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Using AHRQ Quality Indicators for Hospital-level Reporting and Payment

Slide Presentation by Dr. Lewis Foxhall, M.D.

On October 27, 2004, Lewis Foxhall, M.D. made a presentation in a Web Conference entitled Using AHRQ Quality Indicators for Hospital-level Reporting and Payment.

This is the text version of his slide presentation. Select to access the PowerPoint® slides (452 KB).

Public Reporting in Texas

Lewis Foxhall, M.D.
Associate Vice-President, Health Policy
The University of Texas MD Anderson Cancer Center "Making Cancer History"

Slide 1

Public Reporting in Texas

  • Texas Healthcare Information Council (THCIC) formed in 1995.
  • Legislative purpose: Enhance informed healthcare choices by consumers and purchasers.
  • Mandate: Collect and report data on TX hospitals and HMOs.

Slide 2

Selecting Measures: Our Options:


  • Clinical measures from abstracted records.
  • New measures from claims data.
  • AHRQ QI's from claim data.


  • Expensive, hard to validate.
  • Challenging to develop, can't compare to other states.
  • Validated, tools available for risk adjustment and reporting.

Slide 3

Indicators in Hospital Report:

  • Volume Indicators.
  • Risk Adjusted Mortality for Procedures.
  • Risk Adjusted Mortality for Conditions.
  • Utilization Indicators.

Slide 4

Display of Text at top of CABG report

This slide contains an image of the text from the top of the actual CABG report. The title is: Texas Health Care Information Council.

12. Coronary Artery Bypass Graft Risk-Adjusted Mortality Rate, 2002

The text reads: Coronary artery bypass graft (CABG) surgery reroutes or "bypasses" blood around clogged arteries to improve the supply of oxygenated blood to the heart. Thousands of bypass surgeries are performed each year and the death rate is relatively low. However, this relatively common procedure requires skill in the use of complex equipment.

Number of cases in parentheses. Rates not calculated for hospitals with fewer than 30 cases.
Hospital comments indicated by ( C ) following number of cases. Confidence interval indicated by I------I.

*Risk-adjusted mortality rate is significantly lower than state average rate based on 95 percent confidence interval.
**Risk-adjusted mortality rate is significantly higher than state average rate based on 95 percent confidence interval.

Better quality may be associated with lower rates.

Slide 5

Display of top of data table for CABG Report

This slide shows a data table for the CABG Report. The table is depicted as a bar graph and lists 14 different Texas hospitals. The range of the data is from 0.0 to 16.0. A vertical line on the graph shows the average range for the state. Also on the graph is a text box with the words: "2002 Texas rate: 3.5".

State of Texas (25,188) 3.5
Abiline MSA no data available
Abilene Regional Medical Center (200) 3.7
Hendrick Medical Center (241) 3.3
Amarillo MSA no data available
Baptist St. Anthony's Health System Baptists Campus (316)** 5.5
Northwest Texas Hospital (175) ( C ) ** 6.6
Austin San Marcos MSA no data available
Daughters of Charity Brackenridge (50) ( C ) 0.2
Daughters of Charity Seton Medical Center (278) ( C )* 0.8
Heart Hospital Austin (340)* 1.6
North Austin Medical Center (153) 3.5
South Austin Hospital (154) 4.9
St. Davids Hospital (81) 7.1

Slide 6

Information Flow for Hospital Data

This slide shows a flow chart of how hospitals use Form 837. After the hospitals fill out form 837 they send it to the Data Repository. Once the information is in the repository the information is placed into 3 separate areas—the Public Use File, the Hospital Utilization Reports, and the Web Based Quality Reports. These three areas of information are then used by consumers, hospitals, purchasers and other end users.

Slide 7

Users of TX Hospital Quality Information

  • Web site use by consumers.
  • Public use file purchased by hospitals and consumer groups.
  • Data shared within hospitals working on quality improvement projects.
  • Managed care organizations and purchasers exploring potential users.

Slide 8

Statewide Mortality Rate Trends: Highest Volume Procedures and Conditions

This slide depicts a line graph of mortality rates over time. The y-axis shows the mortality rate ranging from 0 to 12. The x-axis shows the years 1999, 2000, 2001, and 2002. The graph includes CABG, Craniotomy, Hip Replacement, AMI, CHF, Pneumonia.

CABG in 1999 is 4.56; 2000 is 4.2; 2001 is 3.9; 2002 is 3.52
Craniotomy in 1999 is 7.12; 2000 is 7.2; 2001 is 6.92; 2002 is 7.01
Hip Replacement in 1999 is 0.27; 2000 is 0.34; 2001 is 0.24; 2002 is 0.22
AMI in 1999 is 11.04; 2000 is 10.82; 2001 is 10.48; 2002 is 9.71
CHF in 1999 is 5.28; 2000 is 4.92; 2001 is 4.84; 2002 is 4.22
Pneumonia in 1999 is 8.85; 2000 is 8.94; 2001 is 8.83; 2002 is 7.94

Current as of March 2005

Internet Citation:

Using AHRQ Quality Indicators for Hospital-level Reporting and Payment. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD.

Return to Web Conference

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