AHRQ Patient Safety Measurement: Overview; Patient Safety Indicators Example

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Slide 1

AHRQ Patient Safety Measurement: Overview; Patient Safety Indicators Example

Irene Fraser, Ph.D., Director
Center for Delivery, Organization and Markets
AHRQ Annual Meeting
September 10,  2012

Slide 2

Three Paths to Safety, Quality and Value—Good Measures and Data Are Central for Each

• Transparency and public reporting.
• Pay-for-performance and payment reform.
• Provider-based redesign and quality improvement.

Also important for state and national tracking.

Image: A stylistic drawing shows trees on either side of a stream.

Slide 3

AHRQ Roles in Patient Safety Measures and Data

Develops and maintains measures.

• Quality Indicators (Patient Safety module).
• Patient Safety Organizations and Common Formats.
• CHIPRA [Children's Health Insurance Program Reauthorization Act].

Tracks progress, provides data for analysis.

• Healthcare Cost and Utilization Project (HCUP).
• National Healthcare Quality and Disparities Reports.
• State Snapshots.

Maintains Measure Clearinghouse.
Creates tools: e.g., MONAHRQ.
Applies tools to quality improvement.

• Partnership for Patients.
• Million Hearts Campaign.

Collaborates to align measures.

Slide 4

Challenge for Measures & Data:  Need to Integrate Best from 3 Worlds

• Scope, uniformity, affordability of enhanced claims data.
• Clinical depth of medical records.
• Potential "new world" of the electronic health record (EHR).
• But 3 need to join the same universe.

Image: A stylistic drawing shows a telescope, the Earth from a distance, and a swirling galaxy.

Slide 5

Quality Indicators

• Measures developed by AHRQ for use with all-payer billing data.
• About 50 endorsed by the National Quality Forum (NQF).
• Under continuous review and improvement.
• Used extensively by states.
• CMS using in Hospital Compare, VBP.
• Used in Partnership for Patients, Million Hearts Campaign.

Slide 6

AHRQ QI Modules

Image: Four circles contain the following text:

Inpatient QIs
Mortality, Utilization, Volume

• 32 hospital & area level measures, 2 composites.
• 13 NQF [National Quality Forum] endorsed measures & 1 composite.

Prevention QIs 
Avoidable  Hospitalizations/Other Avoidable Conditions

• 14 area level measures, 3 composites.
• 14 NQF endorsed measures, 3 composites.

Pediatric & Neonatal QIs
Complications, Unexpected Death

• 20 hospital & area level measures, 1 composite.
• 11 NQF endorsed measures & 1 composite.

Patient Safety QIs
Complications, Unexpected Death

• 25 hospital & area level measures, 1 composite.
• 10 NQF endorsed measures & 1 composite.

Slide 7

Two-thirds of the US Has Access to a Public Report in their State Using AHRQ's Quality Indicators to Report Hospital Quality

26 states use for hospital-level reports.

Additional states report area-level measures.

Image: A map of the United States is color-coded to show which States use H-CAHPS and/or Quality Indicators for public reporting.

Slide 8

Free MONAHRQ tool for public reporting, analysis

(My Own Network Powered by AHRQ)

Image: Two arrows point to a circle captioned "MONAHRQ." Above the circle is the text, "Download MONAHRQ from monahrq.ahrq.gov"; text  underneath the circle reads " Select customization options. MONAHRQ runs on your desktop." The first arrow  is captioned "Load your local hospital discharge data." The second arrow is  captioned, "Load sets of pre-calculated measures.*" On the other side of the circle, a larger arrow points to a  screenshot of the MONAHRQ Web site; the caption reads "Output a healthcare  reporting Web site: You host: internal, password-protected, or public."

* Hospital Compare measures, HCAHPS survey measures, AHRQ Quality Indicators, others?

Slide 9

Six States Now Use MONAHRQ

• Hawaii.
• Nevada.
• Maine.
• Indiana.
• Kentucky.
• Utah.

Image: A screenshot of the Nevada Compare Care Web site is shown.

Slide 10

New Toolkit Supports Efforts To Improve Quality and Safety

• Guides hospitals in using the AHRQ Inpatient and Patient Safety Quality Indicators™ to improve care.
• Explains the quality improvement process and offers tools.
• "Introduction and Roadmap" helps various users identify the best resources for their needs.
• Available at https://www.ahrq.gov/qual/qitoolkit.

Image: The logo of the AHRQ QI Toolkit is shown.

Slide 11

Meeting Challenge Requires Multiple Bridges

Image: A photograph of a bridge is shown.

Slide 12

AHRQ Work to Bridge these Divides

• Work w/ NQF to add measures to EMR, clinically enrich current measures.
• Support HIEs.
• Research, pilots on adding clinical to claims data.
• ARRA grants to continue this work.
• HIT-Value Conference: "Creating a Plan to Get the Best from Both Worlds."
• New measures for using enhanced data.

Image: A photograph of a bridge is shown.

Slide 13

Enhancing Clinical Robustness of Billing Data

Research:

• Adding a few clinical data elements (especially POA and lab values) significantly improves quality assessment using billing data (Pine, et al, JAMA 2007).
• Data Pilots (2007-2009) Established feasibility of linking electronic clinical lab data to billing data and collecting POA in 3 states (FL, MN, VA).

Toolkits for other states:

• Lab data toolkit addresses all facets of the data collection process. http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/lvback.jsp
• POA toolkit will include business case for POA (including example HAC reports), and tools to improve quality of data.

State-wide grant initiatives:

• Six projects will expand clinical linkages and improve race and ethnicity data funded under ARRA [Recovery Act].

Measures: Enhancing Quality Indicators to include POA and Lab Values.

Slide 14

Process for Developing and Maintaining an AHRQ Quality Indicator

Image: Six ovals are arranged in a circle with an arrow pointing from one to the next:

1. Development of  New QI Measure Sets (or Improvement of Existing Sets).
2. Validation of New QI Measure Sets.
3. Submission of New QI Measures to NQF [National Quality Forum].
4. Tool Development.
5. Maintenance, Enhancement & Technical Support Measure of Sets.
6. Assessment.

Arrows point from the sixth numbered oval to four smaller ovals captioned "Retire," "Co-Steward," "Harmonize," and "Maintain & Enhance. "An arrow points from "Maintain & Enhance" to the fifth numbered oval.

Slide 15

Patient Safety Indicators: Looking Ahead

Major goals

• Continue to improve existing measures.
• Add new ones (e.g. Emergency Department).
• Move to ICD10 provides opportunity for further precision, advances.
• Work to mobilize best of all measurement approaches in aligned effort.