Wednesday, April 15, 2009

Leapfrog Reports

The Leapfrog Group has issued the following release today. As you can see on the site, we do quite well on the Leapfrog Standards and have for some time, and they are certainly worthwhile, but they do not address real questions of process improvement in the hospitals, which are more complex and probably ultimately more meaningful. As you can see on this blog, we are working on those challenges and reaching out to the world's leaders in this arena, but truthfully very few mentors or examples exist for comparison and assistance. And, most organizations who focus on such matters are not well attuned to the environment of academic medical centers.

Few Hospitals Meet Standards for First National Measures of Hospital Efficiency for Heart Attack Care, Bypass Surgery, Heart Angioplasty, and Pneumonia

Detailed Hospital by Hospital Results Available at

WASHINGTON, April 15 /PRNewswire-USNewswire/ -- Though it has been 10 years since the Institute of Medicine's Landmark report on the failure of U.S. hospitals to adequately protect patient safety, too many hospitals still have failed to implement standards known to improve quality and save lives.

According to the 2008 Leapfrog Hospital Survey, released today, only 7% of hospitals fully meet Leapfrog medication error prevention (CPOE) standards and low percentages of hospitals are fully meeting mortality standards (see below).

"As the Obama administration and Congress consider health care reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation's $2.3 trillion annual investment," said Leapfrog CEO Leah Binder. "According to our data, a majority of hospitals have significant safety and efficiency deficits."

"As the President has often stated, a reformed high value health care system needs to be cost-effective. Unfortunately, few hospitals are meeting Leapfrog's newly established efficiency measure standards the first such data available in the public domain," said Binder.

Among surveyed hospitals, efficiency standards defined as highest quality and lowest resource use are met by only 24% of hospitals for heart bypass surgery, 21% for heart angioplasty, 14% for heart attack care, and 14% for pneumonia care.

Other highlights of the 2008 hospital survey, include:

-- Relatively low percentages of reporting hospitals are fully meeting volume and risk-adjusted mortality standards, or adhering to nationally endorsed process measures for eight high risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:

    --  43% for heart bypass surgery
    --  35% for heart angioplasty
    --  32% for high-risk deliveries
    --  23% for pancreatic resection
    --  16% for bariatric surgery
    --  15% for esophagectomy
    --  7% for aortic valve replacement
    --  5% for aortic abdominal aneurysm repair

-- Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).

-- Seventy-five percent do not fully meet the standards for 13 evidence-based safety practices, ranging from hand washing to competency of the nursing staff.

-- Only 26% and 34% of reporting hospitals are fully meeting standards for treating two common acute conditions, heart attacks (AMI) and pneumonia, respectively.

-- Only 30% and 25% of hospitals are fully meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.

"In spite of huge opportunities for improvement, many hospitals are, in fact, demonstrating quality excellence and serving as role models," said Binder. "We need to take the lessons learned from the best hospitals and use these to move the status quo forward so all Americans have access to safe, cost-effective care."

Notable improvements by surveyed hospitals in 2008 include:

-- Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from just 10% in 2002.

-- Hospitals with all of Leapfrog's recommended policies in place to prevent common HAIs jumped from just 13% to 35% between 2007 and 2008.

-- Sixty percent of hospitals have agreed to implement Leapfrog's "Never Events" policy when a serious reportable event occurs within their facility.

"Progress on patient safety is moving too slowly," according to Binder. "Consumers and purchasers of health care want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death. The safety goals Leapfrog promotes are achievable. More hospitals should be meeting the Leapfrog standards for common and high risk procedures."

The voluntary Leapfrog Hospital Survey results are as of December 31, 2008, and include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 48 percent of the urban, general acute-care hospitals (53 percent of hospital beds in these areas),

Last year, Leapfrog launched an updated Web site to make it easier for consumers to review and compare vital local hospital safety information, including all of the measures referenced in the Survey.

Individual hospital results can be viewed and compared with other hospitals here.

The Leapfrog Group. On behalf of the millions of Americans for whom many of the nation's largest corporations and public agencies buy health benefits, The Leapfrog Group aims to use its members' collective leverage to initiate breakthrough improvements in the safety, quality, and affordability of health care for Americans. The Leapfrog Group was founded in November 2000 by the Business Roundtable and is supported by its members, the Robert Wood Johnson Foundation, The Commonwealth Fund, the Agency for Healthcare Research and Quality and other sources.

Thomson Healthcare provides data collection, analysis and support services to The Leapfrog Group. The leading provider of decision support solutions that help organizations across the healthcare industry improve clinical and business performance, Thomson Healthcare products and services help clients understand healthcare markets, access medical and drug information, manage costs, and improve the quality of healthcare. Thomson Healthcare is part of The Thomson Corporation (NYSE: TOC; TSX: TOC).


Anonymous said...

Knowledgeable clinicians recognize that Leapfrog standards, while noble and well-intended, are not true measures of care quality. They are payers attempts to get quality for money, which is admirable. However, compliance with Leapfrog standards has never been shown by true scientific analysis to be statistically significantly linked to high quality clinical outcomes. Many programs who do not comply delver excellent care.

Leapfrog is a coalition of Fortune 500 CEOs who set these standards. I would daresay that they perhaps should take a look at our present economy pay more attention to their own businesses than ours.

Anonymous said...

Our business is, in fact, an important part of their business. The cost of health care is one reason American firms have trouble being competitive in world markets.

I remember when Leapfrog started and American medicine said, "Those are the wrong measures." You can't have it both ways, i.e., say they are wrong and then not offer alternatives.

Hal Andrews said...

Doesn't process improvement start with an understanding of where variance is, followed by root cause analysis of what the variance is and why it exists?

The variance in day-to-day outcomes at individual hospitals is readily available from public data, yet hospital executives do not use it. Why?

Anonymous said...

Thank you for such an informative post. Making information of this kind available to the public is always of tremendous benefit.

In Canada, the OHA has officially launched a new website called For the first time, this website allows members of the public to genuinely understand how their local hospital is performing, and takes what used to be complex and dense information and translates it into clear, plain language that is easy to access, read and understand.

On Wednesday, April 29, 2009 from 1:00 to 2:00 p.m., the OHA is offering a live webinar demo of its site, which provides information about the performance of Ontario's hospitals. Click here to register:

Anonymous said...

Speaking of quality measurement, see Dr. Wachter's post on this subject and read the comments.....

.....and the battle goes on.