Leapfrog Performance Measures


The Leapfrog Group is a voluntary, non-profit organization that aims to improve patient safety. For more information, please visit leapfroggroup.org.

The Leapfrog Group includes more than 160 companies and organizations that spend tens of billions of dollars on health care every year for more than 34 million Americans. This group has identified quality and safety practices that can improve patient safety at hospitals. Hospitals, in turn, voluntarily report on the steps they take to adopt these safety practices.

The Leapfrog performance measures are:

  • Computer physician order entry (CPOE) systems
  • ICU physician staffing
  • Evidence-based hospital referral
  • Quality index
  • Never (serious) events
  • Hospital acquired conditions

Computer Physician Order Entry (CPOE)

More than one million serious medication errors occur every year in U.S. hospitals. Computer physician order entry (CPOE) systems can be remarkably effective in reducing the rate of serious medications errors. Using a CPOE system, physicians enter orders into a computer rather than writing them down on paper. Orders are integrated with patient information, including laboratory and prescription data. The order is then automatically checked for potential errors or problems. CPOE systems intercept errors when they most commonly occur Ė at the time medications are ordered.

ICU Physician Staffing (IPS)

More than four million patients are admitted to intensive care units (ICUs) each year. An ICU is a consolidated area of a hospital where patients with acutely life-threatening illnesses or injuries receive around the clock specialized medical and nursing care, such as mechanical ventilation and invasive cardiac monitoring. Mortality rates in patients admitted to the ICU average 10-20% in most hospitals. Overall, approximately 500,000 patients die in ICUs each year. Staffing ICUs with doctors who have special training in critical care medicine (called intensivists) has been shown to reduce the risk of patients dying in the ICU. Hospitals fully meeting the IPS standard have intensivists managing or co-managing all patients in their adult or pediatric general medical and/or surgical ICUs and neuro ICUs, the intensivists are present in the ICU during daytime hours, and the intensivists return at least 95% of urgent pages within 5 minutes.

Evidence-Based Hospital Referral (EHR)

Evidence-based hospital referral means making sure that patients with high-risk conditions are treated at hospitals that frequently perform these treatments. More than 100 scientific studies have demonstrated better results at high-volume hospitals. Lower surgical mortality at high-volume hospitals is not simply a reflection of skillful surgeons and few technical errors with the procedure itself. More likely, it reflects more proficiency with all aspects of care underlying successful surgery, including patient selection, anesthesia and postoperative care.

The standards for evidence-based hospital referral do not apply to hospitals that do not perform the Leapfrog high-risk procedures. The score for EHR is represented by an overall score using the number of patients treated per year, and the risk-adjusted clinical process measures or risk adjusted observed-to-expected mortality rates, where available.

Quality Index (QI)

There are many aspects of a hospital's operations that contribute to overall quality and safety of care. The quality index is based on the 17 different practices that would reduce the risk of harm to patients in certain processes, systems or environments of care. These practices are based upon the National Quality Forums Safe Practices for Better Healthcare measures. The quality index presents a combined single score for all of these practices based on the relative weighting of importance of each practice, the severity of the effect on patients, the relative impact of performance improvement methods, and whether the practice is readily available to a frontline manager.

Never Events

Never events, as defined by the National Quality Forum, are occurrences that should never happen; for instance, surgery on the wrong body part or death due to contaminated drugs or devices. Leapfrog asks hospitals to agree to do the following if a never event occurs: 1) apologize to the patient and/or family for the event; 2) report the event to an outside entity; 3) perform a root cause analysis of the event and 4) waive costs directly related to the adverse event; and 5) provide a copy of the hospital's policy on never events to patients and payers, upon request. Hospitals report their compliance with the Leapfrog never events policy.

Hospital Acquired Conditions

There are three common acute conditions: acute myocardial infarction, pneumonia, and deliveries.

A hospital's rate of hospital-acquired pressure ulcers and rate of hospital-acquired injuries is calculated by dividing the number of discharges with the condition, which was not present on admission, by the number of inpatient days. Rates of the hospital-acquired pressure ulcers and hospital-acquired injuries are reported as a rate of occurrence per 1,000 inpatient days. Hospitals with lower rates have fewer hospital-acquired pressure ulcers and injuries. These two conditions are identified using the same codes that CMS is using for its payment reduction. Hospitals will need to rely on present-on-admission coding to identify which conditions occurred during the hospital stay. Each hospital's score is based on the hospital's performance (rate of occurrence per 1,000 patient days) relative to Leapfrog's established cutpoints.

A hospital's rate of central line-associated bloodstream infections is calculated for each ICU type (medical, surgical, medical-surgical, pediatric medical, pediatric surgical, pediatric medical-surgical, and/or coronary care, neurology) and compared to the rate of other hospitals for that same ICU type. The rate of central line-associated blood stream infections is calculated by dividing the number of central line-associated bloodstream infections acquired in the ICU by the number of central line days in that same ICU.

  • Cesarean section rates for low-risk first time moms
  • Elective deliveries before 39 weeks gestation
  • Appropriate DVT prophylaxis for women undergoing cesarean section
  • Bilirubin screening for newborns before discharge

Survey Methodology

The Leapfrog Groupís Hospital Patient Safety Survey was developed through an extensive literature review, with input from national subject matter experts and quality researchers, and includes the National Quality Forums Safe Practices for Better Healthcare measures. The survey is voluntary and is intended for only non-federal, short-term, acute-care hospitals in designated urban, suburban, and rural regions around the country.

The survey asks for general information about a hospital and then presents questions to determine whether the hospital has fully implemented or plans to fully implement the Leapfrog Groupís recommend quality and patient safety standards. The hospital CEO is required to sign a statement that the survey results are accurate and reflect the current normal operating circumstances at the hospital. Each of the standards is scored using scientifically rigorous algorithms that rank each hospital for each standard as: fully meets standards, substantial progress, some progress, willing to report, declined to report, N/A, and response not required.

The display of "No Response Yet" occurs when a hospital is not included in the Leapfrog Survey information provided by the Leapfrog Group. When the display of "D/R" (Declined to Respond) occurs, it is the result of a hospital being included in the Leapfrog Survey information provided by the Leapfrog Group and

  • The hospital did not respond to this section of the survey or;
  • The hospital was asked to complete the survey but has not submitted one.

The standards for evidence-based hospital referral do not apply to hospitals that do not perform the Leapfrog high-risk procedures. The score for EHR is represented by an overall score using the number of patients treated per year, and the risk-adjusted clinical process measures or risk adjusted observed-to-expected mortality rates, where available. The quality index presents a combined single score for all of these practices based on the relative weighting of importance of each practice, the severity of the effect on patients, the relative impact of performance improvement methods, and is the practice is readily available to a frontline manager.