AHRQ Quality Indicators AHRQ Quality Indicators NQF Update NQF Update

Marybeth Farquhar, PhD, MSN, RNMarybeth Farquhar, PhD, MSN, RN

QI Users MeetingQI Users Meeting

AHRQ 2AHRQ 2ndnd Annual Conference Annual Conference

Rockville, MDRockville, MD

September 10, 2008September 10, 2008

QIs Submitted to NQFQIs Submitted to NQF

Submitted September 2006Submitted September 2006– Select Individual QIs (34)Select Individual QIs (34)

– Composite Measures (4)Composite Measures (4)

– Reporting Template/Framework (2)Reporting Template/Framework (2)

Additional QIs submitted Additional QIs submitted – Perinatal Project (3)Perinatal Project (3)

– Perioperative Project (3)Perioperative Project (3)

NQF TAPSNQF TAPS

Anesthesia & Surgery (16 measures)Anesthesia & Surgery (16 measures) Patient Safety (14 measures)Patient Safety (14 measures) Pediatric (4 measures)Pediatric (4 measures) Composite Measures (4 measures)Composite Measures (4 measures) Public Reporting & ImplementationPublic Reporting & Implementation

CSAC DeterminationCSAC Determination

Deliberated on April 24Deliberated on April 24 VoteVote

– Advance 25 AHRQ QIsAdvance 25 AHRQ QIs

– Defer 1 AHRQ QI (Stroke Project)Defer 1 AHRQ QI (Stroke Project)

NQF BODNQF BOD Appeals processAppeals process Project Completion: December 2008Project Completion: December 2008

NQF Endorsed QIsNQF Endorsed QIs

Diabetes ProjectDiabetes Project– PQI #1 - Diabetes Short-term Complication PQI #1 - Diabetes Short-term Complication

Admission Rate and PQI #14 - Uncontrolled Admission Rate and PQI #14 - Uncontrolled Diabetes Admission Rate.Diabetes Admission Rate.

– PQI #3 - Diabetes Long-term Complication PQI #3 - Diabetes Long-term Complication Admission Rate.Admission Rate.

– PQI #16 - Rate of Lower-extremity PQI #16 - Rate of Lower-extremity Amputation among Patients with Diabetes.Amputation among Patients with Diabetes.

Hospital Additional Priorities 2005-06, Hospital Additional Priorities 2005-06, Pneumonia Mortality SupplementPneumonia Mortality Supplement– IQI #20 – Inpatient Pneumonia MortalityIQI #20 – Inpatient Pneumonia Mortality

NQF Endorsed QIsNQF Endorsed QIs

Ambulatory Care Project: Phase 3Ambulatory Care Project: Phase 3– All PQIs & PQI CompositeAll PQIs & PQI Composite

Standards of Hospital Care: Additional Standards of Hospital Care: Additional Priorities 2007Priorities 2007– AdultsAdults

Death in low mortality DRGs (PSI 2)Death in low mortality DRGs (PSI 2) Death among surgical patients with treatable Death among surgical patients with treatable

serious complications (PSI 4)serious complications (PSI 4) Foreign body left in during procedure (PSI 5)Foreign body left in during procedure (PSI 5) Iatrogenic pneumothorax (PSI 6)Iatrogenic pneumothorax (PSI 6) Postoperative wound dehiscence in abdominopelvic Postoperative wound dehiscence in abdominopelvic

surgical patients (PSI 14)surgical patients (PSI 14)

NQF Endorsed QIsNQF Endorsed QIs Standards of Hospital Care: Additional Standards of Hospital Care: Additional

Priorities 2007Priorities 2007 Accidental puncture and laceration (PSI 15)Accidental puncture and laceration (PSI 15) Transfusion reaction (PSI 16)Transfusion reaction (PSI 16)

– PediatricsPediatrics Accidental Puncture or laceration (PDI 1)Accidental Puncture or laceration (PDI 1) Decubitus Ulcer (PDI 2)Decubitus Ulcer (PDI 2) Foreign Body left during procedure (PDI 3)Foreign Body left during procedure (PDI 3) Iatrogenic Pneumothorax in Non-neonates (PDI 5)Iatrogenic Pneumothorax in Non-neonates (PDI 5) Pediatric Heart Surgery Mortality (PDI 6)Pediatric Heart Surgery Mortality (PDI 6) Pediatric Heart Surgery Volume (PDI 7)Pediatric Heart Surgery Volume (PDI 7) Postoperative Wound Dehiscence (PDI 11)Postoperative Wound Dehiscence (PDI 11) Transfusion Reaction (PDI 13)Transfusion Reaction (PDI 13)

NQF Endorsed QIsNQF Endorsed QIs

Standards of Hospital Care: Additional Standards of Hospital Care: Additional Priorities 2007Priorities 2007– Mortality Rates (Adults)Mortality Rates (Adults)

Congestive heart failure (IQI 16)Congestive heart failure (IQI 16) Stroke (IQI 17)Stroke (IQI 17) Hip Fracture (IQI 19)Hip Fracture (IQI 19) Esophageal resection (IQI 18)Esophageal resection (IQI 18) Pancreatic resection (IQI 9)Pancreatic resection (IQI 9) Abdominal aortic aneurysm repair (IQI 11)Abdominal aortic aneurysm repair (IQI 11)

NQF Endorsed QIsNQF Endorsed QIs

Standards of Hospital Care: Additional Standards of Hospital Care: Additional Priorities 2007Priorities 2007– Volume of Procedures (Adults)Volume of Procedures (Adults)

Esophageal resection (IQI 1)Esophageal resection (IQI 1) Pancreatic resection (IQI 2)Pancreatic resection (IQI 2) Abdominal aortic aneurysm repair (IQI 4)Abdominal aortic aneurysm repair (IQI 4)

– Hospital Level Procedure Utilization RatesHospital Level Procedure Utilization Rates Incidental appendectomy in the elderly (IQI 24)Incidental appendectomy in the elderly (IQI 24) Bi-lateral cardiac catheterization (IQI 25)Bi-lateral cardiac catheterization (IQI 25)

NQF Endorsed QIsNQF Endorsed QIs

Perinatal Care ProjectPerinatal Care Project– Nosocomial Blood Stream Infections in Nosocomial Blood Stream Infections in

Neonates (NQI 3)Neonates (NQI 3)

– Birth Trauma: Injury to Neonates (PSI 17)Birth Trauma: Injury to Neonates (PSI 17)

Hospital Perioperative CareHospital Perioperative Care– Postoperative DVT or PE (PSI 12)Postoperative DVT or PE (PSI 12)

CMS’ Reporting Hospital Quality Data CMS’ Reporting Hospital Quality Data for Annual Payment Update Programfor Annual Payment Update Program

New Measures for FY 2010 UpdateNew Measures for FY 2010 Update– SCIP Cardiovascular 2SCIP Cardiovascular 2– Heart Failure Readmission (30 day)Heart Failure Readmission (30 day)– PSI 4 (formerly FTR)PSI 4 (formerly FTR)– Patient Safety IndicatorsPatient Safety Indicators

Iatrogenic pneumothorax, adultIatrogenic pneumothorax, adult Postoperative wound dehiscencePostoperative wound dehiscence Accidental puncture or lacerationAccidental puncture or laceration

– In patient Quality IndicatorsIn patient Quality Indicators AAA Mortality RateAAA Mortality Rate Hip fracture mortality rateHip fracture mortality rate

CMS’ Reporting Hospital Quality Data CMS’ Reporting Hospital Quality Data for Annual Payment Update Programfor Annual Payment Update Program

New Measures for FY 2010 UpdateNew Measures for FY 2010 Update– Mortality for selected medical conditionsMortality for selected medical conditions

– Mortality for selected surgical proceduresMortality for selected surgical procedures

– Complication/patient safety for selected Complication/patient safety for selected indicatorsindicators

– Cardiac Surgery Measure: Participation in Cardiac Surgery Measure: Participation in a systematic database for cardiac surgerya systematic database for cardiac surgery

NQF Guidelines for Consumer-NQF Guidelines for Consumer-Focused Public Reporting Focused Public Reporting (August 2008)(August 2008)– 7 Guidelines7 Guidelines– Evaluated AHRQ Model ReportsEvaluated AHRQ Model Reports

Health Topic TemplateHealth Topic Template Composite TemplateComposite Template

QI Reporting TemplateQI Reporting Template

Composite MeasuresComposite Measures

Inpatient Quality IndicatorsInpatient Quality Indicators– Mortality for Selected ProceduresMortality for Selected Procedures

– Mortality for Selected ConditionsMortality for Selected Conditions

Patient Safety IndicatorsPatient Safety Indicators– Overall SafetyOverall Safety

Pediatric Quality IndicatorsPediatric Quality Indicators– Overall SafetyOverall Safety

Prevention Quality IndicatorsPrevention Quality Indicators– Overall Preventable AdmissionsOverall Preventable Admissions

AcknowledgementsAcknowledgements

As with any large, complex endeavor, the AHRQ Quality Indicators are supported by a team of researchers, clinicians, and others that work to constantly refine and improve the measures. There are a number of individuals that work on the QIs and contribute to their development and testing that should be acknowledged here, however, I would like to specifically acknowledge Jeffrey Geppert, J.D., of Battelle Memorial Institute; Patrick Romano, M.D., M.P.H., of the University of California; Sheryl M. Davies, M.A., and Kathryn M. McDonald, M.M., of Stanford University for their diligence and continued support of the program. I would also like to thank my colleagues at AHRQ for their suggestions and words of encouragement, but in particular, Mamatha Pancholi, the QI Project Officer, for her support and phenomenal focus over the past two years. I am honored and privileged to be part of an incredible team.