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Planned Updates to the Leapfrog Hospital Safety Grade Methodology

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The Leapfrog Group is planning changes to the Leapfrog Hospital Safety Grade scoring methodology effective with the spring 2021 Hospital Safety Grade. Leapfrog is inviting public comments on these proposed changes through January 31, 2021.

In September 2020, Leapfrog was notified by the American Hospital Association (AHA) that it would not be renewing Leapfrog’s data license for their AHA Annual Survey and Health Information Technology Supplement datasets used in the Hospital Safety Grade. These two datasets have been used by Leapfrog since 2012 to assign scores to hospitals that decline to publicly report via the Leapfrog Hospital Survey on Computerized PhysicianOrder Entry (CPOE), Bar Code Medication Administration (BCMA), and ICU Physician Staffing (IPS). Each of these three measures reflect important, evidence-based structures that hospitals should implement to ensure the safest patient care, and each represent a significant weight within the Hospital Safety Grade. CPOE and BCMA both address the most prevalent patient safety issue – medication errors – and research has shown that staffing ICUs with intensivists (IPS) can reduce ICU mortality by up to 40%.

Leapfrog has worked closely with statisticians at Mathematica, Leapfrog’s National Expert Panel, and their scientific partners at Johns Hopkins Medicine to develop a new imputation approach, which uses the most accurate information publicly available, is feasible to calculate, transparent and reproduceable by hospitals, and useful for those relying on the Hospital Safety Grade (i.e., consumers, purchasers, health plans, etc.).

Effective with the spring 2021 Hospital Safety Grade, if a hospital is missing a publicly reported score from the Leapfrog Hospital Survey on CPOE, BCMA, and/or IPS, the following 3-step methodology will be used to assign a measure score for each of the three applicable measures:

Step 1: Use a Hospital’s Most Recent Score on the Measure – Applies to CPOE, BCMA, and IPS
If the hospital had a score assigned by Leapfrog in the previous six rounds of grades (i.e., fall 2020, spring 2020, fall 2019, spring 2019, fall 2018, or spring 2018), the hospital will be assigned the most recent score on that measure in the current Hospital Safety Grade (i.e., spring 2021).

Step 2: Use the Mode of Scores Assigned to Other Hospitals in the Same Health System – Applies to CPOE and BCMA only.
If the hospital is part of a health system that has at least 6 hospitals, of which at least two-thirds have a score on the CPOE and/or BCMA measure in the current round (i.e., spring 2021) that is publicly reported from the Leapfrog Hospital Survey, the hospital will receive the mode score of the other health system hospitals (the mode is the most frequent score). Leapfrog will determine a hospital’s membership in a health system using the Agency for Healthcare Research and Quality’s Compendium of U.S. Health Systems. If the hospital did not have an IPS measure score assigned by Leapfrog in any of the previous six rounds of grades (some hospitals do not operate intensive care units, and therefore an ICU staffing measure would not be applicable to the hospital), the IPS score will remain missing (i.e., displayed as “Not Available”) and the measure will not be used to calculate the Hospital Safety Grade. The weight for the measure will be re-apportioned to other measures within the process/structural measure domain to calculate the grade.

Step 3: Use the Mean of the Scores Assigned to Other “Like” Hospitals in the U.S. – Applies to CPOE and BCMA only.
The hospital will be assigned to a cohort of other “like” hospitals using four hospital characteristics obtained from the most recent CMS Impact File: (1) number of beds (BEDS), (2) urban/rural status (URGEO), (3) teaching status (Resident to Bed Ratio), and (4) disproportionate share hospital patient percentage (DSHPCT). The hospital will then be assigned the mean score of that cohort, which will be calculated based on hospitals that have a score on the CPOE and/or BCMA measure in the current round (i.e., spring 2021) that is publicly reported from the Leapfrog Hospital Survey. Leapfrog will determine a hospital’s membership in a cohort using the CMS Impact file. If the hospital has not received a score on IPS in any of the previous six rounds of grades (some hospitals do not operate intensive care units, and therefore an ICU staffing measure would not be applicable to the hospital), the IPS score will remain missing (i.e., displayed as “Not Available”) and the measure will not be used to calculate the Hospital Safety Grade. The weight for the measure will be re-apportioned to other measures within the process/structural measure domain to calculate the grade.

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