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					             Using the AHRQ Quality Indicators for Quality Improvement
                        Day 1: Tuesday, September 27, 2005
                                       View presentations at
             http://www.qualityindicators.ahrq.gov/usermeeting_presentations_2005.htm

1. Overview of the AHRQ Indicators- Speakers Irene Fraser, Center for Delivery and
   Marybeth Farquhar, AHRQ

   Measures and data can improve with use. “Good” measures and data can get better
   (though not perfect) but even good measures with bad data can create mischief.
   Currently, there is no gold standard and clinical, administrative, patient experience of
   care data all have strengths and weakness.

   AHRQ’s Measurement Initiatives assist with national tracking and benchmarks,
   measuring local experience of care, measuring culture of safety, physician
   measures, measuring hospital quality and safety, and measure potentially avoidable
   admissions.

   The current AHRQ Quality Indicators are Prevention Quality Indicators, Inpatient
   Quality Indicators, and Patient Safety Indicators. AHRQ is looking to expand the Quality
   Indicators to include pediatric measures, women’s health measures, readmissions,
   emergency department quality, and various other indicators.

   The vision for AHRQ’s Quality Indicator Initiative is to develop, maintain, and evolve
   measures; strengthen administrative data at federal, state, local levels; create tools to
   facilitate use; and bring change through strategies and partnerships.

   The objective of the AHRQ Quality Indicators is to provide a tool to highlight potential
   quality concerns; identify areas that need further study and investigation; track
   changes over time; facilitate transparency through comparative information about the
   quality of healthcare; facilitate decision making; and maximize existing resources.

   The goal for the meeting was to help the participants learn from each other and provide
   input as AHRQ refines their strategic vision in order to deliver what’s most useful.


2. Overview of the Pediatric Indicator Module - Kathryn and Sheryl Davies, Stanford
   University

   In 2000, there were 6.3 million children hospitalizations. The majority of the
   hospitalizations were for premature newborns. The total cost of the hospitalizations was
   $46 billion. The pediatric population is a unique population in that children are either
   very well or sick. They also make up a large percentage of the poor population. They are
   also unique clinically in that the coding is different than adults. The majority of the
   pediatric population receives outpatient care than inpatient care.
   Due to this population being unique, AHRQ is designing a pediatric indicator module.
   The indicators under consideration are intraventricular hemorrhage, respiratory distress
   syndrome, chronic respiratory disease, meconium aspiration syndrome rate, necrotizing
   enterocolitis, neonatal morality, noscocomial bacterima, proportion of VLBW infants
   born at Level III centers, and retinopathy of prematurity.

   The Patient Safety and Mortality indicators under construction are aspiration pneumonia,
   postoperative pneumonia, catheter-associated venous thrombosis, other postoperative
   metabolic derangements, and trauma mortality.

   The timeline for the PedQI software release with current AHRQ QIs adapted for pediatric
   cases is January 2006.

3. Session I- Using the AHRQ Area Level Indicators to Improve Population Health

   Sandra Mahkorn, Wisconsin Department of Health and Family Services- Speaker

   Wisconsin Medicaid Managed Care Program use Prevention QIs for quality
   improvement. The programs that use the QIs are the frail elderly, disabled, and chronic
   disease and disability programs.

   Hospital admission rates and overall numbers of hospital days associated with seven
   chronic and acute Prevention QIs were used to measure the quality of care. Wisconsin
   used Prevention Quality Indicators to guide quality activities. The Prevention QIs
   provided Wisconsin with useful information on how to prevent hospitalizations.

   The Prevention QIs helped the state and managed care programs to assess their
   effectiveness in reducing hospitalizations after members entered their programs; allowed
   managed care programs to compare their results with other programs; allowed programs
   and the state to track progress over time; and provided information that allowed programs
   to set quality improvement priorities.

   Susan McBride, Dallas-Fort Worth Hospital Council

   The Prevention Quality Indicators are used by the Dallas-Fort Worth Hospital Council to
   assess community health. The Council has designed an interactive website for Dallas Fort
   Worth Council Members to examine trends on AHRQ measures and public hospital
   discharge data. The site allows for users to drill into the numerators that are posted for the
   Prevention QIs.

   The next step for the Council is to use the indicators at the regional level to examine
   overall performance and health trends; partner with the Department of Health, Public
   Health and Schools of Public Health to better utilize the measures to improve the health
   of the populations served; find funding to distribute data sharing capability; pursue
   ambulatory data projects; support Texas efforts for public reporting of hospital infection
   rates; and develop community interventions to address health concerns.
   Sam Shalaby, General Motors

   AHRQ partnered with General Motors to research quality and cost drivers of health care.
   AHRQ measured health care quality of the GM employees by using the PQI, IQI, and
   PSI measures.

   AHRQ was able to provide GM cost data tables that detailed the average cost per
   discharge for each indicator in the Michigan area. The table displayed the number of
   discharges per year, total costs, and potential cost savings if the number of discharges
   were reduced by 10%, 20%, 30%, 40%, and 50%.

   The proposed actions that came from this research was to integrate action plans with
   other Community Initiative projects; consider Pay for Performance for providers in
   specific counties; dovetail with Save Dollars/Save lives Project; and focus on the vital
   few projects (PTCA, CABG, CHF, Bacterial Pneumonia, COPD, & Diabetes).

4. Session II- Using the AHRQ Provider Level Indicators as a Catalyst for Quality
   Improvement

   Ben Yandell, Norton Healthcare

   Norton Healthcare provides consumers with all the National Quality Form indicators,
   JCAHO measures and patient safety goals; AHRQ PSIs and IQIs; and other measures
   such as pediatric ORYX and NICU mortality.

   They publicly report every 12 months risk-adjusted rates using the AHRQ software. The
   source of the data is the Kentucky hospital discharge databases. They also create service
   line report cards.

   The organization is unique in that they review charts to verify the accuracy of the data.
   They rarely find coding errors when they compare the administrative data to the medical
   charts.

   Ben Yadell’s final thoughts were that data do not become valid until used; the number is
   what the number is; and even lousy indicators improve care.

5. Session II- Using the AHRQ Provider Level Indicators as a Catalyst for Quality
   Improvement

   Carol Munsch, Covenant Healthcare

   The Convenant Healthcare organization uses the Patient Safety Indicators. The
   Prevention Indicators have been used to manage diabetes in the patient and employee
   population. They also have resulted in the opening new comprehensive diabetes centers.
   The organization has also learned from the use of the Prevention Indicators that some
   indicators still need more validation; coding problems are always a minor annoyance;
   avoid the tendency to react to measures in isolation; and watch for small samples, knee
   jerk reactions.

   Joanne Cuny, University Health System Consortium

   Ms. Cuny discussed the best practices to make a difference in preventing avoidable
   deaths with rapid rescue teams. This relates to the Failure to Rescue quality measure.
   They were able to devise a best practice plan that involved a chain of command from
   noticing early warning signs, assessing the situation, rapid communication up chain
   of command; and the rapid response of the team to address the situation.

6. Session III- Implications of ICD-9-CM Coding Rules for Measuring QIs

   Patrick Romano, UC Davis

   Patrick Romano explained that in many cases the physician might misuse coding which
   makes it appear that something happened that did not. He stated that the coders in many
   cases are not the problem. He also discussed the many ways in which coding may
   present a problem. One such problem may be that in some events multiple codes should
   be used to specify the event. He also warned of overcoding that may present a problem.
   Mr. Romano discussion was very good and explained how if a record is coded wrong that
   it may skew that data in which we report using the AHRQ measures.

				
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