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Buy-Right for Health Care Quality: Evidence and Indicators: Using AHRQ Quality Indicators for Hospital-level Reporting and Payment

Slide Presentation by Denise Remus, Ph.D., R.N.

On October 27, 2004, Denis Remus, Ph.D., R.N. made a presentation in a Web Conference entitled Using AHRQ Quality Indicators for Hospital-level Reporting and Payment.

This is the text version of her slide presentation. Select to access the PowerPoint® slides (3.3 MB).

Using AHRQ Quality Indicators

Denise Remus, Ph.D., R.N.
Senior Research Scientist
The Agency for Healthcare Research and Quality

Slide 1

States with Inpatient Database, 2002

This slide depicts a map of the 50 United States that have inpatient databases as of 2002.

No inpatient data available for Alaska, Idaho, Montana, Mississippi, Alabama, and Washington, DC.
Data not in HCUP for North Dakota, Wyoming, New Mexico, Oklahoma, Arkansas, and Indiana.
HCUP partner states are Washington, Oregon, California, Nevada, Utah, Arizona, Colorado, South Dakota, Nebraska, Kansas, Texas, Minnesota, Iowa, Missouri, Louisiana, Wisconsin, Illinois, Tennessee, Michigan, Ohio, Kentucky, West Virginia, Florida, Georgia, South Carolina, North Carolina, Virginia, Maryland, Pennsylvania, New Jersey, Vermont, Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Hawaii.

Slide 2

AHRQ QI Objectives

  • Provide a tool to:
    • Highlight potential quality concerns.
    • Identify areas for further study.
    • Enable trending of quality over time.
  • Facilitate transparency through comparative information.
  • Facilitate decisionmaking by consumers, purchasers and policymakers.
  • Maximize existing resources by complimenting other measurement efforts.

Slide 3

Current QI Modules

  • Prevention Quality Indicators
    • Ambulatory care sensitive conditions.
  • Inpatient Quality Indicators
    • Mortality following procedures.
    • Mortality for medical conditions.
    • Utilization of procedures.
    • Volume of procedures.
  • Patient Safety Indicators
    • Post-operative complications.
    • Iatrogenic conditions.

Slide 4

QI Guidance Document

This slide shows the cover of the Guidance for Using the AHRQ Quality Indicators for Hospital-level Public Reporting or Payment. At the bottom of the slide is the Web site address:

Slide 5

Texas Health Care Information Council

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.

This slide also shows a data table for the CABG Report. The table is depicted as a bar graph and lists 12 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

Slide 6

Niagara Health Quality Coalition

This slide depicts Graph 12: Coronary Artery Bypass Graft Mortality Rate from the Niagara Health Quality Coalition.

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."

State total in cases: 19,141
State risk-adjusted mortality rate: 3.5%

Three stars indicates better than state average.
Two stars indicates at the state average.
One star indicates worse than the state average.

There are 39 hospitals in this table.

The table shown, however, is not the complete table. The table shows St. Joseph's Hospital Health Center (Syracuse) (772: 2.2%, 4.6%) (3.4%) - two stars; University Hospital SUNY Health Science Center (439: 1.3%, 4.6%) (2.9%) - two stars; St. Elizabeth Medical Center (421: 2.2%, 5.4%) (3.8%) - two stars; Arnot Ogden Medical Center (121: 0.0%, 4.6%) (1.6%) - two stars; Rochester General Hospital (758: 2.5%, 5.0%) (3.7%) - two stars.

Slide 7

Selected Hospital Reporting Web site Addresses (Texas Hospital Report) (Niagara Quality Report) reporting summit 052604/index.html (Summary of Hospital Public Reporting Sites)

Slide 8

Pay for Performance Initiatives Using AHRQ QI's

Premier Hospital Quality Incentive Demonstration
Sponsor: CMS
Duration: 3 years
Approach: Payment incentives and disincentives to top and bottom 20%
Measures: Includes 2 AHRQ Patient Safety Indicators in two patient groups (total of 4)

Quality-In-SightsŪ Hospital Incentive Program
Sponsor: Anthem Blue Cross Blue Shield of Virginia
Duration: 3 years
Approach: Aligns financial incentives with achievements of specific performance goals
Measures: Includes 2 AHRQ Patient Safety Indicators, for PSIs focus is root cause analysis for quality improvement

Slide 9

QI Guidance Document

  • Goal: Help potential users answer questions about if, when, and how to use the QI's for these new purposes.
  • Major Sections:
    • Science behind the measures.
    • Selection factors.
    • Potential users.
    • Recommendations for selection and application.

Slide 10

AHRQ QI's: Next Steps

  • Continued measure development and refinement:
    • Pediatric QI's.
    • Evaluate and improve risk adjustment.
  • User enhancements:
    • More comparative data.
    • New simplified and enhanced software.
    • Expanded communication/user support.

Current as of March 2005

Internet Citation:

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

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