IDS Training Session - Outcome Measures
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Outcome Measures - Intro
• Outcome measure reports help hospital
staff take a look at measureable quality
(length of stay and mortality rate) for their
hospitals and compare to others
• Very easy to filter and show hospitals of
comparable size
• These reports can help in the process of
improvement; should not be the only
source, however
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Goals
• Understanding Severity Adjustment
• Using the Severity Adjusted Reports
• Creating Patient Lists
• Using the Inpatient/Outpatient
Comparison report
• Using the Customized Ratio Report
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Definitions
• Length of Stay
– When Admit Date = Discharge Date
LOS defined as 1
• Peer Group
– Based on Blue Cross Peer Groups
– Useful for comparing to like hospitals
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Understanding Severity
• DRGs originally designed for all patients
• Updates focus on Medicare population
• Measures resource consumption (not
mortality)
• Measures complication/comorbidity
– Comorbidity: the presence of one or more disorders (or diseases) in
addition to a primary disease or disorder
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APR-DRGs
• APR-DRGs are grouped on to each
discharge using a grouper during MHA’s
production process
• This grouper comes from 3M and is
proprietary
• Grouper can not be ‘exported’ as the
grouping goes on behind the scenes in a
‘black box’
• It isn’t a 1 to 1 ratio – multiple MS-DRGs
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can make up one APR-DRG
APR-DRGs
• APR DRGs are designed to measure:
– Severity of Illness: the extent of physiologic
decompensation or organ system loss of
function
– Risk of Mortality: the likelihood of inhospital
death for a patient
– Resource Intensity: the relative volume and
types of diagnostic, therapeutic and bed
services used
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Length of Stay Notes
• A complication / comorbidity is more likely
to increase Severity of Illness than Risk of
Mortality
• LOS and Mortality evaluated
independently
– It is possible to have low level for LOS, but
high level for mortality
• Each APR-DRG has four levels: Minor,
Moderate, Major, & Extreme
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Example of Severity - LOS
Diagnosis
Uncomplicated Diabetes
Level
1. Minor except
Moderate w/ CABG (Coronary
artery bypass graft), Vaginal
Delivery, etc.
Diabetes w/ Renal
Manifestation
2. Moderate
Diabetes w/ Ketoacidosis
3. Major
Diabetes w/ Hyperosmolar Coma
4. Extreme
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Mortality Notes
• Each APR-DRG has four levels: Minor,
Moderate, Major, & Extreme
• LOS and Mortality evaluated
independently
– It is possible to have low level for LOS, but
high level for mortality
• Often need combinations of diseases for
Extreme Risk of Mortality
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Example of Severity - Mortality
Diagnosis
Uncomplicated Diabetes
Level
1. Minor except –
Major – Inflammatory
Bowel Disease, etc.
Diabetes w/ Renal
Manifestation
2.Moderate except Minor – Elective
Procedures
Diabetes w/Ketoacidosis
2.Moderate except Major w/ AMI
Minor w/ Elective PX
Diabetes w/ Hyperosmolar
Coma
3.Major
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Other APR-DRG Modifiers
• Age
• Combination of non-Operating Room
procedures and primary diagnoses
• Combinations of categories of secondary
diagnoses
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APR-DRG Norms Export
• Attain using the Export Wizard
• Sample is for Pneumonia & AMI
• Trimmed data = above or below the standard deviation for that APRDRG
• Run this report to find out exactly how many discharges are in each
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level, or how the trim points are defined
*Demo Data
Severity Adjusted LOS and Mortality Report
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Report Tab 1 – Report Data
• First set the date range for the report
• Name the report if you intend to save it
• Include a description for easy recognition
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Report Tab 2 – Report Settings
• To identify areas for improvement, select
comparison data “Overall” and do not
provide a filter statement
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Report Tab 2 – Report Settings
• It is possible to report on Hospital ID and
look at other hospitals and compare yours
• It is recommended to use the severity
adjusted comparison in this case, however
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Example Report
• Note areas of concern
Note – outliers have been removed
*Demo Data
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Reporting by Physician
• It is possible to use Physician as a level in the
report
• Be confident of credibility of data – ask data
contact (person who sends MHA data) if data
can be relied upon
• Be careful –
– Is attending physician really attending or the
member of a group practice in charge of
case?
• Repeat analysis for previous years to see if
anomaly or real trend
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Severity Adjusted LOS – Trends
• Similar to first report, but allows user to
trend LOS data
• Does not include Mortality data
• Easy to identify real trends and use for
improvement
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Sample Report
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*Demo Data
Severity Adjusted Mortality - Trends
• Similar to first report, but allows user to
trend Mortality data
• Does not include LOS data
• Easy to identify real trends and use for
improvement
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Sample Report
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*Demo Data
Hospital Severity Adjusted Comparison
• Choose date range on first tab
• Choose one or two level report on second tab – one level must
always be HospID
• Use overall comparison data unelss looking at a specific set of data
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Peer Group Comparisons
• Filter on a specific hospital set (filter on
hosp ID)
• Or filter on a peer group
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Example Report
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*Demo Data
Identifying Issues – Patient Listings Report
• Patient listings report will allow you to take
a look at patients that had a low probability
of death
• Choose time period on Tab 1 – Report
Data
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Tab 2 – Report Settings
• Set “Sorted By” to Expected Mortality
– Ascending Sort Order
– This will show patients with low probability of
death first
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Tab 3 – Report Filter
• Set “Disposition” to 20 (Expired)
• This will now show patients that died, but
had a low probability of death first
• Can set a service line or MSDRG filter
here
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Example Report
• Review cases with:
– Low mortality rates
– Few secondary diagnoses
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*Demo Data
Inpatient / Outpatient Comparison
• Shows hospitals reliance on each type of
patient
– Can also be used to see what percentage of a
procedure are performed in outpatient setting
• On Tab 1, select date range
• On Tab 2, select sort settings – cannot
change level
• On Tab 3, select filters – peer groups,
particular hospitals, etc.
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Sample IP / OP Comparison
Index is obtained by comparing percent outpatient for each hospital
to the average percent outpatient for all hospitals included
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*Demo Data
Customized Ratio Report
• Reports by Hospital
• Utilizes Numerator and Denominator Filter
• Answers questions like:
– What percentage of initial AMI patients have a
CABG? PCTA?
– How do I compare to other hospitals on
potential issues?
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C-Section Rate by Hospital
• Numerator Filter – MS-DRG 765-766 (CSections)
• Denominator Filter – MS-DRG 765-768,
774-775 (all deliveries)
• This report only includes cases in the
numerator that are also in the denominator
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C-Section Rate by Hospital
• Tab 1 – Choose date ranges
• Tab 2 – Choose sort order
• Tab 3 – Choose filter settings
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Sample Report
• Index = Observed rate / Average rate
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*Demo Data
Other Example Report Ideas
• Ratio of one DRG to another
• Percentage of Medicare Discharged to
Home for Hip Replacement
– Numerator Filter: Disposition = 01,06,07
– Denominator Filter: MSDRG = 466-468
Pay Source = 01
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Questions?
Michael Ovsenik
Client Representative
Chris Leong
Client Representative
IDS Client Support
idssupport@mha.org
517-886-8448 or 877-999-4653
Http://www.theidsonline.com