An Introduction to NACHRI Analytics

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An Introduction to NACHRI Analytics

• Mary Gorman
• V.P., Education, Member Services
• Management Information Services
• Mitch Harris, PhD
• Director, Research Statistics

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Webinar Logistics
Webinar will last approximately one hour a 45
minute presentation and 15 minutes for
questions Sessions will be recorded and posted
to NACHRI website within 48 hours Please put
your phone on mute (not Hold!) until it is time
for questions Please save your Adobe Connect
password - you may register for additional
webinars with the same username and password If
you have difficulty during the webinar, please
call 703/684-1355 and ask for Vikki Sara
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NACHRI Analytics Discover the Value of Our
Research and Analysis
September Webinar Series
A month-long series of educational programs
exploring how NACHRI Analytics - a suite of data,
benchmarking, and quality improvement programs
and statistical services - can make a difference
for your hospital and childrens health
care. The webinars are free and open to NACHRI
members, but require registration. 
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Why do this Webinar Series?

• .robust, credible, and reliable data are
  available.
• .members are knowledgeable about and have easy
  access to NACHRI data resources and services.
• .NACHRI is an indispensible source for data and
  applied research.

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Todays Objectives
Introduction to the tools and databases available
to members Examples of how NACHRI Analytics
support childrens hospitals operations and
advance the health and well-being of all
children Encourage broader participation in
these databases and utilization of these services
across the membership
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Introduction to the tools and databases available
to members
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Overview

• NACHRI Analytics tools databases
• Clinical Productivity and Staffing Program (CPSP)
• Annual Survey on Utilization and Financial
  Indicators of Childrens Hospitals
• Survey Center
• VPS, LLC
• FOCUS Groups
• Pediatric Quality Measurement System (PQMS)
• Case Mix Comparative Data Program

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Clinical Productivity Staffing Program (CPSP)
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What is CPSP?

• A comparative data program which provides a
  single access point for pediatric staffing and
  utilization information for the inpatient and
  outpatient settings.

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CPSP

• Target Audience / Primary Users
• - Nurse Executives - Directors of Patient Care
• - Nurse Managers - Business Operations Staff
• - Budget Analysts - Quality Specialists
• - Financial Analysts - Performance Improvement
  Staff
• Questions that are answered by CPSP
• - How does my unit compare to others regarding
  worked hours per patient day?
• What is my units trended performance in percent
  daily turnover and average patients treated per
  day?
• What impact will specific changes in my units
  staff mix have?

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CPSP

• Inpatient
• Access to over five (5) years of data
• Data on 22 inpatient units (e.g. PICU, Med/Surg,
  etc.)
• 50 hospitals
• Outpatient
• Clinic level data for tracking, trending,
  managing, and benchmarking for 21 clinic types
• Direct Clinic Hours and Time by Staff Category

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CPSPAdditional Information

• Clinical Productivity and Staffing Program (CPSP)
  Webinar Staffing and Utilization Benchmarking
  Opportunities, Thursday, Sept. 4
• NACHRI Contact Sharlene Davis
• sdavis_at_nachri.org
• 703/797-6026

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Annual Survey on Utilization and Financial
Indicators of Childrens Hospitals
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What is the Annual Survey?

• The NACHRI Annual Survey collects information on
  the utilization, operating, and financial aspects
  of childrens hospitals and provides the ability
  for hospitals to benchmark against like
  institutions.

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Annual Survey

• Target Audience / Primary Users
• - Finance Staff - Public Policy Staff
• - Decision-Support Staff - Public Relations
  Staff
• Strategic Planning and Development Staff
• Questions that are answered by the Annual Survey
• How does my hospital compare to peers regarding
  certain inpatient utilization indicators?
• How does my hospitals trended financial
  performance compare to other childrens
  hospitals?
• What programs and services are provided at
  different childrens hospitals?

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Annual Survey

• NACHRI Annual Survey on Utilization and Financial
  Indicators of Childrens Hospitals web-based
  since FY2000 survey
• Historic data back to 1994
• Average 150 hospitals participating
• Information vital to NACHRI/N.A.C.H. benchmarking
  and public policy activities

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Annual SurveyAdditional Information

• Annual Survey Webinar Providing Children's
  Hospital Statistics, Friday, Sept. 5
• NACHRI Contact Donna Shelton
• dshelton_at_nachri.org
• 703/797-6020

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• VPS, LLC
• A clinical database dedicated to standardized
  data sharing and benchmarking among pediatric
  ICUs.

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VPS, LLC

• Target Audience / Primary Users
• - ICU Clinicians (Physician/Nursing/Fellows)
• - ICU Administrative Staff
• - Quality Specialists
• Questions that are answered by VPS
• How does my units severity adjusted mortality
  rate compare to other ICUs?
• What are the most common conditions treated in
  ICUs?
• - How do the type and number of interventions
  performed at my unit compare to other ICUs?

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VPS, LLC

• A partnership between NACHRI, Childrens Hospital
  Los Angeles, and the National Outcome Center of
  Childrens Hospital of Wisconsin in Milwaukee
• Expanse of data elements covering the PICU care
  experience from admission through discharge,
  including severity of illness indicators
• Standardized comparative clinical dataset of over
  225,000 cases and 74 participating units

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VPS, LLC Additional Information
VPS Webinar Bridging Research, Quality
Improvement, and Management for Childrens
Hospitals, Tuesday, Sept. 9 NACHRI Contact
Lesley Sedehi Staff_at_VPSLLC.org 703/797-6099
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Patient Care FOCUS Groups
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What are FOCUS Groups?

• NACHRI FOCUS Groups are multidisciplinary teams
  from childrens hospitals that address pressing
  issues affecting quality and cost-effective care.
  The FOCUS Groups experience offers hospitals an
  opportunity to use peer consultants in a
  facilitated learning environment to benchmark and
  improve practices and processes.

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FOCUS Groups
Target Audience / Primary Users - Department
Directors (both Nurses and Physicians) -
Financial Analysts - Quality Specialists -
Business Operations Staff - Performance
Improvement Staff Questions that are answered by
FOCUS Groups - What is the ideal number of
nurses needed to safely care for critically ill
children? - What are childrens hospitals best
practices regarding clinic appointment
readiness? - How do you improve patient flow in
the emergency department?
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FOCUS Groups

• Since 1994, NACHRI has provided an organized
  effort to improve the quality of care provided to
  children through its FOCUS Group Initiatives.
•  
• FOCUS Group areas for 2008
• Ambulatory - PICU
• Emergency - Oncology/BMT
• 8-25 hospitals in a FOCUS Group
• Accomplish their work over the course of one year

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FOCUS GroupsAdditional Information

• FOCUS Groups Limitless Networking Opportunities
  Webinar, Wednesday, Sept. 10
• NACHRI Contact Lynne Lostocco
• llostocco_at_nachri.org
• 401/732-8111

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Pediatric Quality Measurement System (PQMS)
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What is PQMS?
NACHRI PQMS is a measurement tool used by the
childrens hospital community to collect, report,
and collaborate on quality measures that apply to
their unique patient population.
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PQMS
Target Audience / Primary Users - Directors of
Patient Care - Quality Specialists - Performance
Improvement Staff Questions that are answered by
PQMS - How does my hospital perform regarding
the use of relievers and systemic corticosteroids
for inpatient asthma? - How does my hospitals
low acuity pediatric asthma ALOS and readmission
rate compare with other childrens hospitals?
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PQMS

• 47 participating hospitals
• An online measuring tool
• Reporting the first Joint Commission core measure
  specific to pediatrics Childrens Asthma Care
  (CAC)
• Incorporation of both NACHRI and CHCA (non-core)
  measures
• Offers Hospital Based Inpatient Psychiatric
  Services (HBIPS) core measure

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PQMSAdditional Information

• Pediatric Quality Measurement System (PQMS)
  Webinar Single Solution for Core and Non-core
  Reporting, Tuesday, Sept. 23
• NACHRI Contact Charles Murray
• cmurray_at_nachri.org
• 703/797-6038

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Case Mix Comparative Data Program
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What is Case Mix?

• The Case Mix Comparative Data Program is a highly
  flexible information system containing a wealth
  of nationally representative pediatric inpatient
  data that allows users to create internal
  benchmarks and contrast own hospital experience
  against truly comparable data.

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Case Mix
Target Audience / Primary Users - Directors of
Patient Care - Quality Specialists - Department
Managers - Performance Improvement Staff -
Business Operations Staff - Decision-Support
Staff - Financial Staff - Public Policy Staff -
Strategic Planning and Development
Staff Questions that are answered by the Case
Mix database - How does my hospitals CMI and
Wage Adjusted Charges per case compare with other
childrens hospitals? - In which of 16 key
departmental cost buckets does your hospital
vary compared to your peers? - What is your
hospitals observed-vs.-expected mortality ratio
for specific clinical conditions?
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Case Mix

• 89 NACHRI members currently contributing
• 44 Freestanding
• 39 Childrens hospitals within hospitals
• 6 Specialty
• Access to over 5 million records from 2000-2008
  1st Quarter

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Case MixAdditional Information

• Case Mix Webinar A Health Care Data Repository,
  Wednesday, Sept. 24
• NACHRI Contact Dukhbhanjan Kaur (D.K.)
• dkaur_at_nachri.org
• 703/797-6071 

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Program Participation Fees
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Examples of how NACHRI Analytics support
childrens hospitals operations and advance the
health and well-being of all children
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Applications Utility of NACHRI Analytics

• Supports internal decision-making and
  benchmarking
• Custom peer group analyses
• Quality improvement initiative identification
• Cost savings initiatives
• Protocol identification and implementation

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Applications Utility of NACHRI Analytics

• Collective Good
• NACHRI is an indispensable source for data and
  applied research which support the health and
  well-being of all children

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Public Policy Research
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CHGME

• Information from Case Mix, Annual Survey and
  other NACHRI surveys provides qualitative and
  quantitative arguments for program authorization
  and funding appropriations
• Childrens Hospital Graduate Medical Education
  Payment Program re-authorized for 5 years
• gt2b appropriated since 2000
• Case Mix data provides CMI for annual hospital
  applications

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Community Benefit

• Challenges to hospital tax-exempt status at state
  and federal levels
• New reporting requirements mandated by some
  states and redesigned IRS Form 990/Schedule H
• NACHRI Community Benefit FOCUS Group and survey
  provided insight and guidance for public
  comments, CHA guidelines revisions, and future
  deliverables

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Public Policy Research Additional Information

• Data-driven Public Policy Webinar Advocating for
  Children's Health and Children's Hospitals,
  Thursday, Sept. 11
• NACHRI Contact Donna Shelton
• dshelton_at_nachri.org
• 703/797-6020
•  

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NACHRI Examination of the Agency for Healthcare
Research and Quality (AHRQ)Pediatric Quality
Indicators (PDI)
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NACHRI Examination of the AHRQ PDIs

• Software applied to data from 2003-2005 from 76
  Childrens Hospitals to obtain rates of events
• Subsequently, clinicians from 28 hospitals
  volunteered to do retrospective chart reviews of
  a sample of patients identified as having a
  potentially preventable patient safety eventdone
  chronologically from most recent charts
• Reviews done via secure chart review web tool
• Pre-populated patient information (age, sex,
  admit date, diagnoses, procedures, etc.)
• PDI specific review questions (Is this patients
  principal diagnosis correct?  Was this event
  preventable?, etc.)
• Hospitals reviewed 10 charts per PDI
• 11 PDIs of interest 10 charts for each PDI 110
  charts per hospital total
• A total of 1703 charts and 1890 events were
  reviewed

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NACHRI Examination of the AHRQ PDIs
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• Lifecycle of NACHRI
• Quality Indicator Assessment Project

NACHRI Case Mix Database
Data
Reports
AHRQ Quality Indicators
Pediatric Quality Measurement Advocacy
Assessment Project
Improvement Projects
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Pediatric Quality Indicators Additional
Information

• Pediatric Quality Indicators (PDIs) Webinar
  Focus on Potentially Preventable Complications
  for Pediatric Patients, Thursday, Sept. 25
• NACHRI Contact Mitch Harris
• mharris_at_nachri.org
• 703/797-6072

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Collaborative on Eradicating Catheter-Associated
Bloodstream Infections (CA-BSIs)
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Examination of CA-BSI Risk Factors

• Average CA-BSI rate for collaborative was reduced
  by almost 50 across 29 PICUs
• Despite this significant improvement, over 300
  CA-BSI events were still reported in the 29 units
  during the initial 15 month period
• Research undertaken to better understand the
  residual CA-BSI cases and identify risk factors
  which could inform next steps in improvement
  efforts
• Examination of clinical and demographic
  characteristics for those patients with central
  lines who did have events with those patients
  with central lines who did not have events

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Examination of CA-BSI Risk Factors
VPS Database
Inclusion of all patients with central lines
CA-BSI Collaborative Database
Identification of Patients with CA-BSI
Patients with central lines No CA-BSI
Patients with central lines CA-BSI
Examination of differences in clinical and
demographic characteristics
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Adherence to Screening Guidelines in Cases of
Suspected Physical Abuse
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Adherence to Screening Guidelines in Cases of
Suspected Physical Abuse

• Recommendations for screening suspected infant
  victims of physical abuse for occult injuries
  have been developed by the American Academy of
  Pediatrics
• There is little information regarding adherence
  to the guidelines for screening and whether the
  presence and characteristics of child abuse
  services have an impact on adherence to
  guidelines for screening
• Hypothesize that adherence to screening
  guidelines will be impacted by whether a hospital
  has child abuse services and by the
  characteristics of those services that are
  available

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Adherence to Guidelines and Availability of Child
Abuse Services
Level of hospitals child abuse services
NACHRI 2008 Child Abuse Services Survey
Patient age, race, and injury severity Case Mix
Database
Hospitals adherence to occult injury screening
guidelines
Case Mix Database
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Questions?