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The Maine MONAHRQ Experience (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Susan Schow made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (2.2 MB). Plugin Software Help.

Slide 1

The Maine MONAHRQ Experience

AHRQ Annual Conference
September 19, 2011
Susan Schow MPH, Epidemiologist
Maine Health Data Organization

Slide 2

MHDO Interest in MONAHRQ

  • Maine Health Data Organization (MHDO) is a small independent state agency:
    • Director and 9 employees.
  • Governing Board of Directors:
    • 21 members representing consumers, employers, 3rd party payers, providers and the State of Maine.

Slide 3

Representation on MHDO Board

  • Consumers:
    • Consumers for Affordable Health Care, Muskie School of Public Service, Center for Economic Policy.
  • Providers:
    • Hospitals, Medical, Osteopathic, Primary Care, Chiropractic, Mental Health Services, Pharmacy, Federally Qualified Health Center, and Home Health.

Slide 4

Representation on MHDO Board

  • Employers:
    • Chamber of Commerce, Maine Health Management Coalition, Bath Iron Works.
  • State of Maine:
    • Dept of Professional & Financial Regulations (Bureau of Insurance), DHHS/Maine CDC.
  • Third-Party Payers:
    • ME Association of Health Plans: Anthem BCBS, CIGNA, Aetna, Harvard Pilgrim.

Slide 5

MHDO Interest in MONAHRQ

  • AHRQ Updates to HCUP members:
    • August 2009 notification of MONAHRQ autumn launch.
  • National Charter Value Exchange Meeting:
    • February 2010 presentation by Anne Elixhauser (AHRQ)

Slide 6

MHDO Interest in MONAHRQ

  • Maine Revised Statutes Annotated §8712 Act to Protect Consumers and Small Business Owners from Rising Health Care Costs:
    • " comparative health care quality information to consumers, purchases, providers, insurers and policy makers... and make provider-specific information regarding quality of services available on its publicly accessible Web site"

Slide 7

MHDO History with QIs

  • Long history with AHRQ Quality Indicators and QI software.
  • First presented QIs for Maine in 2004:
    • Used 2001 Maine data from AHRQ HCUP Project (via Medstat).
    • Posted to MHDO Web site.

Slide 8

Image: Screen shot of a table labeled Prevention Quality Indicators is shown.

Slide 9

Image: Screen shot of a table labeled Inpatient Quality Indicators is shown.

Slide 10

MHDO History with QIs

  • First calculated QIs for Maine in 2006:
    • Used 2004 ME data and AHRQ QI Windows software (v3.0).
    • Presented to the Maine Quality Forum's Advisory Council.
    • Posted to a hidden URL on MQF's Web site (for hospitals only).
    • Later password protected.

Slide 11

Image: Screen shot of a bar chart labeled IQI 4 Abdominal Aortic Aneurysm Repair Volume, 2004 is shown.

Slide 12

Image: Screen shot of a bar chart labeled IQI 23, Laparoscopic Cholecystectomy Rate, Maine 2005 is shown.

Slide 13

MHDO History with QIs

  • Added Maine's Public Health Districts to QI graphics (in addition to counties) in 2006 and 2007.
  • Charts becoming increasingly complex and "user unfriendly".

Slide 14

Image: Screen shot of a bar chart labeled Pediatric Quality Indicators—Chronic Condition Composite Rates by County and by Public Health District, Maine 2007 is shown.

Slide 15

MHDO History with QIs

  • Thomson Medstat developed custom software to calculate PQIs by Maine Hospital Service Areas:
    • Groups of cities or towns that include one or more hospitals to which local residents have the majority of their inpatient admissions.
    • Included numerators for hospitals.
  • Posted publically on MQF Web site:
    • 2006 compared to 2007 data.

Slide 16

PQI 90: Overall Prevention Quality Indicator composite, age 18 and over, age and gender adjusted rate per 1,000 population by Maine Hospital Service Areas

Image: Screen shot of two bar charts labeled PQI 90: Overall Prevention Quality Indicator composite, age 18 and over, age and gender adjusted rate per 1,000 population by Maine Hospital Service Areas, one for 2006 and the other for 2007, is shown.

Slide 17

MHDO History with QIs

  • Used the Preventable Hospitalization Costs Mapping Tool:
    • Generated GIS maps of the PQIs by county.

Slide 18

Image: Screen shot of a map showing Adult Asthma Admission Rate (PQI 15) in the State of Maine is shown.

Slide 19

MHDO History with QIs

  • Also ran Preventable Hospitalization Costs Mapping Tool with 5 years of Maine data (2003-2007):
    • Demonstrate trends.
    • Show potential cost savings by reducing numerators by 10%, 20%, 30%, 40%, 50%.
    • Used by the Governor's Office—Advisory Council on Health Systems Development.
  • Published in the 2010 State Health Plan.
  • Posted on the ME CDC Web site.

Slide 20

Image: Screen shot of a chart and table titled "AHRQ PQI 1: Risk Adjusted Diabetes Short-term Complication Admission Rate, Maine Public Health Districts, 2003-2007" is shown.

Slide 21

Image: Screen shot of a table titled "Cost Savings given 10% Reduction in Numerator" is shown.

Slide 22

NQF Endorses Many QIs

  • Learned of AHRQ efforts to receive National Quality Forum endorsement of QIs at 2007 HCUP Partners Meeting.
  • Certain key stakeholders still nervous about public reporting of individual hospital quality indicators.
  • Became a powerful incentive for public reporting.

Slide 23

Advantages to MONAHRQ/Obstacles Resolved for MHDO

  • Due to limited resources—time, money, personnel (especially IT staff):
    • Unable to create a Web site from scratch.
    • Unable to maintain current Inpatient data Web site (queryable).
    • Unable to convene focus groups.
  • MONAHRQ provides a template pretested with consumers:
    • Plain understandable language and graphics.

Slide 24

Maine's MONAHRQ Version 1.0

  • Applied Maine 2008 Inpatient Data to the MONAHRQ v1.0 software in August 2010:
    • Analyzed resulting reports.
  • Web site created on MHDO local pc server.
  • Included everything but the "experimental" QIs.

Slide 25

Involved Stakeholders

  • Presented Web site to MHDO Board at their September 2010 Meeting.
  • Voted to approve public posting after review period for hospitals.

Slide 26


  • IT performed a security scan and ADA accessibility test:
    • Multi-select issue, cross site scripting.
  • Web site made available for review by Maine hospitals for four weeks (extended extra week):
    • Via private URL (password protected).
    • Also opportunity for user testing.
  • After review and tests successful, site available to the public.

Slide 27

Image: A screen shot of the Maine Health Data Organization Web site.

Slide 28

Questions from Hospitals

  • Six hospitals contacted us with questions or to verify data/QI measures:
    • Where data verification requested, all QIs were substantiated:
      • Used "Provider Reports" and "Patient Level" reports and linked back to hospital medical record numbers.
      • Hospitals pulled charts/records.
      • Conference call with MHDO staff to review on case-by-case basis.

Slide 29

"Patient Level" Reports

Image: A screen shot of a patient report page.

Slide 30

Maine's MONAHRQ Version 2.0

  • New and improved with user friendly icons!
  • CMS Hospital Compare data available.
  • Applied Maine 2009 Inpatient Data to the MONAHRQ v2.0 software in August 2011.
  • Maine included "Present On Admission" (POA) field.

Slide 31

Image: A screen shot of the Maine Health Data Organization Web site home page.

Slide 32

Maine MONAHRQ Version 2.0

Image: A screen shot of a map of Maine showing Risk-adjusted rate per 100,000 people.

Slide 33

Testing Version 2.0

  • IT performed a security scan and ADA accessibility test.
  • Will present to MHDO Board for approval.
  • Web site again initially available for review by Maine hospitals only:
    • Via password protected private URL.

Slide 34

Going Forward

  • Plan to create a separate MONAHRQ Web site for each year (until MONAHRQ available for multiple years):
    • Trending very important to users.
  • Load 2010 data in January 2012.
  • Update annually each July with previous year's data.
Page last reviewed October 2014
Internet Citation: The Maine MONAHRQ Experience (Text Version). October 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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