A Novel Metric that Objectifies and Improves Performance – MEQI (Medicine Efficiency Quality Index)

From the 2019 HVPAA National Conference

Dr. Katherine Hochman (NYU Langone Health), Dr. Brian Bosworth (NYU Langone Health)

Background

Organizations rely on front-line physicians to reliably provide care that is high quality, safe and efficient. While service-level metrics are routinely reviewed, individual-level metrics have traditionally had a lesser focus. This diminishes the ability of a single physician to understand and improve practice habits.

Objective

The goal of the Medicine Efficiency Quality Index (MEQI) is to capture the most important quality, safety and efficiency metrics of the Medicine service into a single equation that is transparent to individual physicians. By making data visible, our goal was to improve care to our patients.

Methods

We created a MEQI formula that captures the institution’s most important quality, safety and efficiency metrics (Figure 1). These included observed:expected length of stay (LOS), early discharge rate, readmission rate, completion of goals of care notes, rate of hospital acquired conditions. Of note, the MEQI is a quality score, so volume/ RVUs are not included in this equation. We discussed both the concept of the MEQI as well as its components at key meetings with front-line staff. We calculate the MEQI goal based on our institution’s goals of the various metrics. We displayed individual MEQI scores in rank order at key monthly meetings. Physicians who were below the goal were bolded in red. All physicians meet with leadership to review MEQI scores on a semiannual basis to discuss strategies to improve.

Results

Since the introduction of the MEQI index, the MEQI score for inpatient hospitalist attendings has increased by 14.8%. Plotting the MEQI against the Variable Direct Cost adjusted for Case Mix Index for each physician allows for an easy visualization of individual performance (Figure 2).

Conclusions

The transparent display of individual MEQI scores provides important feedback and creates a culture of engagement and accountability.

Clinical Implications

Fostering a safe environment and a friendly sense of competition helps drive improved MEQI scores and more importantly better patient care.

Figures

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