Leapfrog Group jumps at chance to give consumers health care info

Consumers and hospitals benefit from public information

Consumers have more information available to them to when purchasing dishwashers than they do to find a good hospital. That, says Suzanne Delbanco, PhD, is part of what inspires her work as executive director of The Leapfrog Group in Washington, DC, an assembly of 100 employers working to improve patient safety and help consumers make more informed hospital choices.

In January, the group released the results of its first hospital survey, covering 248 hospitals in six regions. The group asked responding facilities for information on their use of computerized physician order entry (CPOE) systems, whether they use intensive care specialists, and the volumes the facilities have for several specific procedures, including:

  • coronary artery bypass graft surgery (CABG);
  • coronary angioplasty;
  • abdominal aortic aneurysm repair;
  • carotid endarterectomy;
  • esophageal cancer surgery;
  • high-risk deliveries and the availability of neonatal intensive-care units (ICUs).

"The biggest surprise in the survey results was the willingness of facilities to participate," says Delbanco. "Especially since this is a new initiative."

She also was impressed with the number of hospitals that either met Leapfrog standards, or had plans to implement them in the near term. "In urban areas, it is clear that there is a choice of hospitals for consumers that will have these safety practices," says Delbanco.

Despite the few regions covered, the results of the survey were on par with national estimates, Delbanco says. "There are about 10% of respondents that have intensivists, and between 2% and 5% that have CPOEs."

While consumers certainly will benefit from having this information available, the benefits also will accrue to hospitals, says Michael Langberg, MD, FACEP, chief medical officer and senior vice president for medical affairs at the Cedars-Sinai Health System in Los Angeles.

"We are a community hospital and believe deeply that we have an accountability to the community," Langberg says. "Having reliable and responsible data to gauge the effectiveness of our institution makes us better."

Secondly, Langberg continues, having comparative data out there and available for all to see has, in the experience of a variety of industries, "added energy to quality improvement efforts. Knowing the information is being made public provides yet another impetus to us to make improvements. We have to face the information, look at it, and find ways to do better."

Fewer variations on a theme

Langberg says being able to see competitor data will help his system see where the mean is, where Cedars-Sinai stands compared to the mean, and what variations there are in performance. "We know that this kind of data assists in eliminating variations in care between institutions and moving the average to the positive side," he says. Langberg cites New York as an example, where information on CABG procedures was made public. Without any regulatory effort, hospitals worked to eliminate performance differences within a couple years.

Within his system, there already are changes taking place that will alter what consumers see on the Leapfrog charts in the future. "We are focusing on CPOE and are due to implement it fully and go live in May," says Langberg.

Like Delbanco, Langberg was most surprised by the number of institutions willing to provide this data to Leapfrog. "In California, 44% of the hospitals that were asked participated. There are an awful lot of surveys [hospitals] have to fill out, and this one was voluntary, so I think the participation was great."

The first results charted by Leapfrog are for the participating hospitals as of Dec. 31, 2001. Among the key findings:

  • CPOE: While only 3.3% of hospitals currently have CPOE, another 30% indicated they have plans to have it in place prior to 2004, and three of the six regions have at least one hospital that has fully implemented it.
  • ICU physician staffing (IPS) or ICU intensivists: Of the hospitals submitting responses, 10% have intensivists staffing their ICUs. An additional 18% of responding hospitals indicated plans to implement the practice fully by 2004. Five of the six regions have at least one hospital that has intensivists on staff.
  • Evidence-based hospital referral standards: Although this standard specifies that patient referrals should be based on either publicly reported risk-adjusted outcomes or hospital volume, Leapfrog only is reporting volumes at this time. Of the submitting hospitals, 12% meet the recommended level of annual experience for coronary artery bypass graft surgery. A third — 31% — meets the coronary angioplasty volume recommendation, 21% meet the recommendation for abdominal aortic aneurysm repair, and a fifth reached recommended volumes for carotid endarterectomy. Fifteen percent meet the esophageal cancer surgery volume recommendation, and 22% have neonatal ICUs that meet Leapfrog specifications. In each of the volume standards, at least one hospital in every region meets the recommendations.

Coming soon to a PC near you

Leapfrog will now update the information monthly. And Delbanco says that as the results are released, more and more hospitals are opting to complete the survey and add their data to the list. "There are big spurts of hospitals working on this for our future updates," she says. "I think as more hospitals realize that their peers think this is important data, more will participate."

In addition to increasing the data from regions already covered by the survey, Leapfrog will begin adding regions aggressively. Another 10 - 15 regions are due to be added in March. And the group already is looking at additional safety practices for inpatient and outpatient settings to add to later iterations of the survey.

The process for adding those data elements also is changing. "In the past, we went around to patient safety and quality improvement gurus around that country," she explains. "We asked them, What are the antilock breaks, airbags, and seatbelts for the health care industry?’ They came up with a short list that we knew consumers could understand and that hospitals could put in place. We had strong evidence that this could make a difference."

In the future, however, there are formal partners that will help Leapfrog to develop ideas. They include the Joint Commission on Accreditation of Healthcare Organizations, the National Quality Forum, the National Committee on Quality Assurance, and the Agency for Healthcare Research and Quality.

"They’ll help us think through the next options. But our first goal is to cover the whole country with the survey we have," Delbanco says. But she estimates that will take a couple more years. "The more people who get their feet wet, the more we learn, and the easier it is for others to follow."

Langberg thinks that all of the standards Leapfrog espouses are leaps, and any movement toward them is a success for the hospital or health system reporting the attainment. "I don’t think anyone expects 100% of hospitals to have met these standards," he says. "They are big goals to reach, and personally I was pleasantly surprised by the numbers that met individual components of these goals."

[For more information, contact:

  • Suzanne Delbanco, PhD, executive director, The Leapfrog Group, 1801 K St., N.W., Suite 701-L, Washington, DC 20006. Telephone: (202) 292-6711.
  • Michael Langberg, MD, FACEP, chief medical officer and senior VP for medical affairs, Cedars-Sinai Health System, 8700 Beverly Blvd., Suite 2429, Los Angeles, CA 90048. Telephone: (310) 423-3510.
  • To see the complete data for each region, visit The Leapfrog Group web site at www.leapfroggroup.org.]