AHRQ Quality AHRQ Quality Indicators: History Indicators: History

and Applicationand Application

May-June 2007 May-June 2007

Indicator DevelopmentIndicator Development

AHRQ – Agency for Healthcare Research and Quality (www.qualityindicators@ahrq.gov)

• Originally developed by the Health Care Utilization Project of AHRQ in the early 1990s

• Expanded and refined by AHRQ’s Evidence Practice Center at UCSF and Stanford

• Goal: Accessible, reliable indicators of quality

Three Types of MeasuresThree Types of Measures

• Volume of Inpatient Procedures– A link has been demonstrated between the number of

procedures performed and outcomes

• In-hospital Mortality– Examines outcomes following procedures and for

common medical conditions

• Utilization– Procedures for which questions have been raised about

overuse, underuse, and misuse

WHAIC Indicator ReportsWHAIC Indicator Reports 2003-20052003-2005

Required per HFS 120.26 and contract with WI Department of Administration– Based on hospital data collected by the

“department”– Reformatted to be consistent with nationally

recognized quality indicators– Presents variations in the delivery of inpatient

care at individual hospitals without identifying hospitals

Accessing WHAIC Quality Indicator Accessing WHAIC Quality Indicator ReportsReports

http://whainfocenter.com/dataresources.htmhttp://whainfocenter.com/dataresources.htm

LimitationsLimitations

• Variation among hospitals in the coding of diagnoses and procedures

• Conditions present on admission are not currently identified

• Lack of specificity in ICD-9-CM coding

• Limitations of data content

Hospice CareHospice Care

• In general, included

• Hospitals instructed to exclude records of patients admitted to hospice care

• Includes records of patients with a DNR order (at this time) if not hospice

• Records with condition code “P1” may be excluded in the future

Annual ImprovementsAnnual Improvements

Annual Coding Updates

35 Dx Fields with 35 POA Fields – apply to 2008 discharges (optional)

Composite Measures – IP Mortality for procedures and conditions (optional)

Two New Rate Selections – Population rate and observed/expected ratio (optional)

Advantages of Administrative Advantages of Administrative DataData

• Accessible

• No extra work for hospitals

• Data subject to several edit checks/no separate WHA audit required

• Indicators selected can be measured accurately with discharge data

Validation StudiesValidation Studies

Summary Evidence on the IP Quality Indicators – http://www.qualityindicators.ahrq.gov

– Inpatient Quality Indicators Guide Version 3.0

(February 2006) pages 14-70– AHRQ Summary Statement on Comparative

Hospital Public Reporting– RAND Evaluation of the use of AHRQ and

Other Quality Indicators

CheckPoint IndicatorsCheckPoint Indicators

Mortality Rates – Medical Services

• Acute heart attack

• Acute heart attack without transfer cases

• Acute stroke

• Congestive heart failure

• Gastrointestinal hemorrhage

• Hip fracture

• Pneumonia

CheckPoint IndicatorsCheckPoint IndicatorsMortality Rates – Procedures

• Abdominal aortic aneurysm (AAA) repair• Coronary artery bypass graft (CABG)• Carotid endarterectomy (CEA)• Craniotomy• Esophageal resection• Hip replacement• Pancreatic resection• Percutaneous transluminal coronary angioplasty

(PTCA) 

CheckPoint IndicatorsCheckPoint IndicatorsVolume Measures

• Abdominal aortic aneurysm repair (AAA)• Carotid endaterectomy (CEA)• Coronary artery bypass graft (CABG)• Esophageal resection• Pancreatic resection• Percutaneous transluminal coronary

angioplasty (PTCA)

CheckPoint IndicatorCheckPoint Indicator

Utilization

 

• Incidental appendectomy among the elderly

 

IQI Calculations and IQI Calculations and Reporting for CheckPointReporting for CheckPoint

• Mortality and Utilization – 30 cases in the denominator

• Volume – 5 cases

• Will be initially reported for calendar year 2005 and then updated on an annual basis

• Will be reported using the observed/expected ratio

Indicators Excluded by Indicators Excluded by WHAICWHAIC

• Volume– Pediatric Heart Surgery

• Mortality – Procedures– Esophageal Resection– Pancreatic Resection– Pediatric Heart Surgery

Indicators Excluded by Indicators Excluded by WHAICWHAIC

• Utilization– Bilateral Cardiac Catheterization– Vaginal Birth After Cesarean, all– Laparoscopic Cholecystectomy

Indicators Excluded by Indicators Excluded by CheckPointCheckPoint

Utilization Indicators

• Cesarean delivery rate

• Primary Cesarean delivery rate

• Vaginal Birth After Cesarean, uncomplicated

IQI Approval Process for IQI Approval Process for CheckPoint ReportingCheckPoint Reporting

• Proposal presented to CheckPoint Measures Team

• Teleconference to Hospital Quality Staff

• Proposal Finalized and Approved by WHA Board in October 2006

CheckPoint Approval Process CheckPoint Approval Process for IQIsfor IQIs

• Hospital CEO completes a form indicating whether WHA is authorized to report these measures

• Form can be faxed or mailed to WHA, due back June 29

• Authorization can be updated at any time

Hospital Authorization for Hospital Authorization for CheckPoint IQIsCheckPoint IQIs

Per Hospital, Signed by CEO

Please indicate if your hospital will participate in the reporting of Inpatient Quality Indicators (Inpatient Mortality, Volume, and Utilization):

     Yes, I would like to participate in reporting Inpatient Mortality, Volume

and Utilization Measures

      No, I would not like to participate in reporting Inpatient Mortality,

Volume and Utilization Measures at this time   

CheckPoint Timeline for IQIsCheckPoint Timeline for IQIs

June 29, 2007 Authorization forms due back to WHA

Aug 17, 2007 Hospital preview of IQIs in

CheckPoint

Aug 31, 2007 IQIs publicly released in CheckPoint

CheckPoint Report DisplayCheckPoint Report Display

• Mortality and Utilization will be reported in symbols

• Symbols will represent:

As expected

Better than expected

Worse than expected• Volume will be reported as a number

Potential Uses of IQIsPotential Uses of IQIs

• Quality Improvement

• Pay for Performance

• Benchmarking

• Consumer Education on Healthcare Risks

• Research

CommunicationCommunication

• WHA Press Release(s) – August 31, 2007

• Write-up in Valued Voice – August 31, 2007

• Hospital communication to their communities?

Where does the data come from?Where does the data come from?TodayToday, , nextnext and the and the futurefuture……

Hospital

CheckPoint Website

CMS

Case LevelData

MetaStar

MeasureVendors

Case LevelData

Case LevelData

Aggregate-Medical-Surgical

-H-CAHPS

PeriData.Net

-Demographics-Error Prevention

AggregatePerinatal

Case LevelData

WHAIC (WHA

Information Center)

Claim LevelData

AggregateInpatient Quality Indicators

(IQIs) Future Data Flow

Questions?Questions?

• WHA Contacts:– Dana Richardson drichardson@wha.org – Kathleen Caron kcaron@wha.org