QUEST methodology
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Crunching numbers to recognize QUEST® top performers

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.

We established top performance thresholds (TPTs) for QUEST 3.0 (calendar years 2014-2016) based on the collaborative’s core domains of measurement: Cost and Efficiency, Evidence-based Care, Mortality, Safety, Patient and Family Engagement, and Appropriate Hospital Use. Top performance was calculated based on top quartile performance in all QUEST domains except Cost and Efficiency which is identified by top tercile performance. The TPT methodology for each dimension varies based on the unique measure calculation and methodology outlined below.

QUEST measure: Cost and Efficiency

The QUEST Cost and Efficiency measure is calculated from total inpatient cost per case-mix adjusted discharge.

The data for the Cost and Efficiency 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 Cost and Efficiency consists of performance from all hospitals with Baseline data available and spans from January 2013 through December 2013.

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

COTH status and bed size TPT n
COTH > = 375 beds $6,870 38
COTH < 375 beds $6,110 29
Non-COTH > = 175 beds $5,540 89
Non-COTH < 175 beds $5,340 98

 

QUEST measure: Evidence-based Care

The Evidence-based Care score is the total number of patients that received all the care they were eligible for divided by the number of patients eligible for the focus area.

Evidence-based Care TPT is calculated using 6 process measures in four clinical focus groups (PC, STK, VTE and OP). The current TPT for Evidence-based Care is 95.3 percent, which was the top quartile score of the members in the baseline period.

The baseline data used to set the TPT for Evidence-based Care consists of performance from all hospitals with Baseline data available and spans from January 2013 through December 2013, n=211.

QUEST measure: Mortality

The QUEST® Mortality measure 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 coding and key demographic data. The baseline data used to set the TPT for Mortality consists of performance from all hospitals with Baseline data available and spans from January 2013 through December 2013, n=319.

The current TPT for Mortality is 0.852 based on the most recent recalibration of QualityAdvisor™ data reflecting the top quartile of the O/E ratio from the baseline period.

QUEST measure: Safety

The QUEST Safety measure is a composite score calculated from coded (ICD based) data and NHSN surveillance data. The components are 36 distinct measures of “potential harm” spanning the entire population of the hospital campus, 30 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 Safety composite.

The baseline data used to set the TPT for the Safety composite consists of performance from all hospitals with baseline data available and spans from January 2013 through December 2013, n=262.

The current TPT for the Safety composite is 82.7.

QUEST measure: 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 with Baseline data available and spans from January 2014 through December 2014, n=200.

The current TPT for Patient and Family Engagement is 74.8 percent.

QUEST measure: Appropriate Hospital Use

The QUEST® Readmission measure is the ratio of the observed to expected Readmission Rate (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 coding and key demographic data.  The baseline data used to set the TPT for Appropriate Hospital Use consists of performance from all hospitals with Baseline data available and spans from January 2013 through December 2013, n=308.

The current TPT for Appropriate Hospital Use is 0.899 based on the most recent recalibration of QualityAdvisor data reflecting the top quartile of the O/E ratio from the baseline period.