Special Study: High Performers

October 1, 2003 - October 31, 2005

The High Performers Special Study (HPSS) was conducted by Health Services Advisory Group, Inc. (HSAG), under contract with the Centers for Medicare & Medicaid Services (CMS). The overall goal of the study was to develop and implement a scientifically sound methodology to define and identify high-performing hospitals and those quality improvement practices, characteristics, and attributes that distinguish high performers (HPs) from non-high performers (NHPs).

A quantitative algorithm (the Medicare High Performers Algorithm-Hospital [MHPA-H]) was developed and applied to a national dataset of CMS quality indicators for the period from July 2003 through June 2004. The algorithm measured each hospital’s overall quality of care delivered to patients with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) to categorize hospitals as HPs or NHPs. The top six HPs nationwide were matched at the state level with six NHPs to identify similarities and differences in their QI activities through qualitative research. The Silvey Organizational Momentum Assessment Scale (MAS) was applied to the qualitative data to objectively measure the momentum (level of effort and commitment to clinical quality improvement) demonstrated by the leadership of each hospital. Quality Improvement Organizations (QIOs) and others can use the findings from the HPSS to support health care providers in achieving high performance.

The following are key findings from the study:

• Hospitals have not achieved overall excellence in providing care for AMI, HF, and PN patients. Using the MHPA-H, out of 36 possible points, no hospital exceeded 24 points, and fewer than 1 percent of 3,867 hospitals nationwide scored 16 points or higher.
• Five core characteristics related to QI culture, technology, responsibilities, priorities, and targets were identified that, when combined in various ways, suggest four common QI models of HPs.
• Individual HPs demonstrated 60 percent to 100 percent of these core characteristics, while only 0 percent to 60 percent of these core characteristics were demonstrated by individual NHPs.
• The patterns of core characteristics observed among all HPs strongly suggests that high performance may be driven by either culture or technology, not necessarily both, as long as the QI responsibilities for program implementation and priority setting are clearly delineated at the leadership level.
• Twelve basic change ideas were identified that were common to both HPs and NHPs that appear necessary, but not sufficient, for high performance.
• Nine high-leverage change ideas were identified that appear to drive high performance and further distinguished between HPs and NHPs.

Downloads

• February 2004, State of the Art Report (PDF, 414K)
• October 2004, High Performer Project Update (PDF, 27K)
• October 2004, High Performer Algorithm Update (PDF, 106K)
  

• Complete Report (PDF, 4,586 K)
• Executive Summary (PDF, 349 K)
• Body of the Report (PDF, 631K)
• Appendices A & B (Acknowledgements and “State of the Art” Report Summary) (PDF, 84 K)
• Appendix C (Identifying Top-Performing Medicare Hospitals by Algorithm: Results from a Demonstration Project) (This article is embargoed pending publication and is not currently available.)
• Appendix D (The High Performer Study Algorithm) (PDF, 368 K)
• Appendix E Is implementation of Universal CPOE Associated With Being a “Top Performing” Hospital?) (This article is embargoed pending publication and is not currently available.)
• Appendix F (Consistent Benchmark Performance: Illusion or Reality for Medicare Hospitals?) (This article is embargoed pending publication and is not currently available.)
• Appendix G (HPSS Qualitative Methodology) (PDF, 3,055K)
• Appendix H (HPSS Momentum Assessment Findings) (PDF, 129 K)
• Appendix I (HPSS Data on Continuing Hospital Momentum) (PDF, 90 K)
• Appendix J (HPSS Sample Description) (PDF, 123 K)