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Creating the Maine Snapshots

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On December 6, 2007, Chris McCarthy made a presentation entitled Creating the Maine Snapshots. This is the text version of the event's slide presentation. Please select the following link to access the slides: (PowerPoint® File, 39 KB).

Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12

Slide 1: Creating the Maine Snapshots

Agency for Healthcare Research and Quality
State Healthcare Quality Improvement Workshop:
Tools You Can Use to Make a Difference
December 6-7, 2007

Chris McCarthy, Bath Iron Works
(previously with Maine Quality Forum)

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Slide 2: The Maine Quality Forum

  • Created as part of the Dirigo Health Agency
  • Tasked with assessing the quality of healthcare in Maine and reporting information to the people of Maine
  • Tasked with promoting best practice in Maine
  • Maintained mission of providing actionable information about health care quality in easily accessible format

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Slide 3: Addressing the Mandates

  • Used Institute of Medicine definition (STEEEP) as guiding framework
     — Right thing, the right way, at the right time
  • Guiding Principles of Change
     — Power of public reporting (move from Maine Medical Assessment Foundation model to public model)
     — Value of within state comparisons
     — The people of Maine as constituency rather than specific stakeholders
     — Communication target not necessarily the change target
     — Multi-stakeholder, public processes

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Slide 4: Data Process

  • Started with SAVA (using discharge data) during development of quality metrics
  • Drawing upon National Quality Forum metrics worked with Advisory Council to select metrics to be submitted by hospitals
  • Worked with Maine Health Data Organization (MHDO) re: rulemaking and micro-specification
  • Participated in the Tri-partite group of Pathways to Excellence
  • Developed initial website with a key data component

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Slide 5: Initial Website

  • Used small area variation analysis on procedures of interest
  • Presented data via bar charts developed in Excel
     — Graphs presented hospitals significantly different from the expected
  • Provided data tables for drill down
  • Good start but difficult to understand
  • Very difficult to update new data runs
  • Maine Quality Forum (MQF) site for example: www.mainequalityforum.govExit Disclaimer

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Slide 6: Revision Process

  • Advisory Council advised:
     — Simpler representation
     — Broader audience
     — More than one view of the data
     — Drill down from simplest to most complex (visual to raw data)
  • Needed to include new data (Chapter 270)
  • Dennis Shubert attended presentation re: new AHRQ State Snapshots

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Slide 7: Next Steps

  • Intrigued by dial graphics representation method
  • Shared with Advisory Council
  • Reached out to AHRQ (Dwight) who brokered relationship with Thomson Healthcare (formerly Medstat) and AcademyHealth
  • Connected with Thomson Healthcare
  • Provided us with code

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Slide 8: Medstat

  • MQF Determined a need for support
     — Methods
     — Web design
     — Training
  • Contracted with Medstat (Thomson Healthcare)
  • Contracted with RADCorp
  • Began process of applying methodology to Maine's data
  • Training MHDO Epidemiologist

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Slide 9: Methodological Challenges Encountered

  • Small "N"
     — Limited by number of hospitals
  • Small "n"
     — Limited by number of measures
     — Limited by number of cases within measure
  • Regression Model
  • Nursing Data
  • Phase II SAVA-GIS design

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Slide 10: Political Challenges

  • Maine Hospital Association
     — PTE process
  • Northern New England Quality Improvement Organization
  • Nursing Data
  • Public Process
     — Advisory Council
     — Multi-stakeholder involvement
     — Multiple views
  • Other political considerations

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Slide 11: Resolutions

  • Change to speedometer
  • Change methodology
     — Regression model
     — Data inclusion/exclusion
  • Nursing Data Representation
  • Descriptive Language
  • New MQF data site:

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Slide 12: Phase II

  • GIS maps for variation analyses
  • New Chapter 270 data

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