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Iowa Healthcare Collaborative - Past, Present, and Future Use of AHRQ Quality Indicators (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 14, 2009, Lance Roberts made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (818 KB).

Slide 1


Iowa Healthcare Collaborative—Past, Present, and Future Use of AHRQ Quality Indicators

Lance Roberts
2009 AHRQ Annual Conference
September 14, 2009

100 E. Grand Ave., Ste. 360 . Des Moines, IA 50309-1800
Office: 515.283.9330 . Fax: 515.698.5130


Slide 2


Past—Historical Perspective

  • 2004

Iowa Hospital Association (hospitals) and the Iowa Medical Society (doctors) form IHC

  • 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


Slide 3


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


Slide 4


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


Slide 5


Iowa Report- From Data/Measures to Clinical Domains

Provider-focused Public Report
Clinical Category—Measures:
Cardiovascular Conditions—Heart Attack
Cardiovascular Conditions—Heart Failure
Cardiovascular Conditions—Stroke
Pneumonia Condition
Hip Fracture
Medical and Surgical—Patient Safety
Postoperative Care
Prevention of Blood Clots
Prevention of Healthcare-Associated Infections
Obstetric / Neonatal Care
Pediatric—Patient Safety
Patient Experience in Hospital—HCAHPS Survey


  • Provider Private Report
    AHRQ Quality Indicators
  • Clinical Category
  • Clinical Category
  • Clinical Category

Data / Research Base
AHRQ CMS Primary Sources
Data Sources:
HCUP—Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID)
CMS Hospital Compare—Hospital Quality Initiative
Iowa Healthcare Collaborative—Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention


Slide 6


AHRQ Quality Indicator

A screen shot of the Current "look" of AHRQ QI hospital-level table in Iowa Report is shown.


Slide 7


Private Hospital Reports—AHRQ Quality Indicators


Slide 8


Collaborative Quality Improvement 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


Slide 9


Collaborative Quality Improvement 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


Slide 10


Collaborative Quality Improvement Opportunities

  • Iowa Stakeholders
    • Emergency Care—Aortic Aneurysm/Dissection
    • Cardiologists
      • Reaction to media reports
      • Interest in comparative private/public reporting


Slide 11


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 Services

2007 State Snapshots: Methods. Derived from 2007 National Healthcare Quality Report. March 2008. Rockville, MD: Agency for Healthcare Research and Quality.


Slide 12


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)?


Slide 13


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
        • Tiering, NQF-endorsement, Coding issues, Validation
    • Included information in reports to Iowa legislature


Slide 14


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.


Slide 15


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 Web page


Slide 16


Thank You

100 E. Grand Ave., Ste. 360 . Des Moines, IA 50309-1800
Office: 515.283.9330 . Fax: 515.698.5130

Current as of December 2009
Internet Citation: Iowa Healthcare Collaborative - Past, Present, and Future Use of AHRQ Quality Indicators (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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