All Branch Topic (ABT) Leapfrog Results

[militaryPHYS]

Interested to hear thoughts on leapfrog and its application within the MHS

Sixteen Military Hospitals Receive Leapfrog's Highest Safety Grade - DHA.mil

A hospital must meet specific criteria to be eligible for participation in the Leapfrog safety assessment.

dha.mil

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[DrMetal]

Interested to hear thoughts on leapfrog and its application within the MHS

Sixteen Military Hospitals Receive Leapfrog's Highest Safety Grade - DHA.mil

A hospital must meet specific criteria to be eligible for participation in the Leapfrog safety assessment.

dha.mil

It's not hard to be "safe" when you have low volume and low acuity!

 

[militaryPHYS]

Actually volume is a specific area they focus on. Numbers are reported publicly on leapfrog’s website for each institution. It affects overall score but not sure how it is weighted. I am trying to dig deeper into it

 

[DrMetal]

I've had either first hand experiences (or know of good second-hand reports) of all that Navy MTFs. They're not doing much. Most complex care is getting deferred out.

This is like me bragging about shooting a 78 at my local golf course, not counting all my penalty strokes and taking a dozen mulligans.

 

[militaryPHYS]

Are you saying there is no validity to Leapfrog results?

 

[militaryPHYS]

Leapfrog Hospital Safety Grade and Surgical Volume

The Leapfrog Hospital Safety Grade assigns hospitals a letter grade (A through F) based on 27-30 measures of patient safety, drawn from the Leapfrog Hospital Survey, CMS data, and other sources. Surgical volume is not a standalone measure in the Safety Grade but is indirectly incorporated through related safety and outcome metrics.

Indirect Role of Surgical Volume:
• The Safety Grade includes outcome measures like postoperative complications, surgical site infections, death from serious treatable complications (PSI 4), and accidental punctures or lacerations (PSI 15), which can be influenced by surgical volume.
• Hospitals with low volumes for high-risk procedures may have higher rates of adverse events due to limited experience, which could negatively impact these outcome measures.
• Additionally, the Safety Grade includes process measures like safe surgery practices (e.g., adherence to surgical checklists), which are often stronger in high-volume centers with established protocols.

Weighting in the Safety Grade:
• Each of the 27-30 measures in the Safety Grade is assigned a weight based on its evidence base, opportunity for improvement, and impact on patient safety. The exact weights are determined by an expert panel and updated periodically.
• Surgical volume is not explicitly weighted as a standalone measure, but its influence is embedded in the outcome and process measures mentioned above. For example:
• Outcome measures (e.g., PSI 4, postoperative sepsis) typically account for ~50-60% of the total Safety Grade score, with individual measures weighted between 2-5% each.
• Process measures (e.g., safe surgery practices) account for ~40-50% of the score, with similar per-measure weights.
• If a hospital’s low surgical volume leads to poor performance on outcome measures (e.g., higher mortality or infection rates), this could reduce its Safety Grade, but the effect is diluted across the many measures considered.
• The Leapfrog methodology emphasizes standardized, risk-adjusted metrics, so volume-related impacts are not isolated but rather reflected in broader safety performance.

Example:
• A hospital performing only 5 pancreatic resections annually (below Leapfrog’s threshold of 16) might have higher complication rates, contributing to a worse score on outcome measures like postoperative sepsis or mortality. This could lower its Safety Grade, but the impact would be spread across multiple weighted measures rather than tied directly to the low volume.

 

[DrMetal]

Example:
• A hospital performing only 5 pancreatic resections annually (below Leapfrog’s threshold of 16) might have higher complication rates, contributing to a worse score on outcome measures like postoperative sepsis or mortality. This could lower its Safety Grade, but the impact would be spread across multiple weighted measures rather than tied directly to the low volume.

I don't care how you fudge or weigh the numbers.

A low N is a low N, no matter how you slice it. You shouldn't be drawing any conclusions from it (positive or negative).

It makes no sense, that in their own explanation, they admit a low N, but somehow find a work-around.

That's like me shooting a 76 on a golf course, once, despite all of my other scores easily being in the 90s . . . and then I brag about being a single-digit handicap. (I'm all about the golf analogies)

 

[Dr. Wexler]

DHA loves to collect merit badges.

Reminds me of Walter Reed Bethesda claiming to be a “trauma center” because they met some ACS criteria. Nevermind that🙁1)”trauma center” is actually a geopolitical designation and Maryland does not recognize them as a trauma center
(2) they don’t function as a trauma center anymore than a rehab hospital serves as a trauma center

I know little of Leapfrog but suspect similar forces and gamesmanship are at work. Good bullet points for your yearly report card.

 

[DrMetal]

DHA loves to collect merit badges.

Reminds me of Walter Reed Bethesda claiming to be a “trauma center” because they met some ACS criteria. Nevermind that🙁1)”trauma center” is actually a geopolitical designation and Maryland does not recognize them as a trauma center
(2) they don’t function as a trauma center anymore than a rehab hospital serves as a trauma center

I know little of Leapfrog but suspect similar forces and gamesmanship are at work. Good bullet points for your yearly report card.

Yeah, same with Camp Lejern , claiming to be a "Level 3" Trauma Center . . . meaning they can repair scalp lacerations, that I used to do on a ship all the time. My USS ship was definitely a trauma (more like, drama) center.

 

[Apollyon]

Yeah, same with Camp Lejern , claiming to be a "Level 3" Trauma Center . . . meaning they can repair scalp lacerations, that I used to do on a ship all the time. My USS ship was definitely a trauma (more like, drama) center.

Was "I'm going to jump off the fantail" a real thing?

 

[afteranesthesia]

Leapfrog Hospital Safety Grade and Surgical Volume

The Leapfrog Hospital Safety Grade assigns hospitals a letter grade (A through F) based on 27-30 measures of patient safety, drawn from the Leapfrog Hospital Survey, CMS data, and other sources. Surgical volume is not a standalone measure in the Safety Grade but is indirectly incorporated through related safety and outcome metrics.

Indirect Role of Surgical Volume:
• The Safety Grade includes outcome measures like postoperative complications, surgical site infections, death from serious treatable complications (PSI 4), and accidental punctures or lacerations (PSI 15), which can be influenced by surgical volume.
• Hospitals with low volumes for high-risk procedures may have higher rates of adverse events due to limited experience, which could negatively impact these outcome measures.
• Additionally, the Safety Grade includes process measures like safe surgery practices (e.g., adherence to surgical checklists), which are often stronger in high-volume centers with established protocols.

Weighting in the Safety Grade:
• Each of the 27-30 measures in the Safety Grade is assigned a weight based on its evidence base, opportunity for improvement, and impact on patient safety. The exact weights are determined by an expert panel and updated periodically.
• Surgical volume is not explicitly weighted as a standalone measure, but its influence is embedded in the outcome and process measures mentioned above. For example:
• Outcome measures (e.g., PSI 4, postoperative sepsis) typically account for ~50-60% of the total Safety Grade score, with individual measures weighted between 2-5% each.
• Process measures (e.g., safe surgery practices) account for ~40-50% of the score, with similar per-measure weights.
• If a hospital’s low surgical volume leads to poor performance on outcome measures (e.g., higher mortality or infection rates), this could reduce its Safety Grade, but the effect is diluted across the many measures considered.
• The Leapfrog methodology emphasizes standardized, risk-adjusted metrics, so volume-related impacts are not isolated but rather reflected in broader safety performance.

Example:
• A hospital performing only 5 pancreatic resections annually (below Leapfrog’s threshold of 16) might have higher complication rates, contributing to a worse score on outcome measures like postoperative sepsis or mortality. This could lower its Safety Grade, but the impact would be spread across multiple weighted measures rather than tied directly to the low volume.

Have you drank so much koolaid you are trying to argue against the known issue of volume with Leapfrog results? I remember all the ridiculous certificates and merit badges the AF institution I used to work at gathered....it was so dumb. Half those nurses couldn't function in an actual hospital. Please don't debate the known issue of volume by asking us if the Leapfrog results mean anything. Do you chase ER docs asking about their Press Ganey scores too (The Pit)?

 

[militaryPHYS]

NDAA17 mandated that DHA utilize civilian outcome data metrics so we can be evaluated against our peers. Volume is a known issue in the MHS and I wanted to discuss others thoughts on how it impacts the overall score.

Lots of very well respected civilian hospitals with tons of volume in our area did not score an A. These are outcomes based measures.