Mildred Stahlman, M.D.
VUMC leaps to forefront in report tracking care quality, patient safety
A recent report from a coalition of U.S. employers confirms Vanderbilt's standing as a national leader in adopting measures for patient safety and health care quality.
The report is from the Leapfrog Group, 150 large companies providing health benefits to more than 34 million consumers spread among all 50 states.
“I was very impressed to see just what an elite group of hospitals Vanderbilt turned out to be in,” said VUMC Chief Medical Officer C. Wright Pinson, M.D. “Vanderbilt is being recognized for investments in areas such as computerized physician order entry and staffing of intensive care units. This is the kind of independent external evaluation that many patients and payers look to for assistance in making their evaluations. Our current and prospective patients and payers should be comforted that Vanderbilt is rated among the very best health care providers.”
The Leapfrog Group includes many of the best known names in business — Coca-Cola, IBM, Xerox, General Motors and so on. It was founded in 2000 by The Business Roundtable, an association of Fortune 500 CEOs. The idea behind Leapfrog is to encourage hospitals to undertake certain important “leaps” in quality and patient safety.
The 2004 Leapfrog Group Hospital Quality and Safety Survey takes in 1,664 hospitals located in 24 regions where the member companies in Leapfrog are considered to have large concentrations of employees. East/Mid Tennessee is one of the targeted regions. Volunteering to be in the survey were another 441 hospitals located outside the targeted regions. In all, the survey takes in 2,105 of the nation's approximately 3,900 Medicare-approved acute care hospitals.
Respondents to the survey receive separate scores for each of four quality and safety “leaps”: (1) use of computers by physicians to enter hospital orders; (2) staffing of intensive care units by physicians especially trained to care for critically ill patients; (3) outcomes, process and patient volumes associated with selected high-risk treatments; and (4) adherence to 27 patient safety practices advocated by the National Quality Forum (another private organization devoted to health care quality measurement and reporting).
For each leap, the possible scores range from 0 to 4, with 0 denoting the absence of any response from the hospital regarding the leap and 4 denoting full implementation. The Vanderbilt scores are combined scores for Vanderbilt University Hospital and the Monroe Carell Jr. Children's Hospital at Vanderbilt.
Vanderbilt scored 4s for computerized order entry, intensive care staffing and adherence to National Quality Forum patient safety practices. Vanderbilt was one of only 12 hospitals in the entire survey that achieved 4s for all three of these leaps, and was the only hospital in Tennessee to do so.
This put Vanderbilt in the company of Brigham and Women's Hospital, Massachusetts General and other renowned hospitals.
The report assigns separate scores for six high-risk treatments: coronary artery bypass, percutaneous coronary intervention, abdominal aortic aneurysm repair, esophagectomy, pancreatic resection, and high-risk deliveries/neonatal intensive care.
The survey is designed not to penalize hospitals that make a practice of referring high-risk cases to other hospitals.
Patient volume is considered relevant because studies have shown that, for some procedures, providers who do more of the procedure achieve better outcomes.
In addition to patient volume, the survey looks at outcomes for these six treatments and at adherence to clinical practices known to improve outcomes.
Vanderbilt and two other Nashville hospitals were reported as providing all six of the high-risk treatments. Out of 24 possible points for the six treatments, Vanderbilt scored 20, making it the top performer, followed by Centennial with 18 points and Baptist with 16 points.
St. Thomas Hospital was reported as not providing high-risk deliveries/neonatal intensive care, and out of 20 possible points for the remaining five treatments, this competitor scored 18 points.
Vanderbilt experts applaud the Leapfrog survey design.
“Leapfrog has picked a set of criteria that virtually no one can argue with,” said F. Andrew Gaffney, M.D., VUMC chief quality and patient safety officer. “Providers who have pointed out the shortcomings of typical hospital comparisons are beginning to be heard.”
Gaffney said hospital outcomes comparisons commonly under-adjust for large variances in risk and thus penalize providers who accept more complex cases.
He added that outcomes comparisons also commonly rely on Medicare data that is typically two to three years out of date.
According to Beverley Coccia, director of Managed Care Sales and Service for Vanderbilt, the Medical Center stands to benefit from its exceptional showing in the survey.
“The major payers in Middle Tennessee are certainly very aware of the Leapfrog survey,” Coccia said.
“Nationally and in our region, no other health care quality and patient safety report approaches Leapfrog in terms of attention paid by employers and insurance carriers.”
Healthcare 21 Business Coalition (www.hc21.org), a group that wants to improve the quality and cost of health care in Middle and East Tennessee, will include Leapfrog results as part of its 2004 Hospital Consumer Guide, distributed free to member companies.
For more information see the Leapfrog Web site, www.leapfroggroup.org.