Iowa Healthcare Collaborative

- Past, Present, and Future Use of AHRQ Quality

IndicatorsLance Roberts

2009 AHRQ Annual ConferenceSeptember 24, 2009

100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800

Office: 515.283.9330 • Fax: 515.698.5130

http://www.ihconlie.org

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

Past – Historical Perspective

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

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

Provider-focused Public ReportClinical Category - Measures:

Cardiovascular Conditions – Heart AttackCardiovascular Conditions – Heart Failure

Cardiovascular Conditions – StrokePneumonia Condition

Hip FractureMedical and Surgical – Patient Safety

Postoperative CarePrevention of Blood Clots

Prevention of Healthcare-Associated InfectionsUtilization

Obstetric / Neonatal CarePediatric – Patient Safety

Patient Experience in Hospital – HCAHPS Survey

Provider Private ReportAHRQ Quality Indicators

Data / Research BaseAHRQ CMS Primary Sources

Data Sources: HCUP - Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID)

CMS Hospital Compare – Hospital Quality InitiativeIowa Healthcare Collaborative - Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention

Clinical Category Clinical Category Clinical Category

Iowa Report – From Data/Measuresto Clinical Domains

AHRQ Quality Indicator

Private Hospital Reports –AHRQ Quality Indicators

Collaborative QualityImprovement 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

Collaborative QualityImprovement 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

Collaborative QualityImprovement Opportunities

• Iowa Stakeholders

Emergency Care – Aortic Aneurysm/Dissection

Cardiologists

Reaction to media reports

Interest in comparative private/public reporting

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 Services2007 State Snapshots: Methods. Derived from 2007

National Healthcare Quality Report. March 2008. Rockville, MD: Agency

for Healthcare Research and Quality. http://statesnapshots.ahrq.gov/.

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)?

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

o Tiering, NQF-endorsement, Coding issues, Validation

Included information in reports to Iowa legislature

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

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 webpage

Thank You

100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800

Office: 515.283.9330 • Fax: 515.698.5130

http://www.ihconlie.org