Leapfrog Hospital Survey Results are publicly reported on Leapfrog’s website and used by purchasers and consumers, regional and national health plans, transparency vendors, and researchers. The accuracy of the data we publish and distribute is of utmost importance. Leapfrog has several protocols in place to verify the accuracy of our results. Each protocol is described in detail below.
Affirmation of Accuracy
At the end of each section of the Survey, the hospital's CEO, or their designee, complete an Affirmation of Accuracy, affirming that the information the hospital has submitted in that section of the Survey is indeed accurate. Leapfrog reserves the right to require documentation before certifying and/or publishing any hospital’s Survey Results and does exercise this right at random.
Data Review Warnings in the Online Hospital Survey Tool
Leapfrog’s Online Hospital Survey Tool requires hospitals to “check for data review warnings” before they are able to submit a Survey. When a hospital clicks this button on the Survey Dashboard, sections that have been completed and affirmed will be scanned for potential data entry errors and inconsistencies. For example, if a hospital reports licensed and staffed ICU beds in Section 1 Basic Hospital Information, and then reports not caring for patients in an ICU in Section 5 ICU Physician Staffing, a “data review warning” will be generated. The hospital will still be able to submit their Survey but will be contacted via email by the Help Desk to either (1) correct the error or (2) document that the original response was correct. The data review warning system gives hospitals an opportunity to correct potential errors immediately – while they are still in the Online Hospital Survey Tool.
If a hospital receives a "data review warning," they can either:
- Review their response and make corrections on the spot. Hospitals will need to re-affirm any updated sections before they attempt to submit them again.
- Print their “data review warning” and investigate the issue. Hospitals are encouraged to contact the Help Desk if they have any questions.
Monthly Data Review
Upon the receipt of a hospital’s submitted Leapfrog Hospital Survey, The Leapfrog Group conducts an extensive Data Review of each response submitted in the Survey. The Leapfrog Group conducts this Data Review monthly beginning with June 30 submissions until the Survey is taken offline on January 31. Data review messages are emailed to the primary Survey Contact and System Contact (if applicable) within the first 5 business days of the month AFTER Leapfrog receives a Survey submission beginning with June 30 submissions.
To identify potential data entry or reporting errors, quantitative responses are assessed using empirically driven, normative data quality thresholds. The data quality thresholds are constructed with both high and low benchmarks of acceptability. Data quality thresholds for each question are determined from both external data sources (e.g., state quality reports, other national performance measurement entities) and historical Leapfrog Hospital Survey data. The Data Review also includes assessing qualitative responses for potential data entry errors and inconsistencies. Applying this review methodology, The Leapfrog Group assigns each response into one of three categories:
- Category C: The response provided is plausible and within the data quality thresholds; Leapfrog will not contact the hospital.
- Category B: The response provided is plausible, but it falls outside the data quality thresholds; Leapfrog will contact the hospital and action from the hospital is requested.
- Category A: The response provided is considered implausible, given that the response falls far outside of the data quality thresholds and appears to have been provided with the intent to mislead; Leapfrog will contact the hospital and action from the hospital is required.
Hospitals that receive a Category B Data Review message at the beginning of the month for any measure will be asked to review the associated Survey questions and measure specifications to ensure the submitted responses are correct. Hospitals are asked to (1) contact the Help Desk to confirm the original responses are correct so we can discontinue the monthly Data Review message or (2) to update and resubmit the Survey if a correction is needed.
Hospitals that receive a Category A Data Review message at the beginning of the month for any measure will have until the end of that same month to contact the Help Desk to either (1) document that the original response was correct or (2) correct the data entry or reporting error, or they will be publicly reported as “Pending Leapfrog Verification” for that measure. This term is used to indicate that the hospital has self-reported Survey responses that are under further review by Leapfrog.
If any Category A Data Review messages are not resolved by January 31 (when the Online Hospital Survey Tool is taken offline), the entire section in which the flagged responses were included will be decertified and all measures within the section will be publicly reported as “Declined to Respond.”
In the interim (that is, prior to Leapfrog's receipt of a hospital’s response to a Category B Data Review message or prior to the end of the month for Category A Data Review messages), the original Survey Results are publicly reported on Leapfrog’s website.
When Leapfrog is contacted about a particular Survey response or Leapfrog representatives are made aware of a potential error in reporting, Leapfrog does investigate these concerns and the hospital’s Survey is subject to decertification.
Monthly Requests for Documentation
In addition to the pre- and post-submission Monthly Data Review described above, Leapfrog also randomly selects hospitals to submit documentation to verify the accuracy of various responses from each Section of the Leapfrog Hospital Survey. Hospitals must respond to the documentation request within 30 days or risk having the section publicly reported as "Pending Leapfrog Verification."
On-site Data Verification
On-Site Data Verification builds on Leapfrog’s already robust process for reviewing Survey responses, and, at the same time, answers hospitals’ requests for more information on using the Online Survey Tool and Survey Results for quality improvement.
Leapfrog has commissioned DHG Healthcare to oversee and conduct the On-Site Data Verification with a team of expert reviewers. The Verification Team operates separately from other healthcare consultants within DHG, and does not provide consulting services for any of the hospitals selected for verification. DHG Healthcare is the national healthcare practice of Dixon Hughes Goodman LLP. Please visit their website for more information.
In 2019, DHG Healthcare randomly selected a small number of hospitals for On-Site Data Verification. The hospitals selected for 2019 are notified in the first week of April. Hospitals that have not received notification will not be selected for On-Site Data Verification this year.
On-Site Data Verification is conducted by DHG Healthcare, with technical support from The Leapfrog Group, in the months of July and October.
The protocol for the On-Site Data Verification includes the following for each selected hospital:
- Orientation Call: This call is an opportunity for DHG to review the pre-visit documentation request, the Leapfrog Hospital Survey Binder, finalize the agenda for the half-day scheduled visit, provide examples of the methods that will be used to validate Survey responses, and answer any questions the hospital and their team may have. DHG will provide an orientation checklist to help the hospital determine who should be on this call.
- Pre-visit Documentation Request: Hospitals will use the Leapfrog Hospital Survey Binder while they are collecting information for completing the 2019 Leapfrog Hospital Survey so they can concurrently record and track the information needed for the On-Site Data Verification. As a result, retrospective data collection and record finding will not be necessary.
- Half-Day Scheduled On-Site Visit, which includes:
- Introductory Meeting (approx. 20 minutes): DHG will meet with the hospital's pre-selected team to review the agenda for the day and answer any questions the hospital may have.
- Verification of four to six specific measures (approx. 2.5 to 3 hours): DHG will work through the established agenda by meeting with various team members to administer the verification protocol for selected measures.
- Discussion of quality improvement strategies tied to Leapfrog measures (approx. 30 minutes): DHG will meet with the hospital and their team to share examples of quality improvement strategies in use by other hospitals across the country. DHG will also ask the hospital and their team to share ideas for how Leapfrog could make changes to the Survey and/or Survey Results tools so they can be better used in quality improvement.
- Exit Interview (approx. 20 minutes): DHG will wrap up the day by reviewing the preliminary verification findings report and outlining any necessary next steps. In addition, the hospital and their team will be asked to share feedback on the protocol.
Technical Support from the Leapfrog Hospital Survey Help Desk: If DHG discovers any issues with a hospital’s submitted responses, a summary of those issues will be made available to the hospital (see description below) and the Leapfrog Hospital Survey Help Desk. Help Desk staff will work with the hospital so that they are able to update their Survey appropriately.
Findings Report: A hospital-specific findings report will be shared with the hospital. Findings are not publicly reported.
Leapfrog Hospital Survey Binder
The Leapfrog Hospital Survey Binder was originally designed for those hospitals that have been selected for Leapfrog’s On-Site Data Verification administered by DHG Healthcare. Those hospitals are mailed a binder to collect and organize the information (e.g., reports, documentation, notes, etc.) they use to complete their Leapfrog Hospital Survey AND at the same time, prepare for their verification. DHG uses the information in the binder during the scheduled visit to verify a hospital’s Leapfrog Hospital Survey responses.
However, the Leapfrog Hospital Survey Binder document (PDF) is available for use by all hospitals to collect, organize, and record information during the completion of the Leapfrog Hospital Survey. The document, which is divided into 10 tabs (or sections), one for each section of the Survey, can be printed and placed in a binder. The information is helpful when completing subsequent year’s Surveys, in staff and leadership transitions, and as a historical record. The use of the binder also acquaints hospitals with the elements of On-Site Data Verification.