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Session 4: Pulling it All Together: Demonstration of EQUIPS

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On December 4, 2008, Anne Elixhauser gave a presentation of EQUIPS (now called MONAHRQ), a web-based tool for quality and utilization reporting, at the Using Administrative Data to Answer State Policy Questions Intensive Workshop. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 5.8 MB).

Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 43 | 44 | 45 | 46 | 47 | 48 | 49 | 50 | 51 | 52 | 53 | 54 | 55 | 56 | 57


Slide 1: Input Your Data—Output Your Website: A Web-Based Tool for Quality and Utilization Reporting

Anne Elixhauser
Mamatha Pancholi
Jenny Schnaier
December 4, 2008

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 and the HCUP logo on the right.

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Slide 2: Development Team

Leveraging the Expertise of Four Organizations

  1. AHRQ.
  2. Battelle.
    • Convert existing WinQI Wizard.
    • Produce QIs.
    • Adapt PHC mapping tool.
    • Test the tool.
  3. Social & Scientific Systems, Inc.
    • Produce HCUPnet-like utilization queries.
    • Test the tool.
  4. Thomson Reuters.
    • Lead web development and presentation.
    • Coordinate design efforts.
    • Test the tool.

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Slide 3: Overview

AHRQ EQUIPS you with the tools you need to generate a website—transforming your health care data into information about health, costs, and quality of care.

  • What is EQUIPS?
  • Why is it important?
  • Who is the audience?
  • How will EQUIPS work?
  • When will it be deployed?

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Slide 4: WHAT: The Concept

A web-based tool that provides local information on health care use, costs, volume, and quality.

  1. AHRQ creates and distributes software programs to generate web-based query system.
  2. Local organizations use programs to host a web-based query system.
  3. Local users access the web-based query system to obtain health care information.

The big question was: Is this feasible?

Project presented and approved as part of Value Portfolio Supports CVEs.

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Slide 5: WHY: Rationale

Consumers need health care information to make informed choices.

  • "What hospitals in my area perform heart surgery?"
  • "How many bypass procedures are performed at hospital x versus hospital y?"
  • "What is the quality of care for cardiac procedures at hospitals in my area?"
  • "I don't have insurance, how much should I expect to pay?"

Currently, there is very limited health care data available to answer such questions.

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Slide 6: Rationale

State/local organizations have resource limitations.

  • Unable to develop comprehensive reporting system.
  • AHRQ can provide support for these organizations.

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Slide 7: From Data to Information to Action

  1. Hospital discharge data are already being collected.
  2. Hospital discharge data can generate valuable healthcare information.
  3. Consumers can use this information to make decisions.

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Slide 8: WHO: Two User Groups—Host and End User

  1. HOST USER: Organization building the website.
    • State and local data organizations.
    • Chartered Value Exchanges.
    • Hospitals and health care systems.
    • Health plans.
    • Anyone with access to provider-level data.
  2. END USERS: People using the website.
    • Consumers.
    • Health Planners.
    • Policy Makers.
    • Media.
    • Data Analysts/Researchers.

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Slide 9: HOW: The Making of EQUIPS...

This slide contains a montage with corresponding images of the creation of EQUIPS.

  1. Storyboard.
  2. Iterative rapid development.
  3. Continuous "Alpha" Testing.
  4. Beta Test.
  5. EQUIPS code distributed to organizations with access to hospital discharge data.
  6. Host organizations implement code and load discharge data to create local EQUIPS website on their own servers.
  7. End user website.

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Slide 10: General Considerations as Development Proceeds

Using a smart development and design approach requires the following elements:

  • Efficient development.
    • Adapt existing programs to feed into the EQUIP system.
  • Minimal burden.
    • Develop web system based on most commonly used programs and software platforms.
    • Ensure methods can be understood by wide range of host users.
  • Customizable features.
    • Modular.
    • Customizable user interface.
  • Comprehensibility.
    • Ensure information adheres to standards for conveying statistics to public .
  • Documentation.
    • Document methods throughout for host and end users.
  • Accuracy.
    • Iterative testing of results.

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Slide 11: Customizable Features

  • Modular.
    • User can choose which pieces to implement.
  • Generate user-defined reports.
  • Create maps of various measures.
  • Drill down on specific issues by patient and area characteristics.
  • Customizable Interface.
    • Users can insert their logo and organization name.

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Slide 12: EQUIPS = HCUPnet + QI + More

This slide contains a screenshot of HCUPnet on the left, which provides Query Paths, Output Tables, Interface, Help and Definitions. And on the right are covers of several Quality Indicator guides. QIs are used with the WinQI Tool, AHRQ QI Measures, Reporting Template, and Mapping Tool.

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Slide 13: A Brief Technical Overview

This slide contains a diagram with a Technical Overview of EQUIPS. There are two boxes, the left box entitled: EQUIPS Site Builder ("Wizard"): Moves host user through the process and the right box entitled: Website Query interface seen by end user.

The left box is highlighted, explaining how the EQUIPS Site builder Wizard moves the host user through the process:
Raw data from the user is input into programs that load data, map values, transform data, and build data cubes. This information along with census data, comparison data, and labels lead to SQL Server Database stores: Meta-data, transformed data, and data cubes. After this step, page writers and graphics generators (for Utilization and QI data) are used to support the website query interface seen by the end user. Context and navigation page writers and script writers & cascading style sheet writers are used to further support the interface seen by the end user.

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Slide 14: EQUIPS Paths

Quality Indicators for Hospitals and Geographic Areas

  • View measures of quality for hospitals in either a report for consumers that allows you to compare hospitals in a prescribed format for public reporting, or a report of detailed statistics.

View Maps Showing Potentially Avoidable Hospitalizations

  • View potentially avoidable hospitalizations for counties with estimates of cost savings.

Rates of Health Conditions and Procedures

  • View statistics on prevalence of disease and medical procedures for counties. You may view the information broken down by clinical diagnosis or procedure.

Utilization Statistics for Health Conditions and Procedures

  • View information about number of discharges, charges, costs, length of hospitalization and percent of patients who died in specific hospitals, hospitals in geographic regions, or all hospitals in your State. You can select patients by medical condition or treatment procedure.

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Slide 15: Example Questions

Quality Indicators for Hospitals

  • How does the death rate for heart attack patients compare across four hospitals close to me?
  • What is the rate of tearing after vaginal delivery in four hospitals?

Potentially Avoidable Hospital Stays

  • Which counties have the highest rates of admission for diabetes complications in my state?
  • Which communities have the highest rates of C-sections?

Rates: Health Conditions and Procedures

  • What is the volume of CABG in this area?
  • What is the rate of pneumonia hospitalizations in this region?
  • What is the rate of blood transfusions in the state?

Utilization: Health Conditions and Procedures

  • How many C-sections were performed at area hospitals?
  • What was the average charge?
  • How long do patients usually stay in this hospital for C-sections?

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Slide 16: A Peek at EQUIPS—How will it work?

  • The host user (e.g., local/state organization, an individual hospital) will download the AHRQ EQUIPS Tool and generate a website.
  • The end user (e.g., health consumers, analysts) will access the website created by the host user to obtain health care data.

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Slide 17: A Peek at EQUIPS—A Working Draft: What the Host Sees

This slide contains a screenshot of the Welcome screen in the EQUIPS tool. The box superimposed on the image contains the following text:

  • Based on the existing AHRQ Quality Indicators Wizard.
  • Expanded to build EQUIPS.
  • Import Data Wizard—initial screen.

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Slide 18: Web Builder

This slide contains a screenshot of the Welcome to the Import and Analyze Data Wizard of the EQUIPS tool. The box superimposed on the image contains the following text:
Selected "Import and Analyze" Data Wizard (on the Main Menu bar located on the left).

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Slide 19: Web Builder (continued)

This slide contains a screenshot of the first step of the Wizard Screens, Select input file.

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Slide 20: Web Builder (continued)

This slide contains a screenshot of the third step of the Wizard Screens, Define data mapping. The box superimposed on the image contains the following text:

  • Select options for loading and mapping data.
  • Map input file variables to variables used by software.
  • This file stores all of the mappings for future use.

Note that there is no slide for step 2, Check Readability.

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Slide 21: Web Builder (continued)

This slide contains a screenshot of the fourth step of the Wizard Screens, Mapping quick check. The box superimposed on the image contains the following text: Summary of variables.

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Slide 22: Web Builder (continued)

This slide contains a screenshot of the fifth step of the Wizard Screens, Apply DRG grouper. The box superimposed on the image contains the following text: Select which groupers to apply.

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Slide 23: Web Builder (continued)

This slide contains a screenshot of the sixth step of the Wizard Screens, Check for data errors. The box superimposed on the image contains the following text: Scan file and check for errors.

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Slide 24: Web Builder (continued)

This slide contains a screenshot of the seventh step of the Wizard Screens, Data errors report. The box superimposed on the image contains the following text: Data errors report—choose to exclude problematic data.

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Slide 25: Web Builder (continued)

This slide contains a screenshot of the eighth step of the Wizard Screens, Label coded values. The box superimposed on the image contains the following text: Crosswalk: Map the values from the input data to standard values required by EQUIPs.

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Slide 26: Web Builder (continued)

This slide contains a screenshot of the ninth step of the Wizard Screens, Define Hospital Groupings. The box superimposed on the image contains the following text: Define your groupings of hospitals—choose Hospital Service Areas (HSAs, from Dartmouth) or build your own groupings.

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Slide 27: Web Builder (continued)

This slide contains a screenshot of the tenth step of the Wizard Screens, Edit Hospital Table. The box superimposed on the image contains the following text: Edit hospital lists.

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Slide 28: Web Builder (continued)

This slide contains a screenshot of the eleventh step of the Wizard Screens, Load Data. The box superimposed on the image contains the following text: Data are loaded into an SQL Server. Also on the screen is a start button, with the following notation next to it: Change to Stop button during data load.

Note that there is no slide for step 12, Data Load Report.

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Slide 29: Web Builder (continued)

This slide contains a screenshot of the thirteenth step of the Wizard Screens, Generate Measures. The box superimposed on the image contains the following text: Generating measures that will be displayed in website. Also on the screen is a start button, with the following notation next to it: Button turns to Stop when generating measures.

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Slide 30: Web Builder (continued)

This slide contains a screenshot of the fourteenth step of the Wizard Screens, Preview data. The box superimposed on the image contains the following text: Preview your data. Also on the screen are four buttons: Utilization Measures, Volumes and Rates Measures, Quality Indicators: Report for Consumers, Quality Indicators: Detailed Statistics. A note above the buttons indicates that the user can only select one path to preview at a time.

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Slide 31: Web Builder (continued)

This slide contains a screenshot of the fourteenth step of the Wizard Screens, Preview data with the first button, "Utilization Measures" selected. A small screen for Utilization Measures Preview pops up. The box superimposed on the image contains the following text: Previewing utilization measures. Note that there is no slide for step 15, Export Data.

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Slide 32: End User Website Interface

This slide contains the same diagram as the one found on slide 13 entitled: A Brief Technical Overview. There are two boxes, the left box entitled: EQUIPS Site Builder ("Wizard"): Moves host user through the process and the right box entitled: Website Query interface seen by end user.

The right box is highlighted and contains the following text:
Part of Builder: Which part of EQUIPS does the host want to create?

  • Website query interface seen by end user.
    • HTML and .JPGs for QIs and Utilization information.
    • Navigation.
    • Formats.

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Slide 33: A Peek at EQUIPS—A Working Draft: What the End User Sees

This slide contains a screenshot of the EQUIPS home page interface for the end user.
The box superimposed on the image contains the following text:
Select your path:

  • Quality Indicators.
  • Avoidable Hospitalizations.
  • Rates.
  • Utilization.

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Slide 34: Quality Path

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Quality Indicators, Consumers Report, Description, then Health Topics were selected to arrive at the current view. The box superimposed on the image contains the following text:
Select one of ten quality health care topics:

  1. Heart conditions.
  2. Brain and nervous system.
  3. Childbirth.
  4. Hip replacement and hip fracture.
  5. Operations for cancer of the esophagus and pancreas.
  6. Other surgeries.
  7. Other health conditions.
  8. Medical complications of patients having an operation.
  9. Medical complications of all patients.
  10. Medical care for children.

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Slide 35: Quality Path

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Quality Indicators, Consumers Report, Description, Health Topics, then Indicators were selected to arrive at the current view. The box superimposed on the image contains the following text: Select all indicators within a topic or specific indicators.

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Slide 36: Quality Path

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Quality Indicators, Consumers Report, Description, Health Topics, Indicators, then Hospitals were selected to arrive at the current view. The box superimposed on the image contains the following text:

  • Select a specific hospital or up to four hospitals in an area.
  • Allows easy access to the data through "view data now" feature.
  • Allows download to Microsoft Excel of summary tables.

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Slide 37: Quality Path

This slide contains a screenshot of the EQUIPS interface for the end user. This page is entitled: Compare hospital scores. The box superimposed on the image contains the following text: Click on any indicator and get detailed information in graphic form.

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Slide 38: Quality Path

This slide contains a screenshot of the EQUIPS interface for the end user. This page is an example of Hospital Quality Indicator Charts. The box superimposed on the image contains the following text: Get details for each hospital in rank order, compared to the state average.

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Slide 39: Potentially Avoidable Hospitalization Path

This slide contains a screenshot of the EQUIPS home page interface for the end user. The box superimposed on the image contains the following text: Potentially Avoidable Hospitalizations—based on AHRQ's Prevention Quality Indicators (PQIs—ambulatory care sensitive conditions).

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Slide 40: Preventable Hospitalization Costs Mapping Tool

This slide contains an example of a map generated by the Preventable Hospitalization Costs Mapping Tool. The box superimposed on the image contains the following text:

  • Better understand geographical patterns of hospital admission rates.
  • Calculate potential cost savings if admission rates are reduced.

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Slide 41: Estimates of Potential Cost Savings

This slide contains a screenshot of the table generated by the Preventable Hospitalization Costs Mapping Tool. There is a circle around the first row of the spreadsheet with a note indicating the QI name. Another circle is placed around the first five columns of the fourth row indicating County name, mean cost of admission for indicator, number of cases, and total cost. A third circle is placed around the remaining columns of the fourth row indicating potential cost savings if the number of admissions were reduced by a specified percentage.

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Slide 42: Rates of Conditions and Procedures Path

This slide contains a screenshot of the EQUIPS home page interface for the end user. The box superimposed on the image contains the following text: Rates of health conditions and procedures - use county populations as the denominator in prevalence rates.

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Slide 43: Rates of Conditions and Procedures Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Rates and Volumes, then Medical Diagnosis or Procedure were selected to arrive at the current view. The box superimposed on the image contains the following text: Choose among diagnoses and procedures, grouped by CCS categories.

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Slide 44: Rates of Conditions and Procedures Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Rates and Volumes, Medical Diagnosis or Procedure:CCS DX 661, then Hospital or County were selected to arrive at the current view. The box superimposed on the image contains the following text: Choose specific counties or examine all counties.

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Slide 45: Rates of Conditions and Procedures Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. Specifically, this is a chart of Statistics by county for 661 Substance-related disorders (DXCCS 661) in 2006. The box superimposed on the image contains the following text:

  • For all counties in the state: numbers of discharges and rate per 1,000 population.
  • Will include a mapping function.

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Slide 46: Utilization Path

This slide contains a screenshot of the EQUIPS home page interface for the end user. The box superimposed on the image contains the following text: Utilization statistics (like information from HCUPnet).

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Slide 47: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Utilization is selected to arrive at the current view. The box superimposed on the image contains the following text:
Select:

  • MDCs (body system or etiology).
  • DRGs (dx and pr combined).
  • CCS diagnoses (groups of ICD-9-CM codes).
  • CCS procedures (groups of ICD-9-CM codes).

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Slide 48: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Utilization, then MDC/DRG is selected to arrive at the current view. The box superimposed on the image contains the following text: Select a specific DRG.

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Slide 49: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. From the home page, Utilization, Medical Condition DRG 371, then Hospital or Region are selected to arrive at the current view. The box superimposed on the image contains the following text: Select specific hospitals or examine all hospitals in Hospital Service Areas.

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Slide 50: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. Specifically, this is a chart of Statistics for Cesarean Section without CC in 2006. The box superimposed on the image contains the following text: Detailed patient characteristics for a specific DRG for one hospital.

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Slide 51: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. Specifically, this is a chart of Statistics by Hospital for Cesarean Section without CC in 2006. The box superimposed on the image contains the following text: Information on numbers of discharges, charges, costs, length of stay, percent died for all hospitals individually. National, regional, and state benchmarks included.

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Slide 52: Utilization Path (continued)

This slide contains a screenshot of the EQUIPS interface for the end user. Specifically, this is a chart of Statistics by Hospital for Cesarean Section without CC. The box superimposed on the image contains the following text: Hospitals grouped by Hospital Service Area (Dartmouth Atlas).

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Slide 53: What makes EQUIPS unique?

Empowers organizations and consumers to use data to make informed decisions.

  • Provides organizations with the ability to create/host their own website and upload their own data.
  • Enables local organizations to do their own reporting using a standard, validated method.
  • Allows users to draw together multiple data sources that provide information at the local level.

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Slide 54: WHEN: Timeline—9 months from Concept to Product

This slide contains a timeline of the creation of EQUIPS:
April 2008: Concept.
July 2008: First Build.
July-December 2008: Continuous Builds.
January 2009: Beta Test.
From July 2008 until January 2009: Incremental Builds.

  • Incremental build throughout Summer and Fall using an iterative rapid application development methodology.
  • Target completion date of phase 1: January 30, 2009.

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Slide 55: Challenges

  • Aggressive timeline.
  • Variety of users will want to use the system.
    • Different system capabilities.
    • Different resource availability.
    • System needs to have minimum requirements.
    • Need to keep the cost of implementation low.
  • Limited nature of static model versus dynamic model.

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Slide 56: Phase 1 versus Subsequent Phases

Phase 1

  • 3 Paths.
    • Utilization.
    • Rates.
    • Quality.
  • Mapping capability.
  • National and regional benchmarks.
  • Static design.

Subsequent Phases

  • Additional Paths.
    • Hospital Compare.
    • HCAHPS.
  • Evaluate other data sources.
  • Provide links to other resources.
  • Dynamic design.
    • Consider adding other federal data sources.
  • Many more ideas... soliciting user suggestions.

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Slide 57

Questions?
Comments?
Suggestions?

anne.elixhauser@ahrq.hhs.gov

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