PULSE: Cleveland Clinic Team Develops New Quality Index for Hospitals

November/December 2010


Cleveland Clinic Team Develops New Quality Index for Hospitals
More than 35 million hospital records used to develop publicly available index.

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, then validated on more than 100,000 patients at the Cleveland Clinic. A team led by Daniel I. Sessler, MD, professor and chair of the Cleveland Clinic’s department of outcomes research, used billing and procedure codes to develop an 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 and the risk 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, chief medical officer, respiratory & monitoring solutions, Covidien. “When working with Cleveland Clinic on the Risk Stratification Index, our team took great care to develop an accurate, objective tool to fairly evaluate outcomes.”

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

After using 35 million records from the Centers for Medicare and Medicaid Services to develop and test the Risk Stratification Index, its validity was confirmed by applying it to more than 100,000 Cleveland Clinic records. 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‚Äîthus 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 was the study’s lead author. His 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.