100 e. grand ave., ste. 360 • des moines, ia 50309-1800 office: 515.283.9330 • fax: 515.698.5130
DESCRIPTION
Iowa Healthcare Collaborative - Past, Present, and Future Use of AHRQ Quality Indicators Lance Roberts 2009 AHRQ Annual Conference September 24, 2009. 100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800 Office: 515.283.9330 • Fax: 515.698.5130 http://www.ihconlie.org. - PowerPoint PPT PresentationTRANSCRIPT
Iowa Healthcare Collaborative
- Past, Present, and Future Use of AHRQ Quality
IndicatorsLance Roberts
2009 AHRQ Annual ConferenceSeptember 24, 2009
100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800
Office: 515.283.9330 • Fax: 515.698.5130
http://www.ihconlie.org
2004
• Iowa Hospital Association (hospitals) and the Iowa Medical Society (doctors) form IHC
• Cornerstones
Promote Responsible Public Reporting – “Iowa Report”
Supportive State Policy – IHA collects data, IHC research
Align and Equip Providers on Quality and Value
Engage the Community for Clinical Improvement
Raise the Standard of Care
Past – Historical Perspective
Public Reporting Policy
• Responsible Public Reporting Policy
Engage stakeholders – Data Committee Importance to measure and report - (STEEEP), variation,
or overall poor performance
Scientific acceptability of measure properties
• NQF – endorsement
• AHRQ Tiering
Usability – understandable, useful for decision making
Feasibility – data are readily available, low burden
Historical Perspective
• 2005 Iowa Report
• 10 AHRQ QIs – aggregate Iowa performance compared to US, Midwest, Low/High US states
• 2008 Iowa Report
• 16 Hospital-level and 18 aggregate QIs
Provider-focused Public ReportClinical Category - Measures:
Cardiovascular Conditions – Heart AttackCardiovascular Conditions – Heart Failure
Cardiovascular Conditions – StrokePneumonia Condition
Hip FractureMedical and Surgical – Patient Safety
Postoperative CarePrevention of Blood Clots
Prevention of Healthcare-Associated InfectionsUtilization
Obstetric / Neonatal CarePediatric – Patient Safety
Patient Experience in Hospital – HCAHPS Survey
Provider Private ReportAHRQ Quality Indicators
Data / Research BaseAHRQ CMS Primary Sources
Data Sources: HCUP - Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID)
CMS Hospital Compare – Hospital Quality InitiativeIowa Healthcare Collaborative - Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention
Clinical Category Clinical Category Clinical Category
Iowa Report – From Data/Measuresto Clinical Domains
Collaborative QualityImprovement Opportunities
• Iowa Stakeholders
Maternal Birth-related Trauma
Multiple year underperformer
Research – Roberts, Ely, Ward; Factors Contributing to Maternal Birth-related Trauma, 2007
Difficult to convene an Obstetrical Trauma Workgroup
Hospitals/Systems involved in QI – using hospital-level QI reports and our research
Collaborative QualityImprovement Opportunities
• Iowa Stakeholders
Anesthesiologists
Another specialty interested in measurement and QI
PSI 1 Descriptive Statistics – 2002-2006 SID
• Descriptive study of adverse events
• E9386 – “Peripheral Nerve and Plexus Blocking Anesthetics”
Sharing list of NQF-endorsed anesthesia-related measures
Demotion of PSI 1 – Complications of Anesthesia
Collaborative QualityImprovement Opportunities
• Iowa Stakeholders
Emergency Care – Aortic Aneurysm/Dissection
Cardiologists
Reaction to media reports
Interest in comparative private/public reporting
What Does Future Look Like?
• AHRQ’s Tools that May Assist Collaboratives / States
Consumer Reporting Tools - MONAHRQ
Pilot - Adding clinical data to administrative data
ER – PSIs, PQIs
Efficiency measures (potentially all-payer readmission)
Health Plan
Medicaid Home and Community-
Based Services2007 State Snapshots: Methods. Derived from 2007
National Healthcare Quality Report. March 2008. Rockville, MD: Agency
for Healthcare Research and Quality. http://statesnapshots.ahrq.gov/.
What Does Future Look Like?
• Value – “Business Case” and “Value” of collaborative QI efforts
Working with AHRQ researchers and tools - Iowa SID, NIS, HCUP Cost-to-Charge Ratio files
• Matching Software – match patients with adverse event to similar patients without
Are adverse events associated to excess ….
LOS ? From 2004 to 2007 – Avoided approx. 929 days
Mortality ? Avoided Approx. 10 – 16 deaths
Charges ? Avoided Approx. $3.9 million
Cost ?
How many events are Present on Admission (POA)?
AHRQ Support / Tools We Value
• AHRQ QI Support
An efficient mode to receive help on use of tools
E.g. – PSI 3 - Decubitus Ulcer
• AHRQ Quality Indicator Learning Institute (QILI)
An effective collaborative for AHRQ QI Users
Affected our Data Committee Policies
o Tiering, NQF-endorsement, Coding issues, Validation
Included information in reports to Iowa legislature
How Else Can AHRQ Help?
• Healthcare-Associated Infections – gaining a lot of attention
CAUTI
C-Diff -
Iowa trend is similar to National trend
potential 2008 attributable cost savings if Iowa C-Diff – reduced by 10% $1.5 - $2.2 Million – Iowa IP’s – use SID/NIS if possible!!
– Research will help shape– Iowa Statewide HAI Plan
Costs based on CDC Report:
Scott, DR (CDC), The Direct Medical Costs of Hais in US Hospitalls and the Benefits of Prevention. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf
How Else Can AHRQ Help?
• Improve Documentation
Use of AHRQ Support Line may be reduced if documentation is improved
• Continue AHRQ QILI
Focus on equipping users for responsible public reporting
Highlight/integrate other supportive tools – HCUP software, statistical briefs, State Snapshots, AHRQ HAI webpage