AHRQ Quality IndicatorsAHRQ Quality Indicators
Irene Fraser, Ph.D.Irene Fraser, Ph.D.
Director, Center for Delivery, Org. and MarketsDirector, Center for Delivery, Org. and Markets
September 26, 2005September 26, 2005
How Hazardous Is Health Care?How Hazardous Is Health Care?
1
10
100
1,000
10,000
100,000
1 10 100 1,000 10,000 100,000 1,000,000 10,000,000
Number of encounters for each fatality
To
tal
liv
es
lo
st
pe
r y
ea
r
DANGEROUS(>1/1000)
ULTRA-SAFE(<1/100K)
HealthCare
Mountain Climbing
Bungee Jumping
Driving
Chemical Manufacturing
Chartered Flights
Scheduled Airlines
European Railroads
Nuclear Power
Source: Berwick, D.M.
Systems Often Fail…Systems Often Fail…
System Designfor Quality
& Value
The Goal:The Goal:System ImprovementSystem Improvement
(microsystems & macrosystems)
Measure and Document Results
• Quality • Patient Safety• Efficiency• Access• ROI
IncentThrough aligned payment, public reporting, etc.
Facilitateby improved
HIT
Informby evidence andmodels of successful design strategies
Measurement Challenges (1):Measurement Challenges (1):Measure All DimensionsMeasure All Dimensions
EffectivenessEffectiveness SafetySafety TimelinessTimelinessPatientPatient
CenterednessCenteredness
StayingStayingHealthyHealthy
GettingGettingBetterBetter
Living withLiving withIllness/disabilityIllness/disability
End ofEnd ofLife CareLife Care
Source: Institute of Medicine. Source: Institute of Medicine. Envisioning the National Health Care Envisioning the National Health Care Quality ReportQuality Report. 2001.. 2001.
Measurement Challenges (2): Measurement Challenges (2): Align MeasuresAlign Measures
Horizontally, within efforts forHorizontally, within efforts for National trackingNational tracking
– NHQR and NHDRNHQR and NHDR
Public reportingPublic reporting– Hospital Quality Alliance Hospital Quality Alliance – Ambulatory Quality AllianceAmbulatory Quality Alliance– National Quality Forum National Quality Forum
Pay-for-performancePay-for-performance Quality improvementQuality improvement
Vertically, so these efforts are nestedVertically, so these efforts are nested
Measurement Challenges (3):Measurement Challenges (3):Data, Data, DataData, Data, Data
Measures and data can improve with use – “good” measures and Measures and data can improve with use – “good” measures and data can get better (though not perfect) data can get better (though not perfect) – BUTBUT – Even good measures with bad data can create mischief – Even good measures with bad data can create mischief
Need local data, but national benchmarksNeed local data, but national benchmarks There is no gold standardThere is no gold standard
– Clinical, administrative, patient experience of care data all Clinical, administrative, patient experience of care data all have strengths, weaknesseshave strengths, weaknesses
– EHR no data panaceaEHR no data panacea
Measurement Challenges (4):Measurement Challenges (4):Need Usable ProductsNeed Usable Productsand Strategies for Useand Strategies for Use
AHRQ Measurement AHRQ Measurement InitiativesInitiatives
National tracking and benchmarksNational tracking and benchmarks– National Healthcare Quality/ Disparities ReportsNational Healthcare Quality/ Disparities Reports
Measuring local experience of careMeasuring local experience of care– CAHPS for plans, hospitals, nursing homes etc.CAHPS for plans, hospitals, nursing homes etc.
Measuring culture of safetyMeasuring culture of safety Physician Measures – Ambulatory Quality AlliancePhysician Measures – Ambulatory Quality Alliance Measuring hospital quality and safetyMeasuring hospital quality and safety
– Inpatient Quality Indicators, Patient Safety Indicators, Healthcare Cost and Util. Inpatient Quality Indicators, Patient Safety Indicators, Healthcare Cost and Util. ProjectProject
Measuring potentially avoidable admissionsMeasuring potentially avoidable admissions– Prevention Quality IndicatorsPrevention Quality Indicators
Vision for Quality Indicators Vision for Quality Indicators InitiativeInitiative
1.1. Develop, maintain, evolve measuresDevelop, maintain, evolve measures
2.2. Strengthen administrative Strengthen administrative datadata at federal, at federal, state, local levelsstate, local levels
3.3. Create Create toolstools to facilitate use to facilitate use
4.4. Bring change through Bring change through strategies and strategies and partnershipspartnerships
Current AHRQ Quality Current AHRQ Quality IndicatorsIndicators
Prevention Quality Prevention Quality
IndicatorsIndicators
Inpatient Quality Inpatient Quality Indicators Indicators
Patient Safety Patient Safety IndicatorsIndicators
Ambulatory care sensitive Ambulatory care sensitive
conditionsconditions
Mortality following procedures Mortality following procedures Mortality for medical conditionsMortality for medical conditions Utilization of proceduresUtilization of procedures Volume of proceduresVolume of procedures
Post-operative complicationsPost-operative complications Iatrogenic conditionsIatrogenic conditions
For Discussion: Other For Discussion: Other Potential Quality Indicators ?Potential Quality Indicators ?
Pediatric Measures – under wayPediatric Measures – under way Women’s Health Measures?Women’s Health Measures? Readmissions?Readmissions? Emergency Department Quality?Emergency Department Quality? OthersOthers
On the Horizon: Evidence On the Horizon: Evidence Review of Efficiency MeasuresReview of Efficiency Measures
New Initiative: Identify, New Initiative: Identify, Categorize, and Categorize, and Evaluate Health Care Evaluate Health Care Efficiency MeasuresEfficiency Measures– Conduct thorough Conduct thorough
literature reviewliterature review
– Create typology for Create typology for measuresmeasures
– Develop evaluation Develop evaluation criteria for measurescriteria for measures
– Timeline: 1 yearTimeline: 1 year
Vision for Quality Indicators Vision for Quality Indicators InitiativeInitiative
1.1. Develop, maintain, evolve measuresDevelop, maintain, evolve measures
2.2. Strengthen administrative data at federal, Strengthen administrative data at federal, state, local levelsstate, local levels
3.3. Create Create toolstools to facilitate use to facilitate use
4.4. Bring change through Bring change through strategies and strategies and partnershipspartnerships
HI
AZ
CAUT
CT
FL
GA
IA
ILKS
MA
MDMO
NJ
NYOR
PA
SCTN
CO
WA
WI
VA
ME
MI
TX
WVKY
NC
VT
RINE
MN
AL
DE
MT
ID
MS
NV
ND
SD
NM
OHIN
LA
AROK
NH
Data: Most States Have Inpatient Data: Most States Have Inpatient Datasets, Are HCUP PartnersDatasets, Are HCUP Partners
AK
WY
HCUP Partner
Does Not Collect Inpatient Data
Legend
DC
Enhancing Administrative Enhancing Administrative Data: Adding More Clinical Data: Adding More Clinical
Data ElementsData Elements
EHRHCUP
• Add clinical data elements
• Provide timely benchmarks
• Connect Partners with EHR community
• Universe of hospitalcare in a state
• Hospitalcharacteristics
• Link to contextualfactors
• Patient episode ofcare
• Real time• Additional clinical
data elements
• Data• Clinical data
elements
Vision for Quality Indicators Vision for Quality Indicators InitiativeInitiative
1.1. Develop, maintain, evolve measuresDevelop, maintain, evolve measures
2.2. Strengthen administrative data at federal, Strengthen administrative data at federal, state, local levelsstate, local levels
3.3. Create tools to facilitate useCreate tools to facilitate use
4.4. Bring change through Bring change through strategies and strategies and partnershipspartnerships
Uses of AHRQ Quality Uses of AHRQ Quality Indicators: Original GoalIndicators: Original Goal
Create indicators at all levels: national, state, Create indicators at all levels: national, state, community and hospital for use incommunity and hospital for use in– National tracking – AHRQ and NHQRNational tracking – AHRQ and NHQR
– Quality and safety improvement – hospital Quality and safety improvement – hospital associations in many statesassociations in many states
– Identifying areas of preventable hospitalizations Identifying areas of preventable hospitalizations – many regional efforts– many regional efforts
Example: Targeting Interventions for Example: Targeting Interventions for Potentially Preventable AdmissionsPotentially Preventable Admissions
National Cost: $29 billionNational Cost: $29 billion Diabetes: $2.5 billionDiabetes: $2.5 billion
– Short-term complicationsShort-term complications
– Long-term complicationsLong-term complications
– Uncontrolled diabetesUncontrolled diabetes
Changing Times Brought Changing Times Brought Expanded UsesExpanded Uses
QIs have demonstrated big impactQIs have demonstrated big impactin short timeframe:in short timeframe:
Hospital-level report cards Hospital-level report cards – Texas, New York State, ColoradoTexas, New York State, Colorado
Pay-for-Performance Pay-for-Performance – CMS Premier Demo, Anthem of VirginiaCMS Premier Demo, Anthem of Virginia
Hospital profilingHospital profiling– Blue Cross Blue Shield of IllinoisBlue Cross Blue Shield of Illinois
At Least 12 States Use or Plan to Use AHRQ At Least 12 States Use or Plan to Use AHRQ QIs for Public Hospital ReportingQIs for Public Hospital Reporting
States using AHRQ QIs for public reporting at hospital levelStates using AHRQ QIs for public reporting at hospital level
(CA, CO, FL, KY, ME, MN, NY, OR, TX, UT, VT, parts of WI)(CA, CO, FL, KY, ME, MN, NY, OR, TX, UT, VT, parts of WI)
Source: Preliminary Data from NAHDO Survey, September 2005Source: Preliminary Data from NAHDO Survey, September 2005
QI Analyses QI Analyses Show Big Variations inShow Big Variations in
Cost AND QualityCost AND Quality
AHRQAHRQReporting Template ProjectReporting Template Project
Lit review of effective templates for Lit review of effective templates for comparative quality infocomparative quality info
Conduct interviews and focus groups w/ key Conduct interviews and focus groups w/ key audiences, including:audiences, including:– PurchasersPurchasers
– ProvidersProviders
– ResearchersResearchers
– Quality Measurement OrganizationsQuality Measurement Organizations
– Hospital Associations, etc.Hospital Associations, etc.
Based on evidence, develop and test Based on evidence, develop and test templatestemplates
Vision for Quality Indicators Vision for Quality Indicators InitiativeInitiative
1.1. Develop, maintain, evolve measuresDevelop, maintain, evolve measures
2.2. Strengthen administrative data at federal, Strengthen administrative data at federal, state, local levelsstate, local levels
3.3. Create tools to facilitate useCreate tools to facilitate use
4.4. Bring change through strategies and Bring change through strategies and partnershipspartnerships
Partnerships Partnerships
HCUP partnersHCUP partners– state data organizations, hospital associations, private associationsstate data organizations, hospital associations, private associations
NAHDONAHDO State governmentsState governments Other hospital associationsOther hospital associations Employer coalitions and employer groupsEmployer coalitions and employer groups CMS, others in DHHSCMS, others in DHHS ResearchersResearchers
StrategiesStrategies
Partnering with users to identify and share best practicesPartnering with users to identify and share best practices– Annual Quality Indicators Users MeetingsAnnual Quality Indicators Users Meetings– National, regional meetings through Knowledge Transfer Contracts on Payment, National, regional meetings through Knowledge Transfer Contracts on Payment,
MeasurementMeasurement Technical Assistance and TrainingTechnical Assistance and Training
– SQI ContractSQI Contract– RTI Curriculum GuideRTI Curriculum Guide– Patient Safety Improvement CorpsPatient Safety Improvement Corps– Training sessions at state, national meetingsTraining sessions at state, national meetings– WebcastsWebcasts
What else????What else????
Goals for this meetingGoals for this meeting
Help us learn from each other.Help us learn from each other. Provide input as we refine our strategic Provide input as we refine our strategic
vision so that we can vision so that we can deliver what’s most deliver what’s most useful to you.useful to you.
Help Us Identify and Prioritize Help Us Identify and Prioritize Activities to:Activities to:
Develop, maintain, evolve measuresDevelop, maintain, evolve measures Strengthen administrative data at federal, Strengthen administrative data at federal,
state, local levelsstate, local levels Create tools to facilitate useCreate tools to facilitate use Partner with usersPartner with users Monitor and evaluate impactMonitor and evaluate impact
……and Help Us with Strategic and Help Us with Strategic Issues:Issues:
How to Balance InvestmentHow to Balance Investment
Tools, Best Tools, Best Practices,Practices,
Implement Implement
What We KnowWhat We Know
New New Measures,Measures,
Evidence Evidence Base for Base for FutureFuture
Irene Fraser:Irene Fraser: [email protected]@ahrq.gov
Home PageHome Pagehttp://www.AHRQ.govhttp://www.AHRQ.gov
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