Cleveland Clinic-Led Team Develops New Quality Index for Hospitals

In a major paper published in the journal Anesthesiology, a Cleveland Clinic-led research team announced the development of a new publicly available tool to help patients, regulators and hospitals compare patient outcomes and quality.

The Risk Stratification Index was developed using more than 35 million Medicare and Medicaid records, and then validated using more than 100,000 Cleveland Clinic patient records. A team led by Daniel I. Sessler, MD, Professor and Chair of Cleveland Clinic’s Department of Outcomes Research, used billing and procedure codes to develop the objective and transparent system which allows for outcomes to be compared across institutions and even among individual physicians.

Federal healthcare reform is placing a high value on healthcare quality, as measured by mortality, hospital readmissions and length of patient hospital stays, among other factors. As federal officials consider pay-for-performance reimbursement models for hospitals, the need for reliable, fair and equitable quality measures becomes imperative.

Hospitals that compare favorably can share best practices with other healthcare organizations or become regional centers of excellence. In either case, reliable quality measures would help drive quality and lower healthcare costs by steering patients toward the facilities that perform best and offer the best outcomes.

“Hospitals are already being compared,” Dr. Sessler said. “But comparisons only make sense after adjusting for baseline risk and the risks associated with different operations. Our Risk Stratification Index allows for an accurate and fair comparison among hospitals using only publicly available data.”

Cleveland Clinic worked with Covidien on interpreting the data for the Risk Stratification Index.

“Gathering accurate quality healthcare data is increasingly important,” said Douglas Hansell, MD, MPH, Vice President and Chief Medical Officer of Covidien, Respiratory and Monitoring Solutions. “When working with Cleveland Clinic on the Risk Stratification Index, the team took great care to develop an objective tool to fairly evaluate outcomes.”

Dr. Sessler said the quality of healthcare services is currently difficult to measure because institutions use various — often proprietary — systems to evaluate outcomes. To help deal with this problem, Dr. Sessler’s team developed objective risk-adjustment models for length-of-stay, and for in-hospital, 30-day and 1-year mortality.

The system is statistically stable to as few as 5,000 patients; thus even a small hospital can use it reliably. And a large hospital could use the system at frequent intervals to evaluate improvements in outcome.

“An important aspect of our Risk Stratification System is that it is entirely objective, reproducible and transparent,” Dr. Sessler said. “It does not include any adjustments or subjective fixes. Therefore, the system provides a fair basis for comparing outcomes among hospitals.

“Hospitals can adjust for their patients’ baseline level of illness and the risk associated with various procedures using only standard billing records — thus permitting important outcomes such as mortality to be fairly compared among hospitals,” Dr. Sessler said.

The investigators have put their Risk Stratification Index in the public domain; any entity can use it freely.

Dr. Sessler, Professor and Chair of the Department of Outcomes Research, Cleveland Clinic, was the study’s lead author. The co-authors were Jeffrey C. Sigl, PhD, Senior Director, Analytical Research, Covidien; Paul J. Manberg, PhD, Vice President, Clinical Research and Regulatory Strategy, Covidien; Scott D. Kelley, MD, Vice President and Medical Director-BIS, Covidien; Armin Schubert, MD, MBA, Professor and Chair, Department of Anesthesiology, Ochsner Clinic, New Orleans, Louisiana and Nassib G. Chamoun, MS, Vice President, Technology, Research and Clinical Development, Covidien.

About Cleveland Clinic

Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. It was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. About 2,100 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. In addition to its main campus, Cleveland Clinic operates nine regional hospitals and 15 Family Health Centers in Northeast Ohio, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and opening in 2012, Cleveland Clinic Abu Dhabi. In 2009, there were more than 4.6 million visits throughout the Cleveland Clinic health system and 170,000 hospital admissions. Patients came for treatment from every state and from more than 100 countries.

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