Regional data initiative stretches hospital dollars
Project handles 3 reporting needs, and then some
Here’s a regional data collection and reporting collaborative that cures many reporting headaches and stretches information management dollars for the 51 participating hospitals. It provides them with standardized data adaptable to a host of measurement needs. The Data Initiative was established in 1997 through the Dallas-Fort Worth Hospital Council (DFWHC) in Irving, TX.
This regional approach makes the jobs of quality managers in the individual hospitals easier, notes Denise Remus, PhD, RN, vice president of the Data Initiative. The goals, already well under way, include:
1. Establish a centralized data repository and effective analytical and reporting capabilities.
2. Provide a standardized database to measure operational, clinical, and quality health care indicators for use at the regional level.
3. Create hospital-level quality improvement projects based on report results.
4. Expand data collection to area physician offices.
Remus acknowledges the presence of differing opinions on whether the indicators they use are true clinical measures. She says there were many compromises from the project’s inception to its present stage of evolution. That’s as you might expect with so ambitious an effort. "The physician always wants numbers that make sense clinically, and the administrator doesn’t want to break the budget," Remus notes. "Administrators see every dollar that goes into data processing as a dollar away from patient care."
To balance budgetary and clinical agendas, representatives from participating hospitals settled on data from ICD-9 codes, admitting notes, and selected practices in obstetrical, neonatal, and cardiac care. The challenge of risk adjustment still lies ahead. "Some people don’t see this as clinical data," Remus notes, "but we believe they are clinical indicators that have quite a bit of validity to them." Because of the stringent reporting standards, results from the Data Initiative match those generated by chart reviews. The reports contain observed-to-expected results for each hospital. Hospital-to-hospital comparisons are not made.
Value for the data dollar
The participating facilities transmit their data to Remus and her staff of five. They compile and forward the data to satisfy each facility’s reporting requirements for:
• ORYX reports to the Joint Commission on Accreditation of Healthcare Organizations;
• Texas Healthcare Information Council;
• Healthcare Value Initiative, a collaborative effort with health care purchasers represented by the Dallas-Fort Worth Business Group on Health (DFWBGH).
(For more on the DFWBGH, see the series "Buyers Shape Health Care Quality," including the cover story, "Corporations want to negotiate directly with providers on care quality" and "A look at value-based purchasing in action," QI/TQM, April 2000, p. 37-44.)
From the beginning, Data Initiative participants vowed to standardize data and break the maddening, expensive cycle of rejection and resubmission. To that end, Remus and her staff methodically train and update the hospital data specialists. She writes newsletters and technical updates and works with individual data managers to correct inaccuracies.
She’s accessible by phone or e-mail and maintains a high profile in the hospital community, often visiting individual facilities. "We think the only place data can be edited and cleaned is at the hospital — and before it leaves the hospital," contends Remus. "So we’ve spent a lot of time to get good, clean data. Otherwise, the analysis would be questionable."
Good, clean data only
With noticeable pride, she explains that each set of numbers in each Data Initiative report does add up, and is directly traceable from report to individual hospital chart.
The Data Initiative provided a PC-based software package to each participating hospital. The current one was created by Remus and her staff. In the near future, however, they’ll switch to a program they’ve codesigned with the MEDSTAT Group of Ann Arbor, MI. Participating hospitals have required all their software vendors to edit their programs for consistency with Data Initiative reporting standards. "Nothing we do is secret or proprietary," Remus states. They just want "clean" data.
Here are the specifications hospital data must pass before submission to the Data Initiative:
• Format edits — for file structure, layout, numeric entries in numeric fields, valid dates in date fields, etc.
• Content edits — of all information required by the Texas Health Care Information Council, the Health Care Financing Administration (HCFA) (valid principal diagnosis, diagnosis code or procedure consistent with sex code), as well as additional edits developed to incorporate clinical logic.
• Three levels of error edits — (a) to catch inconsistencies with state or HCFA reporting requirements; (b) to verify or correct odd reports such as a 12-year-old obstetrical patient; and (c) to catch and report emergent trends to individual hospitals, such as Medicare patients under age 65.
Four quarters ago, hospitals would submit their data the day before they were due at third-party headquarters. That sent Remus and staff scrambling on the weekend to complete reports by deadline.
Having learned to self-edit, however, and now sold on the rewards of participation, many information managers send data up to a week or two ahead of schedule. Most are error-free. Payoffs for the hospitals include significantly less work, the ability to query their own data, and ease of reporting for other obligations.
Data Initiative chronology
The initiative is guided by six standing committees on clinical quality to technical and regulatory issues. The Data Initiative Executive Committee consists of key leaders from each hospital. Since Remus has worked in every nursing setting, she has credibility at all levels. "We picked the right liaison from all the hospitals, then we went to the clinical groups."
Each facility chose its own representatives from disciplines including nursing, medicine, and quality improvement. Representatives become as involved as they wish. Remus observes that committee members "leave their hospital concerns at the door and they all work together by sharing articles, discussing problems, exchanging ideas. We don’t have the hospital competitiveness. Everybody has a sense of ownership."
The value of the knowledge exchange is stunning, she comments. Individuals who hold national leadership positions engage with quality managers from small hospitals who hardly ever have the opportunity to leave their campuses. "That’s why we’ve been so successful," she notes.
The other component of success is the trust earned by the DFWHC’s integrity. The CEO has been with the council practically since its inception 25 years ago. It’s a nonprofit organization which members do not regard as a vendor. "We’ve proven that we can handle data confidentiality well. We’re seen as nonbiased and we remain accessible to the members," notes Remus. "The Data Initiative is their project; they feel a sense of ownership toward it."
Need More Information?
For more on the Data Initiative, go to:
o Dallas-Fort Worth Hospital Council, Irving, TX, Web site: www.dfwhc.org.
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