Response to 'Association Between Hospital-Reported Leapfrog Safe Practices Scores...

Response to 'Association Between Hospital-Reported Leapfrog Safe Practices
Scores and Inpatient Mortality,' Journal of the American Medical Association
(JAMA); April 1, 2009

Statement of Leah Binder, CEO
The Leapfrog Group
WASHINGTON, March 30 /PRNewswire-USNewswire/ --Today's JAMA study provides
useful insight into the study of patient safety and inpatient mortality and
will be used by The Leapfrog Group as we continually refine and improve the
measures used in the Leapfrog Hospital Survey. Where possible, the measures
included in the Leapfrog Hospital Survey are used and endorsed by quality
advocacy organizations such as The Joint Commission, National Quality Forum
(NQF) and Centers for Medicare and Medicaid Services (CMS).

The study addresses only one of many elements of the Leapfrog Hospital Survey
-- the Safe Practices Score, which is a bundle of 13 NQF-endorsed safe
practices. The Survey contains other elements including: measures of
efficiency, common acute conditions, hospital acquired conditions, and most
importantly, Leapfrog's three original safe practices ("leaps") which, as the
researchers point out, have well-established correlations with risk-adjusted
mortality and other positive outcomes.

The fact that this study could be done at all attests to our commitment to
100% transparency of healthcare information and data. Unfortunately, the
comparison data set used by the researchers - the Nationwide Inpatient Sample
- limits the conclusions that can be generalized from this study, as
acknowledged by the study's authors.

The comparison data set used by the researchers confined them to using data
from only 24 states, for a total of 155 hospitals, or 14% of the
Leapfrog-reporting hospitals. Leapfrog's annual survey includes over 1,282
hospitals from all 50 states. The Leapfrog Group's three original leaps -
implementation of computerized physician order entry systems, intensivist
staffing in ICUs, and evidence-based hospital referral (for high risk
procedures) - have been studied extensively and linked to improved hospital
outcomes, including reduced mortality.

Most recently, Dr. Ashish Jha from Harvard Medical School and colleagues
published a paper supporting this relationship in the Journal of the Joint
Commission. A description of that publication is available at:
http://www.leapfroggroup.org/media/file/Release-Lower_mortality_at_Leapfrog_hospitals.pdf

The process and structure measures in the Safe Practices Score are perfectly
sensible. The idea that creating a safety culture, ensuring an adequate
nursing workforce, preventing central venous line infections, and requiring
hand washing, among other safety practices, would lead to a safer environment
seems obvious.

But clearly we cannot assume that structural and process improvements
automatically lead to the outcomes we desire. The JAMA study challenges health
services researchers and measure developers to devise more direct measures of
outcomes.

The Leapfrog Group will consider this study carefully and with the support of
health care researchers, consider several questions about the hospital survey:

-- Should we give hospitals more credit for those items in the safe
practices that require the most action?
-- Should we move away from a "training wheels" approach? Instead
of providing hospitals credit for each individual step taken to
achieve
full implementation of a given practice, should we simply require a
CEO's sign-off indicating the safe practice is being routinely
followed?
-- Should we seek to raise the bar on the Safe Practices standard?
Perhaps
only a handful of the hospitals in the top quartile of our survey are
doing enough about the safe practices to see demonstrable results.
-- Should we eliminate the safe practices entirely from the survey? It is
difficult to believe that well established safety practices are not
helpful to patients in profound ways, but with further research we
will
be able to objectively assess.

About The Leapfrog Group
The Leapfrog Group (www.leapfroggroup.org). On behalf of the millions of
Americans for whom many of the nation's largest corporations and public
agencies buy health benefits, The Leapfrog Group aims to use its members'
collective leverage to initiate breakthrough improvements in the safety,
quality, and affordability of health care for Americans. The Leapfrog Group
was founded in November 2000 by the Business Roundtable and is supported by
its members, The Commonwealth Fund, the Agency for Healthcare Research and
Quality and other sources.

SOURCE The Leapfrog Group

Christine Paoletti, The Leapfrog Group, +1-202-292-6768