Ribbons and pies represent data that hospitals reported for discharges between January 1st, 2009 and December 31st, 2009.

The Maine Health Management Coalition awards pies and ribbons to hospitals that meet certain standards for quality care. Pies and ribbons are awarded in four areas:

1. Heart attack (AMI)
2. Heart failure (CHF)
3. Pneumonia (PNE)
4. Surgical care (SCIP)

Starting August 2009, the hospital rating system awards 2 different color ribbons – blue ribbons and blue ribbons with a gold inlay for meeting certain standards of care. These ratings are explained below.

The MHMC gets each hospital’s performance information from the Northeast Health Care Quality Foundation (NHCQF), Maine’s Quality Improvement Organization (QIO). Data is collected and submitted by the hospital every quarter.

The hospital’s performance rate shows the percent of the time that its patients got all of the care they needed. Hospital performance is based on the Appropriate Care Measure (ACM), which is the percent of patients that received ALL the care they were qualified to receive – the right care for every patient every time. This is also known as the “perfect care” measure and is thought to be the most meaningful for patients.

Pies are determined by comparing a hospital’s performance to how other hospitals around the country perform.

What Pie Looks Like	What it is Called	What Pie Rating Means
	One-quarter (¼) pie	Lower than U.S. average
	Half (½) pie	No different than U.S. average
	Three-quarter (¾) pie	Higher than U.S. average
	Full pie	Equal to or better than the top hospitals
	Unable to Determine	No pie, or “unable to determine” is not a reflection of performance. It means that we are unable to evaluate the correct score for statistical reasons (the hospital’s confidence interval spans both the national 50th and 90th percentiles).

Ribbons are then awarded based on the pies:

What Ribbon Looks like	What it is Called	What Ribbon Rating Means
	Blue ribbon with gold seal inlay	Best choice
	Blue ribbon	Better choice
	No ribbon	Performance is below U.S. average
	Unable to Determine	For those we are unable to evaluate

What is Special Recognition? For information on mortality and readmission data, click here.

Understanding Hospital Ratings for Select Clinical Quality: Advanced Explanation

See below for more details about the Select Clinical Quality Ratings.

Process of Care:

Clinical quality facts are collected from hospitals’ patient records. The data is changed to rates that measure:

1. How well the hospitals care for their patients
2. The percentage of times that a patient received all of the care that they needed to result in a better outcome

The measures reported are:

How Does MHMC Turn the Facts Into Ratings?

It is not easy to turn each patient interaction into a quality rating, but below are some examples of how it is done.

Example A:

Each heart failure patient needs four things done

All 100 patients have all four things done

Hospital A receives a performance score of 100% for heart failure because it provided all of the care for every patient every time

Example B:

Each heart failure patient needs four things done

Eighty of the 100 patients receive all four things they need. Ten of the patients receive only 3 of the 4 things, and the other ten receive only 2 of the 4 things

Hospital B receives a performance score of 80% for heart failure because it provided all of the care for only eighty of the 100 patients (80/100=80%) every time

Turning Data into Pies for Clinical Care Categories:

Pies are determined by comparing a hospital’s performance to how other hospitals around the country perform. More specifically, pies are based on how the hospital compares to the national average (national 50th percentile) and to the top performers (national 90th percentile).

The absolute performance is not used for comparison (for example the 100% or 80% from examples A & B above) but, rather, what is called the confidence interval.

It is easier to be sure that something will happen again if you are basing your decision on a large sample size versus a small sample.

Example A:

The MHMC considers that some hospitals have more patients and others fewer patients before awarding pies and ribbons. The QIO determines a confidence interval for each hospital based on the number of patients each hospital sees. Hospitals can earn pies as follows:

What Pie Looks Like	What it is Called	What Pie Rating Means	More Detail
	Unable to Determine	No pie, or unable to determine, is not a reflection of performance. It means that we are unable to evaluate the correct score for statistical reasons (hospital confidence interval that spans both the national 50th and 90th percentiles).
	One-quarter (¼) pie	Lower than U.S. average	If a hospital’s confidence interval falls below the 50th percentile performance of all hospitals that report nation-wide, that hospital receives a ¼ pie.
	Half (½) pie	No different than U.S. average	If a hospital’s confidence interval spans the 50th percentile, they receive ½ pie.
	Three-quarter (¾) pie	Higher than U.S. average	If a hospital’s confidence interval is between the 50th and the 90th percentile performance, they are awarded a ¾ pie.
	Full pie	Equal to or better than the top hospitals	If a hospital’s confidence interval is at or above the 90th percentile performance, they are awarded a full pie.

Turning Data into Ribbons for Clinical Care Categories:

Once the pies are determined, ribbons are awarded as follows:

What Ribbon Looks like	What it is Called	What Ribbon Rating Means	More Detail
	Unable to Determine	For those we are unable to evaluate	If a hospital’s confidence interval crosses both the 50th and the 90th percentile performance, they are “unable to determine.” This does not mean that a hospital is performing poorly. In fact, many of the hospitals that are unable to be evaluated are actually performing well – they gave the right care to the right patients all of the time! Using our drive-to-work-time example above, Unable To Determine does not mean that Person B does not have actual results better than Person A. It just means that one cannot statistically evaluate if Person B’s results are different from the other drivers.
	Blue ribbon with gold seal inlay	Best choice	Equal to a full pie at or above national 90th percentile. National 90th percentile is calculated by rating all of the hospitals from highest to lowest, selecting the top performing hospitals that care for 10% of all of the patients, and using the mean of those hospitals as the national 90th percentile benchmark
	Blue ribbon	Better choice	Awarded for ½ or ¾ pies. Being at or above the 50th percentile means that the hospital performed better than the average performance in the country
	No ribbon	Performance is below U.S. average

What is Special Recognition? For information on mortality and readmission data, click here.

MHMC used a variety of data resources to measure patient experience, safety, and clinical quality. If you would like to review these data sources yourself, please click on the links below:

• Hospital Select Clinical Quality – Please contact MHMC for more information http://www.mhmc.info/about/contact-us/