200708 Hospital Accountability Agreement Indicators

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2007/08 Hospital Accountability Agreement
Indicators
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Overview

• The HAA Indicator Classification Framework
• HAA Indicators for 2007/08
• Performance
• Monitoring
• Developmental
• Explanatory
• Volumes

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Indicator Classification Framework
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Hospital Accountability Indicator Criteria

• Primary Criteria
• Direct measure (or potential measure) of Ministry
  strategic goal or priority
• Construct validity
• Evidence basis
• Within hospital control
• Responsiveness to change
• Secondary Criteria
• Availability and timeliness of data
• Data quality and reliability
• Acceptability and familiarity

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Indicator Classes

• Performance Indicators Variance from corridor
  will trigger consequences under HAA (same
  definition).
• Monitoring Indicators No consequences
  associated with corridor used to support
  negotiations and planning.
• Developmental Indicators No consequences
  associated with indicator further work required
  to ensure data quality, timeliness, accuracy may
  graduate.
• Explanatory Indicators No consequences
  provides operational information. Supports
  negotiation, problem-solving, and planning (with
  some limitations).

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HAA Indicators for 2007/08
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Performance Indicators for 2007/08
Financial Health
Organizat-ional Health
Pt Access Outcomes
System Integration

• Total Margin
• Current Ratio

- Percentage Full Time Nurses

• Risk of Readmission (to own facility) for
  Selected CMGs
• Percentage of Chronic Patients with New Stage 2
  or Greater Skin Ulcers

None

• Total Acute Activity, inc Inpatient Day
  Surgery Mental Health Inpatient Separations
  Eldcap Complex Continuing Care Rehabilitation
  Ambulatory Care Emergency Visits

Volumes
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Summary of Changes Performance Indicators

• Refinement of Risk of Readmission to Own Facility
  indicator
• Expansion of CMGs (GI and Cardiac)
• Discontinuation of CMGs with relatively low
  readmission levels and high transfer rates
• Joint Replacement for Trauma (CMG 351)
• Hip Replacement (CMG 352)
• Femur or Pelvic Procedures for Trauma (CMG 662)
• Refinements to corridor calculation based on
  Actual less Targeted Performance
• Addition of CCC indicator
• Percentage of patients with new stage 2 or
  greater skin ulcer
• LOS indicators
• Acute LOS retired
• Total LOS now explanatory indicator

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Volumes

• Volume corridors have not yet changed as data was
  updated last year using 2004/05 data
• Ministry targets are typically based on
  historical volumes
• IPBA results provide information into negotiation
  process only

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Volumes

• Pending issues
• Impact of change in CMG definitions
• Mental Health Reporting System
• Consideration of acute volume segmentation
• E.g. elective/urgent or program-based

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Monitoring Indicators for 2007/08 HAA
Financial Health
Organizat-ional Health
Pt Access Outcomes
System Integration

• Operational Efficiency

- Percentage Sick Time Hours to Total Earned Hours

• of ED Patients (Triage Levels I,II,III) where
  LOS is Less than 6 Hours
• of ED Patients (Triage Levels IV,V) where LOS
  is Less than 4 Hours
• Risk of Readmission (to any facility)
• Change in FIM Score (Stroke RCGs only)
• Total Rehabilitation LOS (Stroke RCGs only)
• of Chronic Patients with Rehab Potential who
  Improved in Performance of ADL
• of Chronic Patients with Pain (long-stay)
• of Chronic Patients whose Bladder Continence
  Worsened
• of Chronic Patients in Physical Restraints
  Daily

- Percentage of ALC days
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Summary of Changes Monitoring Indicators

• Addition of Indicators
• Organizational Health
• Sick time indicator for full-time staff (using
  hours)
• Patient Access and Outcomes
• ED indicators
• Percentage of visits within target LOS timeframe
  (by triage grouping)
• Rehab indicators
• Change in FIM function and total LOS for stroke
  RCG cases
• CCC quality indicators
• Risk of Readmission to Own Facility
  evidence-based target Congestive Heart Failure
• System Integration
• Mean number of ALC days per separation
• Retiring of
• Timeliness to discharge home
• Timeliness to discharge to home care

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Developmental Indicators for 2007/08 HAA
Financial Health
Organizat-ional Health
Pt Access Outcomes
System Integration

• NEER Performance Index
• Overtime Hours
• MOS UPP Earned Hours (patient care areas only)

• stroke patients managed on designated acute
  stroke unit at any point during hospitalization
• ischaemic stroke patients discharged on
  antithrombotic therapy unless contraindicated
• stroke patients with atrial fibrillation
  treated with anticoagulant therapy unless
  contraindicated
• stroke patients who receive CT/MRI prior to
  hospital discharge
• stroke patients discharged to home or place of
  residence
• patients discharged to inpatient rehabilitation
• of AMI Patients Treated with Primary PCI or
  Thrombolysis
• ED Time to Admission
• Wait Times wait times within Ontario
  priority-based wait time target for cataract,
  cardiac bypass, cancer surgery, hip and knee
  replacement and MRI/CT scans

• Attainment of Early Post-Acute Home Care
• Timeliness to First Home Care Visit
• Intensity of Home Care
• Proportion of Referred Pts Receiving Home care

• Capital Health
• Other measures of Operational Efficiency

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Summary of Changes Developmental Indicators

• Organizational Health
• Reclassification of NEER index (to allow for
  development of interpretation guidelines)
• Addition of
• Percentage of overtime hours
• MOSUPP earned hours
• Patient Access and Outcomes
• Suite of Stroke Strategy indicators
• Percentage of AMI pts treated with primary PCI or
  Thrombolysis
• ED time to admission
• Suite of Wait Time Strategy indicators
• System Integration
• Measures of hospital-home care integration
• Timeliness of home care (2 indicators)
• Intensity of post-acute home care (2 indicators)

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Explanatory Indicators for 2007/08 HAA
Financial Health
Organizat-ional Health
Pt Access Outcomes
System Integration

• Total Margin (Hospital Sector Only)

• Relative Total LOS
• Rehab LOS Efficiency
• Rehab Change in FIM function score with LOS and
  patient adjustments

• Propensity to Refer to Home Care

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Summary of Changes Explanatory Indicators

• Financial Health
• Total Margin (Hospital Sector Only) to evaluate
  influence of other sources on consolidated total
  margin
• Patient Access Outcomes
• Total LOS indicator (reclassified as monitoring)
• Rehab indicators
• LOS efficiency
• Change in FIM function (with LOS and patient
  adjustments)
• System Integration
• Refinement to Propensity to Refer (Discharge) to
  Home Care

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Summary of Indicators
Source HAPS, pp 17-18
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Summary of Indicators
Source HAPS, pp 17-18
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Summary of Indicators
Source HAPS, pp 17-18
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