Clinical Quality & Outcomes: Measuring Outcomes - Apollo Hospitals

The true measures of quality for a hospital are the outcomes that matter to patients. Measuring the outcomes for healthcare services delivery is one of the most important functions for a quality conscious and value focussed organisation. These outcome measures help to monitor quality of patient care and clinical processes within the organization.

Outcomes data gives you information on how well a hospital provided care for most of its patients. When outcomes are measured and published, it fosters improvement and helps healthcare organizations adopt best practices. Publishing outcomes indicates a true commitment to an environment of constant improvement and transparency.

You can use the following information to help you compare hospitals for their quality focus.

Quick Check for Quality

Look for a hospital that:

Is accredited by the Joint Commission International (JCI), the gold standard for healthcare quality across the globe or a national accreditation body such as the National Accreditation Board for Hospitals & Healthcare Providers (NABH)
Has experience with your condition
Has had success with your condition
Has adopted the continuous quality improvement model for improving its quality of care
Tracks patient outcomes (how well the patients do)
Has formulated quality/outcome indicators to measure and improve systems and processes
Has a robust infection control programme and ensures strict compliance

The Apollo Hospitals Group is committed to the highest standards of quality and clinical excellence for its patients. Our priority is to ensure that all patients are cared for in a way that is safest and most efficient. We strive to provide high-quality services for best clinical outcomes. In order to efficiently measure and compare key clinical outcome processes across all the hospitals in the Group, Apollo Hospitals devised and is successfully using the ACE@25 scoring system. We are the first corporate hospital group in India to start benchmarking and monitoring clinical performance outcomes since 2005 through the ACE@25 dashboard. We were also the first to start publishing data in 2009 in our annual excellence report.

Earlier known as ACE@25, this scorecard has been renamed as ACE 1 in 2015 with revision in indicators and benchmarks.

ACE 1 is a balanced score card focusing on clinical excellence. This scoring system features a set of key parameters that measure complication rates, mortality rates and average lengths of stay after major procedures, such as CABG, TKR, THR and Endoscopy. ACE 1 also includes hospital acquired infection rates, satisfaction levels with pain management and medication errors. Our outcome measures have been benchmarked against published results of reputed institutions in the world. We perform Group-wide audit of data at regular intervals in a year to check the source and validity of the data.

MORE ABOUT ACE 1

Whatever is measured tends to improve. Keeping this in mind, Apollo Hospitals Group has devised and introduced ACE @ 25 – a balanced scorecard focusing on clinical excellence that addresses provision of evidence-based quality care, that offers safe environment to our patients and strengthens the functional efficiency of our hospitals, stimulating quality improvement while reducing variations.

Concept

ACE @ 25, (renamed as ACE 1 from 2015) is a clinical balanced scorecard focusing on clinical excellence, and incorporates parameters which are mission critical for the clinical milieu of our organization. Every parameter is benchmarked with the international institution that is considered best-of-class in the respective parameter. Benchmarks have been chosen from the world’s best institutions including Cleveland Clinic, Mayo Clinic, National Healthcare Safety Network, University of California, San Francisco, and Agency for Healthcare Research and Quality, US.

Methodology

For the purpose of ACE 1 reporting, the Group hospitals have been divided into three groups depending on their bed strengths, location and services offered as Group A, B and C. Each indicator has been lucidly defined and the numerators and the denominators have been clearly delineated. Benchmarking defines our Group expectations with weighted scores for the outcomes. The scoring system ensures that the segments measure up to a statistically significant range of figures which are further color coded as green, orange and red. The cumulative score achievable is capped at 100.

Architecture

The ACE @ 25 balanced score card has been developed online, with live capabilities using our Apollo Lighthouse platform for monthly inputs with relevant data, using the PHP framework hosted through cloud technology. The mechanism is so devised to maintain the integrity and confidentiality of data with respect to each of the Apollo Hospitals.

Few indicators are given below as examples:

INDICATOR	BENCHMARK	RANGE	SCORE
CABG mortality rate	0.50%	<0.80	4
	Cleveland Clinic	0.81-1.2	3
		1.21-1.6	2
		1.61-2	1
		>2	0
Ventilator Associated Pneumonia (VAP)	0.9	<0.9	4
	National Healthcare Safety Network	0.91-2.5	3
	2012	2.51-4.1	2
		4.11-5.7	1
		>5.7	0

Implementation

The monthly summary of the performance is reviewed by the Oversight Committee and the individual hospitals draw action plans on improving scores in parameters that they are scoring low. Trends in scores in individual parameters are identified every quarter, every six months and annually. This helps in looking for consistency in good or poor performance, identifying improvement or decline and irregular fluctuations. Consistent low performance, decline or fluctuation in scores for any parameter becomes the focus area of the hospital and is aggressively worked upon for improvement.

Accolades

ACE@25 was chosen for presentation at the ISQua Conference, 2011 and Conference of the Royal College of Physicians, 2014. Besides this, it has also been published as a case study by the Richard Ivey School of Business and won the FICCI Healthcare Excellence Award 2011.