AHRQ Quality Indicators AHRQ Quality Indicators Maryland Health Services Maryland Health Services Cost Review Commission Cost Review Commission October 21, 2005 October 21, 2005 Marybeth Farquhar, AHRQ Marybeth Farquhar, AHRQ
Overview Overview � AHRQ Quality Indicators � AHRQ Quality Indicators � Current Uses of the Quality Indicators � Current Uses of the Quality Indicators � Case Studies of P4P � Case Studies of P4P � Future Enhancements � Future Enhancements
AHRQ Quality Indicators (QIs) AHRQ Quality Indicators (QIs) � Developed through contract with UCSF � Developed through contract with UCSF- -Stanford Stanford Evidence- -based Practice Center based Practice Center Evidence � Use existing hospital discharge data, based on � Use existing hospital discharge data, based on readily available data elements readily available data elements � Incorporate severity adjustment methods (APR � Incorporate severity adjustment methods (APR- - DRGs, comorbidity groupings) in IQIs DRGs, comorbidity groupings) in IQIs � Current modules: Prevention QIs, Inpatient QIs, � Current modules: Prevention QIs, Inpatient QIs, and Patient Safety Indicators and Patient Safety Indicators
Example Indicator Evaluation Example Indicator Evaluation INITIAL LITERATURE REVIEW EMPRICAL ANALYSES AND DEFINITION USER DATA PANEL EVALUATION FURTHER FURTHER REVIEW? EMPIRICAL ANALYSES REFINED DEF. FINAL DEFINITION
Overview of AHRQ QIs Overview of AHRQ QIs � Prevention � � � Ambulatory care sensitive Prevention Ambulatory care sensitive Quality Indicators Quality Indicators conditions conditions � � Mortality following procedures Mortality following procedures � � Mortality for medical conditions Mortality for medical conditions � Inpatient Quality � Inpatient Quality � � Utilization of procedures Utilization of procedures Indicators Indicators � � Volume of procedures Volume of procedures � Patient Safety � Patient Safety � � Post- -operative complications operative complications Post Indicators Indicators � � Iatrogenic conditions Iatrogenic conditions
Structure of AHRQ QI Structure of AHRQ QI � � Definitions based on Definitions based on ICD- -9 9- -CM diagnosis and procedure codes CM diagnosis and procedure codes – ICD – Often along with DRG, MDC, sex, age, procedure dates, – Often along with DRG, MDC, sex, age, procedure dates, – admission type, admission source, discharge disposition, admission type, admission source, discharge disposition, discharge quarter (new) discharge quarter (new) � � Numerator is the number of cases “ “flagged flagged” ” with the outcome with the outcome Numerator is the number of cases of interest (e.g., Postoperative sepsis, avoidable hospitalization on of interest (e.g., Postoperative sepsis, avoidable hospitalizati for asthma, death) for asthma, death) � � Denominator is the population at risk (e.g. pneumonia patients, Denominator is the population at risk (e.g. pneumonia patients, elective surgical patients, county population from census data) elective surgical patients, county population from census data) � � The observed rate is numerator / denominator The observed rate is numerator / denominator � � Volume counts for selected procedures Volume counts for selected procedures
Advantages Advantages � Public Access � Public Access – All development documentation and details All development documentation and details – on each indicator available on website on each indicator available on website www.qualityindicators.ahrq.gov www.qualityindicators.ahrq.gov – Software available to download at no cost Software available to download at no cost – – Standardized indicator definitions Standardized indicator definitions – – Can be used with any administrative data: Can be used with any administrative data: – HCUP, MedPac, state datasets, payer HCUP, MedPac, state datasets, payer data, hospital internal data data, hospital internal data
Advantages (cont’ ’d) d) Advantages (cont � Scope � Scope 79 individual measures, will be more – 79 individual measures, will be more – – Each measure can be stratified by other variables Each measure can be stratified by other variables – including patient race, age, sex, provider, including patient race, age, sex, provider, geographic region geographic region – Include priority populations and areas: Child – Include priority populations and areas: Child health, women’ ’s health (pregnancy and child s health (pregnancy and child- - health, women birth), diabetes, hypertension, ischemic heart birth), diabetes, hypertension, ischemic heart disease, stroke, asthma, patient safety, disease, stroke, asthma, patient safety, preventative care preventative care – Focus on acute care but do cross over to – Focus on acute care but do cross over to community and outpatient care delivery settings. community and outpatient care delivery settings.
Advantages Advantages � Indicator Maintenance � Indicator Maintenance � National Benchmarks � National Benchmarks – National Healthcare Quality Report National Healthcare Quality Report – – National Healthcare Disparities Report National Healthcare Disparities Report – – HCUPnet HCUPnet –
Limitations Limitations � Data � Data- -known limitations of administrative known limitations of administrative data data � Developed for quality improvement, � Developed for quality improvement, evaluations conducted within that evaluations conducted within that context context � Risk � Risk- -adjustment limitations adjustment limitations � Evidence � Evidence- -base timing: Research vs. base timing: Research vs. demand for information demand for information
General Uses of the AHRQ QIs General Uses of the AHRQ QIs � Hospital Quality Improvement � Hospital Quality Improvement – – Internal and Internal and External External Individual hospitals and health care systems – Individual hospitals and health care systems – – Hospital association member- -only reports only reports – Hospital association member � National, State and Regional Reporting � National, State and Regional Reporting National Healthcare Quality/Disparities Reports – National Healthcare Quality/Disparities Reports – � Public Reporting by Hospital � Public Reporting by Hospital Texas, New York, Colorado, Oregon, – Texas, New York, Colorado, Oregon, – Massachusetts, Wisconsin Massachusetts, Wisconsin � Pay � Pay- -for for- -Performance by Hospital Performance by Hospital CMS/Premier Demo, Anthem of Virginia – CMS/Premier Demo, Anthem of Virginia – � Hospital Profiling � Hospital Profiling Blue Cross/Blue Shield of Illinois – Blue Cross/Blue Shield of Illinois –
Pay for Performance: Pay for Performance: Case Studies Case Studies � CMS/Premier Demonstration Project � CMS/Premier Demonstration Project � Blue Cross/Blue Shield of Illinois � Blue Cross/Blue Shield of Illinois � Anthem BC/BS Virginia Pay for � Anthem BC/BS Virginia Pay for Performance Project Performance Project
National Comparative Reporting: National Comparative Reporting: Pay for Performance Pay for Performance � CMS / Premier: Pay for Performance � CMS / Premier: Pay for Performance Demonstration Project Demonstration Project – Two PSIs Two PSIs – � Postoperative hemorrhage or hematoma � Postoperative hemorrhage or hematoma and and � Postoperative physiological and � Postoperative physiological and metabolic derangement metabolic derangement � In two distinct patient populations � In two distinct patient populations - - hip hip and knee replacement and CABG and knee replacement and CABG � Will create composite score (quality and � Will create composite score (quality and safety) safety)
State Level Comparative Reporting: State Level Comparative Reporting: Pay for Performance (cont.) Pay for Performance (cont.) � Blue Cross Blue Shield of Illinois (BCBSIL) � Blue Cross Blue Shield of Illinois (BCBSIL) – Hospital Profiles include multiple aspects of Hospital Profiles include multiple aspects of – hospital performance. Indicators include: hospital performance. Indicators include: � Compliance with the Leapfrog standards � Compliance with the Leapfrog standards � AHRQ Quality Indicators � AHRQ Quality Indicators – – Inpatient and Patient Inpatient and Patient Safety for 2004 profiles Safety for 2004 profiles � Hospital � Hospital- -specific satisfaction and quality indicators specific satisfaction and quality indicators from the BCBSIL from the BCBSIL � Accreditation status � Accreditation status � Percentage of board certified physicians � Percentage of board certified physicians � And several other indicators... � And several other indicators...
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