Utah hospitals want to be accountable for the care that they provide to their patients, and they want the citizens of Utah to learn more about their own health care. Consumers need access to facts that can help them make informed health care decisions. In addition, the data can be used to improve care within hospitals through benchmarking and sharing of best practices to constantly improve clinical processes related to patient care. CheckPoint provides data that has integrity and, as close as possible, reflects the actual care provided.

There are 50 hospitals that participate in the CheckPoint program. These hospitals are responsible for caring for the majority of the patients who are admitted to Utah hospitals every year.

CheckPoint is a voluntary program. For some hospitals, the ability to report is largely an issue of resources. Utah will work with these hospitals to attempt to address resource needs.

Not all measures in CheckPoint are relevant for the patient population of every hospital. For example, some patients may enter a hospital and require additional services that necessitate them being transferred to a second hospital. Hospitals must decide which measures apply to them, based on the services that they provide.

All hospitals add measures to the CheckPoint program over time as they begin to collect the information. When a new measure or mesaure set is added, to participate in CheckPoint, these hospitals are required to identify a third party data system and put in place the processes required to take this information from patient charts.

No data collected is noted by a (-) in the hospital reports. This symbol indicates that the hospital did not collect the data for that measure for this time period.

"Data collected, but not enough cases to be representative of care provided in this reporting period" is noted by a (+) in the hospital reports . This symbol indicates that the hospital is collecting data for this measure and has reported the data to CheckPoint. However, it did not meet the minimum case requirement of 25 cases in the reporting period. The 25 case minimum is a technical requirement for CheckPoint data to assure that the rate is statistically representative of the care that is provided by the hospital.

The 14 clinical measures of quality in CheckPoint help consumers understand how effective the care is that they receive in a hospital compared to care that research indicates will lead to the best outcome. There are six measures for heart attack, four measures for congestive heart failure and four measures for pneumonia.

Heart Attack Measures

1.	Aspirin at arrival – Percent of heart attack patients that receive an aspirin within 24 hours before or after arriving at the hospital
2.	Aspirin at discharge – Percent of heart attack patients that are prescribed an aspirin when they are discharged from the hospital
3.	Beta-blocker at arrival – Percent of heart attack patients that receive a beta blocker medication within 24 hours of arrival at the hospital
4.	Beta-blocker at discharge – Percent of heart attack patients that are prescribed a beta-blocker medication when they are discharged from the hospital
5.	ACE Inhibitor for Left Ventricular Systolic Dysfunction (LVSD) – Percent of heart attack patients with low heart function that are prescribed an ACE inhiitor medication when they are discharged from the hospital
6.	Smoking Cessation Counseling – Percent of heart attack patients with a current or recent history of smoking cigarettes, who are given smoking cessation counseling during their hospital stay.

Congestive Heart Failure

7	Left Ventricular Function (LVF) assessment – Percent of heart failure patients that are given a test to assess the function of their heart before, during or soon after discharge from the hospital
8.	ACE Inhibitor for Left Ventricular Systolic Dysfunction (LVSD) - Percent of congestive heart failure patients with low heart function that are prescribed an ACE inhibitor medication when they are discharged from the hospital
9.	Smoking Cessation Counseling – Percent of heart attack patients with a current or recent history of smoking cigarettes, who are given smoking cessation counseling during their hospital stay.
10.	Discharge Instructions – Percent of heart failure patients discharged to home with written instructions to the patient or caregiver that addresses all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen.

Pneumonia

11.	First antibiotic within 4 hours – Percent of patients admitted to the hospital with pneumonia that receive their first dose of antibiotic within 4 hours of arrival.
12.	Oxygen assessment – Percent of patients admitted to the hospital with pneumonia that have their oxygen level evaluated within 24 hours prior to or after arrival at the hospital
13.	Pneumococcal screening and/or vaccination – Percent of patients 65 years and older admitted to the hospital with pneumonia that are asked if they had received a pneumococcal vaccination, and if they had not, received the vaccination prior to discharge from the hospital
14.	Smoking Cessation Counseling – Percent of patients admitted to the hospital with pneumonia that have a current or recent history of smoking cigarettes, who are given smoking cessation counseling during their hospital stay.

The measures in CheckPoint were selected because they are three of the most common causes of hospitalization: pneumonia, heart attack, and congestive heart failure. By giving consumers information about these three conditions, we can help improve their overall health status by sharing with them the kind of care that they should expect to receive. The processes that are reported in CheckPoint were selected because they are scientifically proven to increase the chance of a positive patient health outcome.

The Centers for Medicare and Medicaid Services (CMS) receives all patient data, not just data relevant to Medicare. The data in CheckPoint includes ALL patients regardless of who pays for the care.

Yes. The way that data is collected for each measure removes cases that have contraindications to this care. For example, if a patient has an aspirin allergy that patient would not be included in the measure that requires an aspirin be given.

Yes. Because the data is updated every few months it would be difficult and costly to update paper copies of the reports. For those consumers who do not have computers at home, computers are readily available at public libraries and in hospitals where people can get help accessing the Web site.

The medical services data in CheckPoint is updated every three months.

The data is collected from individual patient charts and submitted to a third party data system by the hospital staff. The error prevention data is collected from patient charts and by reviewing hospital procedures. This data is entered directly into the CheckPoint data system by the hospital staff. These data collection processes more accurately reflects actual care given in Utah hospitals.

No. As hospitals submit the data to the Centers for Medicare and Medicaid Services (CMS), the data is audited for accuracy at several points in the data submission process before it is placed in the CheckPoint Web site. The medical services data is reported per patient on a quarterly basis and the rates on the measures are calculated by CMS. An individual hospital doesn't know their rate on any one measure until they receive a report from CMS. Compare it to taking a test, and handing it to the teacher. You don't know your grade until you get the test back.

CMS validates the data by randomly “pulling charts” from the hospital's files and checking them. The data is then accessed by the Utah quality improvement organization, Health Insight, which sends the files to WHA for publication to the CheckPoint Web site. Health Insight is a trusted source of valid information on hospitals. Health Insight has gathered hospital data for more than a decade, while working with hospitals on projects designed to improve quality.

The Utah Hospital Association is developing a validation process for the error prevention data to assure that it is accurate and collected in a consistent way from hospital to hospital.

The strength of CheckPoint is in the fact that unlike other reports on hospitals, the data used is very timely. The medical services data is updated every three months (March 15, June 15, September 15, December 15). The error prevention data is updated every six months (March 15, September 15). The timeframe that the data in each report was collected from is listed on the top of the report.

The reporting of quality and safety measures on CheckPoint is a work in progress. The Public Reporting Advisory Group, along with participating hospitals, will regularly evaluate other measures to include on the Web site.

No. Hospitals provide services that are needed by the consumers in their service area. Hospitals collect data and report on measures that are appropriate for their patient population.

CheckPoint requires, for statistical accuracy, a hospital to report 25 cases or more that met the criteria for each measure. If a hospital does not have 25 qualified cases in the reporting period, a (+) indicator will show on the report.

CheckPoint may be useful to a variety of health care stakeholders:

1. Insurance companies and employers have asked health care providers to publish information that will be useful in assessing the quality of care received by their members and employees.
2. Consumers may use the information for two purposes:
       --To select a health plan when offered options by their employer that include different provider networks;
       --To select a hospital in anticipation of a hospital stay.
3. Reporters will use the CheckPoint information to learn more about the hospitals in their communities.
4. Legislators are interested in making sure that consumers have access to quality and safety information for decision making.
5. Hospitals will use the data in CheckPoint for benchmarking their care and identifying best practice hospitals.

What impact do quality reports have on consumer behavior?

We are in the early stages of consumers taking a more active role in their health care choices. As people bear more financial responsibility for their health care through higher deductibles and co-payments, their need for information will increase. Utah hospitals want to have information about quality and safety readily available as people realize that information of this kind is needed. At this time, Utah hospitals are joining one of the leaders in the area of voluntary reporting of quality and safety information.

Utah is viewed as a national leader in the area of voluntary hospital reporting efforts. There are a few mandatory, legislated efforts where similar reports are available and there are a couple of states that are working on voluntary efforts.

Utah hospitals also voluntarily report quality measures to a national initiative called Hospital Compare.

Volume is only one type of quality indicator. We are reporting process measures instead because new research demonstrates a stronger link between process measures and the outcome of care. In addition, they are typically better learning tools for hospitals in improving their processes. Consumers can get a better idea of the type of care that they should expect to receive from their health care provider if process measures are used.

The medical services measures relate to medical conditions and are rates expressed as a percentage of time that eligible patients receive that care.