Wisconsin hospitals want to be accountable for the care they provide to their patients, and they want the citizens of Wisconsin 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. CheckPoint provides information that, as close as possible, reflects the actual care provided.

There are 129 hospitals that voluntarily participate in the CheckPoint program. This includes all acute care hospitals in the state plus a few specialty hospitals.

At this time, the only hospitals that are not participating in CheckPoint are hospitals that specialize in one type of care, for example, mental health care. Currently CheckPoint does not have any measures that apply to these hospitals.

Not all hospitals treat all patients. Hospitals must decide which measures apply to them, based on the services that they provide. 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 so they are transferred to a second hospital. Hospitals must decide which measures apply to them, based on the services that they provide.

Hospitals provide data to the CheckPoint program as they begin to collect the information. When a new measure or measure set is added, some hospitals will be ready to report, while others will need time to get ready to report.

What happens if a hospital has low volume (small number of patients) for a measure?

See "Low Reporting Volume."

No data collected at this time or no cases met criteria?

Not all hospitals collect and report data for all of the measures reported in CheckPoint. There are several reasons for this:

• Hospitals treat different types of patients based on the needs of their communities. A hospital may not provide direct care to the type of patients that are reported on by one or more of the measures in CheckPoint. If a patient requires care that is not provided by the hospital where they are currently receiving care, that hospital will arrange a transfer to an appropriate facility.
• Hospitals provide many types of care. Each hospital has a quality improvement plan which determines which types of patients they will monitor and focus their improvement efforts on. If a hospital determines that they will not monitor their care in an area where CheckPoint has measures, this hospital will not have any data to report to CheckPoint for that type of care.
• In order for a patient's information to be included in a CheckPoint measure, that patient must meet certain criteria. The criteria are required to increase the chance that the information reported for each hospital is the same. If a patient's information does not meet this criteria, that case is removed from the measure. On occasion, this will eliminate all cases from the report for an individual hospital even though they provide that type of care.

Data collected, but not enough cases to be representative of care provided in this reporting period?

The medical and surgical services measures include cases that are collected over four calendar quarters. Each quarter, the reports are updated to include more current quarters. In order to meet the CheckPoint criteria for public reporting, a hospital must have at least 25 cases in the four quarters that are combined to make up that report. The 25 case minimum requirement increases the chance that the rate reported accurately represents the hospital's patient population for that measure. If a hospital has submitted cases, but does not meet the 25 cases minimum requirement, a + sign appears for that measure.

Where can I find rates for a hospital that has less than 25 cases?

Rates for measures that have less than 25 cases are reported in two ways:

• Click on the hospital name to view all measure rates for one hospital
• Click on “+” in the report to view a trend report for that hospital and measure

What are the measures?

CheckPoint reports measures that help consumers understand how effective a hospital is at providing care that research indicates will lead to the best outcomes. Some of the measures focus on the quality of care for specific diagnoses or procedures, while others track progress towards the use of safe practices.

How did you select the measures that are in CheckPoint?

The measures in CheckPoint were selected because they are common reasons to go to the hospital.  The measures in CheckPoint were also selected because they reflect care that is scientifically proven to increase the chance of a positive outcome. By giving consumers information, we can help improve their overall health by sharing with them the kind of care that they should expect to receive.

What patients are included in the CheckPoint data?

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

Yes. The way that data is collected for each measure removes cases that do not meet criteria 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.

How often is the data refreshed in CheckPoint?

The medical and surgical services data in CheckPoint is updated every three months. The error prevention data is updated every six months. Mortality, volume and utilization data is updated annually.

How was the data collected for CheckPoint?

The medical and surgical data are collected from individual patient charts and submitted to a third party data system by the hospital staff. The error prevention data are collected from patient charts and entered directly into the CheckPoint system by the hospital staff. These data collection process reflects actual care given and error prevention practices in Wisconsin hospitals. See Data Collection and Validation for details on how the data for each measure is collected.

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. CMS validates the data by reviewing charts from the hospital's files. The medical and surgical services data 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.

The data is then accessed by the Wisconsin quality improvement organization, MetaStar, which sends the files to WHA for publication to the CheckPoint Web site. MetaStar is a trusted source of valid information on hospitals. MetaStar has gathered hospital data for more than a decade, while working with hospitals on projects designed to improve quality.

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

What period of time was the data collected?

The strength of CheckPoint is that unlike other reports on hospitals, the data used is very timely. The medical, surgical service, and index data are updated every three months (March 15, June 15, September 15, and 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 is listed at the top of the report.

Will new measures be added in the future?

Since the initial release of the first 15 measures, new measures have been added to CheckPoint. The reporting of quality and safety measures on CheckPoint is a work in progress. The Wisconsin Quality Steering Committee, along with participating hospitals, will regularly evaluate other measures to include on the Web site. See Future Measures to learn more.

Who will use CheckPoint?

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 their employer gives more than one health plan option;
    --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. Wisconsin hospitals want to have information about quality and safety readily available as consumers need it. At this time, Wisconsin is a leader in voluntary reporting of quality and safety information.

Wisconsin is viewed as a national leader in voluntary hospital reporting of quality and safety information. Some states have laws requiring hospitals to report this information.

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

The expected mortality rate for an illness or procedure is calculated based on each hospital’s case mix (risk adjusted by diagnosis-related group, age, gender and comorbidity) compared to the national average for that same case mix. Their actual mortality rate is then compared to this calculated expected rate of mortality.

If the ratio of a hospital’s actual mortality rate compared with their expected mortality rate falls within an as expected range, the hospital is ranked “As Expected.” If the ratio of a hospital’s actual mortality rate compared with their expected mortality rate is lower than the expected range, the hospital is ranked "Better". If the ratio of a hospital’s actual mortality rate compared with their expected mortality rate is higher than the expected range, the hospital is ranked "Worse".

What are the goals of the HCAHPS survey?

The HCAHPS survey is designed to meet three goals:

1. To produce information that allows objective and meaningful comparisons of hospitals on topics that are important to consumers;
2. Public reporting of the survey results creates new incentives for hospitals to improve their quality of care; and
3. Public reporting increases public accountability by providing information on the quality of hospital care provided in return for the payment the hospital receives for that care.

How are the 27 measures in the HCAHPS survey used?

Each of the 27 survey questions is used in the following ways:

• Summary measures
   – Communication with nurses (Questions 1, 2, and 3)
   – Communication with doctors (Questions 5, 6, and 7)
   – Responsiveness of hospital staff (Questions 4 and 11)
   – Pain management (Questions 13 and 14)
   – Communication about medicines (Questions 16 and 17)
   – Discharge information (Questions 19 and 20)
• Individual measures
   – Cleanliness of hospital environment (Question 8)
   – Quietness of hospital environment (Question 9)
• Global measures
   – Overall rating of hospital (Question 21)
   – Willingness to recommend hospital (Question 22)

Questions 10, 12, 15 and 18 are screener questions that direct the respondent to answer specific questions in a section.
Questions 23, 24 and 27 are used with items from hospital administrative records to adjust for differences in patient mix across hospitals.
Questions 25 and 26 are related to race and ethnicity and will be used for work related to health care disparities. They will also provide information for AHRQ’s congressionally mandated reports on health care disparities.

How is the HCAHPS survey administered?

The HCAHPS survey data is collected 48 hours to six weeks after discharge from adult patients. Participating hospitals may either use an approved survey vendor or collect their own survey data if approved by CMS to do so. Hospitals must survey patients each month of the year. Hospitals may use a random sample of patients, but must submit at least 300 completed surveys per year. If a hospital does not meet this requirement they must survey all patients.

Are the HCAHPS survey results adjusted?

The HCAHPS survey results are adjusted for the mode of survey administration (mail, telephone and/or interactive voice response) and patient characteristics (health status, education, service line, age, ER admission, response percentile, service by linear age interactions, and primary language other than English). For more information about the HCAHPS survey visit www.hcahpsonline.org .