CalHospitalCompare.org Enables C A L I FOR N I A Easy Comparison of Inpatient Care H EALTH C ARE F OU NDATION In California, as in other states, the  Be a user-friendly tool that is easy to quality of inpatient care varies considerably from understand and navigate; hospital to hospital and even from one department  Follow a single, standardized protocol for to another within the same institution. A facility reporting data; fact sheet known for its top-notch cardiac care, for instance, may perform poorly in preventing hospital-  Help hospitals improve their outcomes by acquired infections. To provide information focusing on measures for common conditions about hospital care, a variety of government and where performance varied; private entities have undertaken initiatives to  Equitably account for differing patient mix measure and/or report on quality indicators. Most and morbidity; and California hospitals, as a result, have responded to myriad requests for performance data focusing on  Meet the needs of all stakeholder groups. disparate areas of care and often requiring separate tracking programs. Working on a consensus basis, the taskforce adopted 50 hospital performance measures To create a standardized “report card” on hospital that they agreed were indicative of quality and quality that would better meet the needs of all aligned with national initiatives of the Joint stakeholders, the California Hospital Assessment Commission and the National Quality Forum. and Reporting Taskforce (CHART) was convened The California Office of Statewide Health in 2004 with funding from the California Planning and Development and the Joint HealthCare Foundation. The broad-based Commission are among the regulatory and initiative involved active participation from all accrediting agencies that support CHART. More stakeholder groups: hospitals, government entities, than 240 hospitals — representing 86 percent insurers and health plans, clinicians, employers of the average daily hospital census in the and the business community, labor unions, and state — participate in the reporting program, consumers. which is funded by health plans and hospitals. Because a variety of hospital-performance The CHART public report card, which is updated initiatives already existed, the CHART taskforce quarterly, was introduced two years ago, on was able to learn from that experience and March 7, 2007 on a specially created Web site. incorporate the best ideas in their planning. The site, CalHospitalCompare.org, is In particular, the stakeholders wanted the report maintained by the California HealthCare card to: Foundation. The CHART measures are grouped into several clinical, patient safety, and patient  Serve as a “one-stop shop” for consumers that experience categories, including: would combine comprehensive information M arch from many sources;  Cardiac care 2009  Maternity care CHART Board of Directors CHART is governed by a broad-based board of  Pneumonia treatment directors whose members meet frequently and also participate actively on one or more committees. Under  Intensive care unit (ICU) CHART’s governance structure, voting privileges are  Pressure-ulcer rates weighted equally among the five stakeholder groups: health plans, hospitals, purchasers, consumers, and  Patient safety health professionals and foundations. The CHART board includes representatives from the following  Surgical infection prevention organizations: • Aetna West Region*   Patient experience • Anthem Blue Cross* • Association of California Nurse Leaders Across these categories, a total of 71 performance • Blue Shield of California* measures are further stratified and reported on the • California Health Care Coalition Web site. Five performance ratings — superior, above • California HealthCare Foundation* average, average, below average, and poor — are displayed • California Hospital Association for each measure in color codes that facilitate easy • California Medical Association comparison. Consumers can compare up to five hospitals • California Office of Statewide Health Planning and simultaneously on various measures. Site visitors can also Development see the percentage of patients who would recommend a • California Pan Ethnic Health Network particular hospital to friends or family members. • CalPERS • Catholic Healthcare West The participating CHART hospitals receive additional • CIGNA HealthCare of California* detailed data on their performance beyond what is • Community Health Councils reported publicly. For many of the measures, breakdowns • Health Net* of the data are available so that hospitals can identify • Hospital Association of Southern California specific problem areas and determine where to target • Kaiser Foundation Health Plan* their improvement efforts. In the area of surgical • Kaiser Foundation Hospitals infection, for example, hospitals receive data on specific • Pacific Business Group on Health types of surgery. In the patient experience category, • Sacramento Healthcare Decisions hospitals receive details on patients’ perceptions of care • San Mateo Legal Aid Society coordination. Results include patients’ views on whether • St. Joseph’s Health System tests were done in a timely manner and whether the • Sutter Health doctors and nurses treating them told them the same • Tenet thing regarding diagnosis, treatment, and prognosis. *Funding organizations The data-collection and analysis system is designed and operated independently by the University of California at San Francisco Philip R. Lee Institute for implementing the measures and gathering data; they have Health Policy Studies, with assistance from experts at online access to the training materials as well as experts other California universities and RAND Corporation. who provide guidance as needed. Hospitals participating in CHART receive training on 2  |  California HealthCare Foundation Since the launch of CalHospitalCompare.org, many participate in policy formation, the resulting decisions health plans operating in California adopted its tend to have strong backing from all parties. A common methodology as their own rating system, including goal is to increase awareness of CalHospitalCompare.org use of the CHART ratings to determine their centers so that patients will have the pertinent quality informa­ of excellence designations and to support pay-for- tion at hand when they are choosing a provider for performance programs. inpatient care. Some data have emerged showing quality benefits for participating hospitals compared to national averages, About the F o u n d at i o n The California HealthCare Foundation is an independent as well as to non-CHART institutions, suggesting philanthropy committed to improving the way health care that transparency is an important factor in improving is delivered and financed in California. By promoting quality. For example, at the time of CHART’s launch, innovations in care and broader access to information, our participating hospitals performed above the national goal is to ensure that all Californians can get the care they average on 15 of the 19 measures for which national need, when they need it, at a price they can afford. For more benchmarks were available; by November 2008, that information, visit www.chcf.org. increased to 20 of 22 measures. Currently, CHART hospitals outperform national benchmarks in a number of areas including administering the right drugs for pneumonia and for heart attacks, and prevention of surgical infection. Furthermore, hospitals that have been in CHART since its launch provide the appropriate heart failure diagnoses and treatments 85 percent of the time, while those that have never joined do so only 75 percent of the time. Likewise, pneumonia prevention measures have been provided 78 percent of the time at these CHART hospitals, compared to only 59 percent of the time in non-CHART hospitals. As CHART evolves, measures are adjusted and new ones added to fill gaps in information needed to improve quality. Additions in the area of patient outcomes and readmissions are planned, and measure sets for children’s hospitals and for rural and critical access hospitals are under discussion. Ongoing issues include maintaining the right balance between differing stakeholders’ needs. While health plans seek more measures of hospital efficiency, for example, consumers would like to see additional “shoppable” measures such as hospital performance on elective procedures. Because all stakeholder groups actively CalHospitalCompare.org Enables Easy Comparison of Inpatient Care  |  3