200810 HAPSHSAA PAO: Complex Continuing Care Indicators

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• 2008-10 HAPS/H-SAA PAO Complex Continuing Care
  Indicators
• Part B CCC Index Indicator

October 2007
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Overview

• This session covers Patient Access and Outcome
  Complex Continuing Care indicators in the 2008-10
  Hospital Annual Planning Submission (HAPS)
  Guidelines and Web-Enabled Reporting System
  (WERS)
• Part A Thirteen CCC Component Indicators
• Part B CCC Index Indicator
• Aimed at hospital and LHIN staff involved in the
  preparation and review of HAPS
• Updated and expanded as needed

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2008-10 HAPS/H-SAA Indicators Domains
Training Development
Financial Health
Organizational Health
Capital Health IT/Med Equipment
Turnover Rate
Paid Sick Time (Full-time)
Operational Efficiency
Vacancy Rate
Paid Overtime (Full-time Part-Time)
Capital Health Facility Condition Index
Nursing FTE
Current Ratio Consolidated
Staff Satisfaction
Total Margin Sector Code 1
Workplace Safety Indicators
Total Margin Consolidated
Readmissions to Own Facility
Readmissions (All Facilities)
CCC Skin Ulcers
Mental Health
CCC Index Indicators
ALC Indicators
Volumes
Rehab Indicators
ED Indicators
Stroke Care Index Indicators
Patient Safety
Hospital-CCAC Integration Indicators
System Integration
Patient Access Outcomes
HSMR
Adult IP Sat Indicators
ED Sat Indicators
Paediatric Sat Indicators
Patient Experience
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2008/10 HAPS/H-SAA - PAO CCC Indicators

• Performance Indicator
• New Stage 2 or Greater Skin Ulcers (no change)
• Monitoring Indicators
• Presence of Indwelling Catheters (no change)
• Improvement in Performance of Activities of Daily
  Living (no change)
• Presence of Disruptive or Severe Pain (no change)
• Decrease in Bladder/Urinary Continence (no
  change)
• Presence of Patients in Daily Physical Restraints
  (no change)
• New to hospital accountability no change to
  indicator calculation
• Decline in Ability to Walk or Wheel Self
• Increase in Depression or Anxiety
• Communication Decline
• Patients with New Falls
• Presence of Pressure Sores
• Use of Antipsychotic Medication Without a
  Diagnosis of Psychosis
• Short-Stay Patients With Disruptive or Severe
  Pain

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2008/10 HAPS/H-SAA - PAO CCC Indicators

• Explanatory Indicators
• None
• Developmental Indicators
• CCC Quality of Care Index (new)

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2008/10 HAPS/H-SAA - PAO CCC Indicators

• Indicator definitions are based on number of
  assessments that meet the criteria described in
  the Hospital Report 2007 Complex Continuing Care
  www.hospitalreport.ca
• Assessments must meet the definitions for both
  the numerator and denominator
• For HAPS, a minimum sample size of 30 cases is
  required for calculation of individual
  indicators 200 cases for calculation of index
  indicator

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Developmental Indicator CCC Quality of Care Index

• Requirements for Composite Indicator
• Administrative and Policy sensibility
• Clinical sensibility
• Statistical credibility
• Proposed aggregation approach
• Common Odds Ratio

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CCC Quality of Care Index Component Indicators

• Indicator component data structure
• Event data
• Presence/absence of event per individual
  observation dichotomous variable
• Risk markers for event for each observation
• Multiple cohorts of subjects
• Event definition specific to each cohort
• Multiple facilities

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CCC Quality of Care Index Common Odds Ratio

• Odds Ratio the ratio of the probability of
  occurrence of an event to the probability of the
  event not occurring
• Several indicators of quality in CCC for each
  hospital each estimates the facilitys results
  compared to those expected within Ontario
  hospitals.
• Each estimate can be expressed as an odds ratio
• Separate indicator component odds ratio estimates
  are combined to form an estimate of the common
  odds ratio
• Eligible Hospitals
• Sum of indicator component denominators at least
  200 in previous year

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CCC Quality of Care Index Common Odds Ratio
Calculation Steps

• Hospital Report adjusted score (observed/expected
  provincial standard rate) for each indicator
  within each facility is used as the basis for the
  common odds calculation
• Adjusted scores (reported as a percentage) are
  multiplied by the indicator/facility denominator
  to create an adjusted numerator for each
  indicator/facility
• Adjusted numerators and denominators are treated
  as simple binomial outcomes and input into a
  logistic regression with additive components for
  each facility and each indicator domain
• Facility coefficients are centered on the median
  of all facilities coefficients ? common log odds
  ratios for the facilities compared to the median
  facility value
• Confidence intervals (for difference from the
  median) are calculated from the ANOVA from the
  logistic fit.

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CCC Quality of Care Index Interpretation

• The facility common odds ratio is the ratio of
  the overall facility odds of an event compared to
  overall expected odds of an adverse event
  (estimated across all facilities)

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CCC Quality of Care Index Data Requirements

• Ongoing estimate of raw effects
• Can be continuously updated by hospital
• Interim estimate of adjusted effects
• Quarterly feed from CIHI/MOHLTC
• Spreadsheet tool to calculate estimate of common
  odds to be made available
• Final results depend on the risk-adjusted
  estimates calculated by CIHI

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Monitoring the Common Odds Ratio

• Excel tool to be provided on www.jppc.org to
  convert raw CCC indicator values into the
  estimated common odds ratio for the facility

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More Information

• Clinical Utilization and Outcome Technical Report
  (Hospital Report 2007 Complex Continuing Care)
  www.hospitalreport.ca/downloads/2007/ccc_2007.htm
• Appendix F Clinical Utilization and Outcomes
  Indicator Definitions (Hospital Report 2003
  Complex Continuing Care) www.cms.hhs.gov/quality/n
  hqi
• Other e-learning and background materials in this
  series are posted on www.oha.com, with links on
  WERS, FIM, LHIN and JPPC websites
• If you have questions, please contact your local
  LHIN www.lhins.on.ca

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We Welcome Your Feedback

• For more information on this e-Learning series or
  other initiatives of the LHIN-JPPC Communication
  Education Work Group please contact
• Mimi Lowi-Young, Chair
• c/o Ontario Joint Policy and Planning Committee
  (JPPC)
• 415 Yonge Street, Suite 1200
• Toronto, ON M5B 2E7
• Tel [phone] Fax [phone]
• www.jppc.org