QUEST methodology
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Become a top performer!

Premier crunches quite a bit of data for our QUEST collaborative. Here’s how we get to the winners of the QUEST Award for High-Value Healthcare.

New this year, we added a peer group improvement award designed to recognize QUEST2020 top performing hospitals’ success within relevant peer groups that address hospital size and academic status. Awardees were determined as follows:

  • Each QUEST2020 member was grouped into only one of six categories: CAH, Academic, COTH ≥ 375 beds, COTH < 375 beds, Non-COTH ≥175 beds and Non-COTH < 175 beds.
  • Calculation was made of improvement/deterioration from baseline data in 2016 (prior to QUEST2020) through third quarter of 2017 in four priority areas:
    • Mortality
    • Readmissions
    • Affordability
    • Safety
  • We summed all improvement and deterioration across the four priorities by member within each peer group for a total performance score.
  • The top performer in each peer group was named Winner, and the second best performer was named Finalist.

For the TPT performance awards, QUEST2020 (calendar years 2017-2019) is structured around a set of top performance thresholds (TPTs) based on the collaborative’s five acute priorities of measurement:  

  • Affordability
  • Effective Care and Coordination
  • Prevention and Treatment for Leading Causes of Mortality
  • Person and Family Experience
  • Patient Safety

Top performance was calculated based on top quartile performance with the exception of Affordability, which is identified by top tercile performance. The TPT methodology for each priority varies based on the unique measure calculation and methodology outlined below and each TPT is based on a complete year of 2016 data.

QUEST2020 Priority: Affordability

The QUEST Affordability Priority is calculated from total inpatient cost per case-mix adjusted discharge.

The data for the Affordability measure comes from the OperationsAdvisor® application for subscribers or via the general ledger and financial statements for non-subscribers.  The baseline data used to set the TPT for Affordability consists of performance from all hospitals that have data available within the complete January 2016 through December 2016 timeframe.

The current TPT for Affordability (which is segmented based on bed size and COTH status) is set at the top thirty-third percentile of baseline cost as follows:

Cost Segment TPT     Facility Count      
COTH > = 375 beds TPT $6,320 n = 12
COTH < 375 beds TPT $4,380 n = 7
Non-COTH > = 175 beds TPT $5,530 n = 58
Non-COTH < 175 beds TPT $5,350 n = 78

QUEST2020 Priority: Prevention and Treatment for Leading Causes of Mortality

The QUEST® Prevention and Treatment for Leading Causes of Mortality Priority is the ratio of the observed to expected mortality (O/E ratio) of all acute inpatient discharges. Expected mortality is calculated by applying the CareScience® risk-of-mortality model. The data source for Mortality is QualityAdvisor™, whose algorithms use patient-level ICD-10 coding and key demographic data. The baseline data used to set the TPT for Mortality consists of performance from all hospitals that have data within the complete January 2016 through December 2016 timeframe, n = 169.

The 2017 TPT for Prevention and Treatment for Leading Causes of Mortality is 0.758 reflecting the top quartile of the O/E ratio from the baseline period.

QUEST2020 Priority: Patient Safety

The QUEST Patient Safety priority has a composite score calculated from coded (ICD based) data and data from the National Healthcare Safety Network (NHSN). The components include 35 distinct measures of “potential harm” spanning the entire population of the hospital campus, 29 of which are measures from coded and 6 measures from NHSN. The coded measures are rolled up into one composite and the NHSN measures are rolled up into a second composite. Once the composites are calculated using an algorithm that accounts for the rarity and volatility of each harm component, the overall harm composite is combined with the coded composite being weighted at 15 percent and the NHSN composite at 85 percent. A facility must have both composites to have an overall Patient Safety composite.

The baseline data used to set the TPT for Patient Safety consists of performance from all hospitals that have data available within the complete January 2016 through December 2016 timeframe, n = 144.

The current TPT for the Safety composite is 80.2.

QUEST2020 Priority: Patient and Family Engagement

The source of Patient and Family Engagement data comes from the files collected from each facility’s Patient Satisfaction Vendor (using the same files which are sent to CMS’ Hospital Compare website.) The baseline data used to set the TPT for Patient and Family Engagement consists of performance from all hospitals that have data available within the complete January 2016 through December 2016 timeframe, n = 113.

The current TPT for Patient and Family Engagement is 74.6 percent.

QUEST2020 Priority: Effective Care and Coordination

The QUEST Effective Care and Coordination measure is the ratio of the observed to expected Readmissions (O/E ratio) of all acute inpatient discharges. Expected readmission is calculated by applying the CareScience® 30-day risk adjusted model. The data source for Readmission is QualityAdvisor™, whose algorithms use patient-level ICD-10 coding and key demographic data. The baseline data used to set the TPT for Effective Care and Coordination consists of performance from all hospitals that have data available within the complete January 2016 through December 2016 timeframe, n = 169.

The 2017 TPT for Effective Care and Coordination is 0.862 reflecting the top quartile of the O/E ratio from the baseline period.