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Hands-On Tool Training: Preventable Hospitalization Costs: A County-Level Mapping Tool

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On December 6, 2007, Melanie Chansky provided Hands-on Tool training for the Preventable Hospitalization Costs: A County-Level Mapping Tool at the State Healthcare Quality Improvement Workshop. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 708 KB).

Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21


Slide 1: Hands-On Tool Training: Preventable Hospitalization Costs: A County-Level Mapping Tool

State Healthcare Quality Improvement Workshop:
Tools You Can Use to Make a Difference
December 6-7, 2007
Melanie Chansky
Battelle Centers for Public Health Research and Evaluation

On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, "AHRQ — Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov."

This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left.

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Slide 2: System Requirements

  • Windows version:
      — Windows NT, XP, 2000, or Vista only.
      — Microsoft .NET framework, v2 or higher.
      — Office 2003 or higher.
  • SAS version:
      — SAS version 9 or higher.
      — Office 2003 or higher.
  • Not currently available for Macs.

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Slide 3: QIs Used in the Tool

  • Version 3.1 Prevention Quality Indicators (14 — all).
  • Version 3.1 Pediatric Quality Indicators (5 — area level only).
  • The PHC tool does NOT process any Inpatient Quality Indicators or Patient Safety Indicators.

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Slide 4: Navigating the Tool

The PHC tool is fairly simple and has only four screens. Users navigate through these screens to use the tool. The 4 screens are:
  — Overview
  — Specify Discharge Dataset
  — Select QIs to Process
  — Map Display Options

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Slide 5: Screen 1: "Overview"

  • None of the functions of the tool are accomplished using this screen.
  • Presents a shorter version of what is found in the technical documentation.
  • Available as a resource if needed.

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Slide 6: Screen 2: "Specify Discharge Dataset"

  • Allows users to select the hospital discharge data file to be used for analysis.
      — Single state, single year (1995-2007).
  • Must manually select state and year from drop-down menu.
  • On-screen explanation (also found in technical documentation) explains required file format and variables.

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Slide 7: Required Variables

The following variables must be present in your data file:
  — Age (patient age in whole years)
  — Ageday (patient age in days)
  — Sex (sex coded 1 for male, 2 for female)
  — DX1 (ICD-9-CM primary diagnosis)
  — PR1 (ICD-9-CM primary procedure)
  — MDC (major diagnostic category)
  — DRG (diagnosis related group)
  — PSTCO (county of patient residence)
  — Atype (admission type)
  — Asource (admission source)

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Slide 8: Optional Variables

The following variables are optional, but are needed if the user wants the PHC tool to calculate potential cost savings:

  — Totchg (total charges)
  — Hospid (State Inpatient Database hospital identifier)

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Slide 9: Screen 3: "Select QIs to Process"

  • Can select any or all available QIs to be processed using the user-supplied dataset.
  • PQIs and PDIs are located on separate tabs.
  • This is the last required screen. Users can submit their data and finish here.

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Slide 10: Sample Map

This slide shows a map of uncontrolled diabetes admission (2001, PQI14) in California. The map is broken down by county and is color-coded to show different categories of rates per 10,000 people. The first category is 0.02-0.36, the second category is 0.4-0.74, the third category is 0.77-1.97, the fourth category is 2.46-8.68, and the fifth category is 8.69-144.21. The southern part of California has the lowest rate (0.02-0.36). The eastern part of the state has the highest rate (8.69-144.21).

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Slide 11: Screen 4: "Map Display Options"

  • Allows users to overlay population information onto maps.
  • Requires a second dataset with variables county, sex, age, and pop.
  • Produces map with stick figures representing the relative size of the population at risk for the selected QI.

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Slide 12:

This slide shows a map of uncontrolled diabetes admission (2001, PQI14) in California. The map is broken down by county and is color-coded to show different categories of rates per 10,000 people. The map is similar to the one shown before, except this map also uses an indicator shaped like a person to show the number of people age 18 and over in a given area. The size of the person indicates the number of people in an area. The smallest person indicator represents 55-143 people. The next indicator represents 145-224 people. The largest person indicator represents 231-445 people.

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Slide 13: Outputs

  • All outputs are automatically placed in the folder where your dataset is located.
  • Outputs include:
      — CSV file
      — Excel file
      — Maps

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Slide 14: CSV File

  • One ASCII CSV dataset is created regardless of how many QIs were selected.
  • The dataset is always called summaries.csv.

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Slide 15: Excel Files

  • One Excel file is created for all PQIs selected, another Excel file is created for all PDIs selected.
  • Files are always called PQI or PDI.
  • Each selected PQI/PDI will have its own worksheet named after the specific QI, e.g., PQI14, PQI1, etc.
  • Contains same data as CSV file, but is easier to read.

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Slide 16: CSV & Excel Files Include:

  • Numerator count of flagged cases.
  • Denominator count of the at-risk population.
  • Observed rate.
  • Risk-adjusted rate.
  • Standard error of risk-adjusted rate.
  • Whether county is significantly higher or lower than statewide rate.
  • Potential cost savings associated with a 10% reduction in flagged cases (optional).

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Slide 17: Maps

  • Separate maps will be created for each selected QI.
  • Files will be named after the QI, e.g., PQI14, PQI1.
  • Can be opened and manipulated using any graphics program or picture viewer.

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Slide 18 (no title)

It is recommended that users move and/or rename all output files after running the PHC tool because the automatically-generated file names are not specific and files can easily be overwritten!

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Slide 19: Where to Download

Download the PHC mapping tool (SAS and Windows versions) and all technical documentation at:

http://www.qualityindicators.ahrq.gov/mappingtool.htm

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Slide 20: Questions

If you have technical questions of any kind while using the PHC tool, contact the QI team at: Support@qualityindicators.ahrq.gov or 1-888-512-6090

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Slide 21:

My contact information:

Melanie Chansky
chanskym@battelle.org
703-248-1659

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AHRQ Advancing Excellence in Health Care