Monday, 6 October 2014

Clinical safety: "The Leapfrog Group" and other benchmarkings

The Hospital Safety Score is a scaled assessment (A / B / C / D / E / F) of American hospitals that aims to provide that insurers and citizens have access to proven clinical safety information offered by each hospital in the system. The Hospital Safety Score is a summary of 26 parameters that feed on both a voluntary survey and official sources: AHRQ (Agency for Healthcare Research and Quality), CDC (Centre for Disease Control and Prevention), CMS (Centres for Medicare and Medicaid Services) and "American Hospital Association Annual Survey."
In the latest version, 2,514 hospitals participated in the survey, of which 780, 31%, had scored an A and 25% in category B, but note that 1,096 centres, 44% of the overall have been classified in categories C and below. We must however clarify that benchmarking, based on standard deviations; means that each centre competing every year does so with updated marks from all the members in the series.

The Hospital Safety Score is promoted by "The Leapfrog Group", an independent, non-profit association that was created by a group of businessmen concerned about the additional costs of medical errors, hospital-acquired infections and preventable complications. "The Leapfrog Group," which also has the support of health professionals, intends to bring about major leaps in the levels achieved by hospitals in terms of clinical safety and quality of services, and to achieve these objectives only has two tools, which are really one: benchmarking and transparency. 

The 5th Report of the Central Results of Catalonia has a clinical safety dimension, but doesn’t produce any synthetic indicator. However, I would like to make a couple of comments. The first is the infection rate for primary knee arthroplasty, which has an average value of 0.6%-1.4%. Look at the table on page 107 of the report where you can see that there are 10 hospitals with values ​​above 2.0%, and two of which amounted to 3.4%. Another indicator that I want to highlight is the infection rate for colorectal surgery that has an average value of 9%, with two centres in the public network where the infection rate is more than double the expected cases (19.8%).

In the Iasist Top 20, the area of patient safety analyses 8 indicators obtained from the American official agency AHRQ (Agency for Healthcare Research and Quality). The  Iasist benchmarking also lacks a synthetic indicator of clinical safety, but there is some data from this competition that is very relevant, as the case of infections after certain medical interventions shows that in the TOP group of general hospitals, the results are remarkably better than in the other centres: the TOP hospitals have a 0.17 rate while others, a 1.03 (83% lower in the TOP), or for deaths of surgical patients with serious but treatable complications, which are 14% lower in the TOP group.


The dynamic benchmark with clinical safety data is very powerful, because it is also dynamic, i.e. achieving some values ​​is not sufficient, but if all the centres aim to improve, the comparison standards also improve and thus the centres, that despite their progress, don’t improve as much as the average of their "competitors", continues to have poor results.

Moreover, this is information of great interest to the public in two ways: a) knowing the innate danger in being admitted at a given centre, and b) being aware, just as the American businesses with their "The Leapfrog Group", that the lack of clinical safety increases health budgets in an absolutely avoidable way.

Jordi Varela

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