Iowa Healthcare Collaborative - Past, Present, and Future Use of AHRQ Quality Indicators (Text Version)

---

On September 14, 2009, Lance Roberts made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (818 KB).

---

Slide 1

 

Iowa Healthcare Collaborative—Past, Present, and Future Use of AHRQ Quality Indicators

Lance Roberts
2009 AHRQ Annual Conference
September 14, 2009

100 E. Grand Ave., Ste. 360 . Des Moines, IA 50309-1800
Office: 515.283.9330 . Fax: 515.698.5130
www.ihconline.org
 

 

Slide 2

 

Past—Historical Perspective

• 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

 

Slide 3

 

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

 

Slide 4

 

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

 

Slide 5

 

Iowa Report- From Data/Measures to Clinical Domains

Provider-focused Public Report
Clinical Category—Measures:
Cardiovascular Conditions—Heart Attack
Cardiovascular Conditions—Heart Failure
Cardiovascular Conditions—Stroke
Pneumonia Condition
Hip Fracture
Medical and Surgical—Patient Safety
Postoperative Care
Prevention of Blood Clots
Prevention of Healthcare-Associated Infections
Utilization
Obstetric / Neonatal Care
Pediatric—Patient Safety
Patient Experience in Hospital—HCAHPS Survey

 

• Provider Private Report
  AHRQ Quality Indicators
• Clinical Category
• Clinical Category
• Clinical Category

Data / Research Base
AHRQ CMS Primary Sources
Data Sources:
HCUP—Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID)
CMS Hospital Compare—Hospital Quality Initiative
Iowa Healthcare Collaborative—Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention

 

Slide 6

 

AHRQ Quality Indicator

A screen shot of the Current "look" of AHRQ QI hospital-level table in Iowa Report is shown.

 

Slide 7

 

Private Hospital Reports—AHRQ Quality Indicators

 

Slide 8

 

Collaborative Quality Improvement 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

 

Slide 9

 

Collaborative Quality Improvement 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

 

Slide 10

 

Collaborative Quality Improvement Opportunities

• Iowa Stakeholders
  • Emergency Care—Aortic Aneurysm/Dissection
  • Cardiologists
    • Reaction to media reports
    • Interest in comparative private/public reporting

 

Slide 11

 

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 Services

2007 State Snapshots: Methods. Derived from 2007 National Healthcare Quality Report. March 2008. Rockville, MD: Agency for Healthcare Research and Quality. http://statesnapshots.ahrq.gov/.

 

Slide 12

 

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)?
        

 

Slide 13

 

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
      • Tiering, NQF-endorsement, Coding issues, Validation
  • Included information in reports to Iowa legislature
    

 

Slide 14

 

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
 

 

Slide 15

 

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 Web page

 

Slide 16

 

Thank You

100 E. Grand Ave., Ste. 360 . Des Moines, IA 50309-1800
Office: 515.283.9330 . Fax: 515.698.5130
www.ihconline.org