Scoring Method
In order to provide a valid and reliable comparison of quality performance across providers, The Delta Group utilized a number of statistical methods prior to calculating percentile scores for each quality measure, quality measurement category, and clinical category. Specifically, The Delta Group:
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Removed statistical outliers at three (3) standard deviations from the mean of the log distribution of charges and length of stay within each MS-DRG terminal grouping (based on severity level, age cohort and CC cluster).
- Evaluated hospital performance for each quality measure within the following quality measurement categories:
- Mortality Overall
- Complications Overall
- Inpatient Quality
- Core Process
- Patient Safety*
- Patient Satisfaction
*Excluded the following patient safety indicators (PSIs) from public reporting due to inconsistent coding practices among hospitals or the prevalence of false positives: complications of anesthesia (PSI 1), death in low mortality DRGs (PSI 2), accidental puncture and laceration (PSI 15), and transfusion reaction (PSI 16).
- Assigned each quality measure to one or more of the following clinical categories:
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Overall Hospital Care
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Overall Medical Care
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Overall Surgical Care
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Cancer Care
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Cardiac Care
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Cardiac Surgery (Major)
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Interventional Carotid Care
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Coronary Bypass Surgery
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Gall Bladder Removal
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Gastrointestinal Care
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Gastrointestinal Hemorrhage
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General Surgery
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Heart Attack Treatment
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Heart Failure Treatment
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Hip Fracture Repair
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Interventional Coronary Care
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Joint Replacement
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Major Bowel Procedures
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Neurological Care
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Neurological Surgery (Major)
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Organ Transplants
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Orthopedic Care
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Orthopedic Surgery (Major)
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Pneumonia Care
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Pulmonary Care
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Spinal Fusion
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Spinal Surgery
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Stroke Care
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Transplant of Bone Marrow
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Transplant of Heart
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Transplant of Kidney
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Transplant of Liver
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Transplant of Lung
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Trauma Care
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Vascular Surgery
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Women's Health
- Each hospital’s performance on each measure was tested for its level of statistical significance using a z-value (based on the one-proportion z-test) which was then converted to a z-score to convert all data to a standard normal distribution (z-scores ensure an appropriate statistical distribution and equal weighting where each z-score corresponds to a point on a standard normal distribution characterized by a new mean of zero and a new standard deviation of 1; with an approximate range of -3 and +3 standard deviations).
This statistical routine accomplishes the following:
- Accounts for each hospital’s standard deviation from the mean and the effect of their respective caseload volume (z-value).
- Prior to calculating percentile performance, the z-score converts all underlying distributions (e.g., AMI-1 core measure, AMI-2 core measure, PSI 1, PSI 2, and etc.) to a standard normal distribution so that percentile performance can be accurately identified within and across quality measurement categories.
By incorporating both z-values and z-scores, this approach produces normally-distributed “statistically significant percentiles of performance” for accurately and uniformly assessing the quality of hospital care.
Eligibility Requirement for Composite Scoring and Ratings
Hospitals must receive a composite quality score ≥ 90th percentile with no lower than a "√" rating for any measurement category.
Rating Method
Using Table 1 below, each hospital’s quality rating was determined by assigning its respective percentile score to the appropriate percentile reference range and identifying the associated quality rating (√++ through √--).
Distribution of Quality Ratings
The percentile reference ranges distribute hospital quality ratings as follows*:
- 10% receive the “highest” quality rating (√++)
- 15% receive a “high” quality rating (√+)
- 50% receive an “average” quality rating (√)
- 15% receive a “low” quality rating (√-)
- 10% receive the “lowest” quality rating (√--)
*Prior to the removal of hospitals which do not meet eligibility requirements