 58% reduction in child abuse rates between 2013 and 2014 – 99% of NFP mothers report breastfeeding at birth, compared to 91% of Oregon WIC participants. – Nearly 60% of NFP mothers continue to breastfeed at six months, compared to 43% of Oregon WIC participants. – Immunization rates for two year-olds are more than 90% for NFP infants, compared to 74% statewide – 40% of mothers who entered the program without a diploma/GED have since earned one, and another 18% are working towards obtaining one

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Babies First!

• Babies First! serves children ages 0-5 who are at-risk for poor
• utcomes.
• Eligibility criteria include medical and social risk factors
• PHNs conduct assessment, screening, case management, and

health education.

• 4,258 children served in 2014
• Improved immunization rates (annual flu and 2 year-old)
• Increased attendance at well-child exams and annual dental exams

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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CaCoon

• Care coordination for children with special health needs
• CaCoon children have complex needs. CaCoon diagnoses

include cleft palate, developmental delay, Down syndrome, epilepsy, failure to thrive, hearing loss, heart and brain disorders, cerebral palsy, spina bifida, and cystic fibrosis.

• 1,821 children served in 2014
• CaCoon clients have higher immunization rates, well child visits,

primary care visits, and dental care.

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Proposed Metric: Recommendations

• Consider Home Visiting System

– Services provided prenatally and after birth

• Agnostic screening tool is a set of standardized questions that

can be built into EHR or branded and combined with other questionnaires

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Contacts

Cate Wilcox, MCH Section Manager Cate.S.WILCOX@state.or.us 971-673-0299 Anna Stiefvater, Perinatal Nurse Consultant Anna.K.STIEFVATER@state.or.us 971-673-1490

PUBLIC HEALTH DIVISION Maternal and Child Health Section

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Year 4 EDIE report discussion

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Year 4 EDIE measure

• Revised metric beginning in Year 4:

– Number of patients readmitted to the ED within 30 days of a visit when that patient has been seen in that same facility 5 times in previous 12 months – Hospital reporting needs?

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Best Practice Collaboration Discussion

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Wrap-up

• Next meeting: Tuesday, September 13, 10 am –

noon

• H-TAG webpage

www.oregon.gov/oha/analytics/Pages/Hospital-Metrics- Technical-Advisory-Group.aspx

• OHA contact for all HTPP related questions:

metrics.questions@state.or.us

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