Transparency for Quality Improvement Efforts at the Kentucky by ixl26840

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									Transparency for Quality Improvement
               Efforts

    at the Kentucky Cabinet for
 Health and Family Services (CHFS)
             Trudi Matthews, MA
            Senior Policy Advisor
            Office of the Secretary
                               Trudi Matthews et al.




Cabinet for Health and Family Services
Slide #2
                  Kentucky Legislation & Policy

•         2005 law (HB 278)        Secretary’s
          Advisory Committee on Transparency
•         Transparency        2006 law (HB 380) on
          public release of cost and quality data
•         Health Care Information Center Website:
     –         Launched March 2007
     –         Data on avoidable hospitalizations & inpatient
               quality
     –         Consumers can compare KY hospitals on
               quality
     –         http://chfs.ky.gov/ohp/healthdata/
Cabinet for Health and Family Services
Slide #3
Cabinet for Health and Family Services
Slide #4
      How did KY staff use the AHRQ Tools?

• AHRQ Diabetes Guide and Workbook helped
  direct staff to:
     – Look at chronic diseases & focus on diabetes
     – Assemble most recent data in formats of the
       Diabetes Guide
     – Be productive in the analysis phase
     – Interpret data with better understanding
     – Achieve credibility by using national measures
       and AHRQ methods

Cabinet for Health and Family Services
Slide #5
                                         Data Sources

    The Kentucky CHFS collects:
    • UB-92 inpatient records:
           – 600,000 per year                           • Procedures &
                                                          Diagnoses
           – All Kentucky hospitals                     • Volume
                                                        • Length of stay
    • Outpatient surgery records:                       • Charges
                                                        • HCUP Partner
           – Hospital-based
           – Some ambulatory surgery centers
    • Public Health Data – BRFSS, Vital
         Statistics, etc.
    • Medicaid & State employee claims

Cabinet for Health and Family Services
Slide #6
                                    Quality Measures


  • Non-proprietary consensus-based sources:
               • AHRQ: Agency for Healthcare Research and Quality
               • CMS: Centers for Medicare and Medicaid Services
               • Others (JCAHO, NQF, etc.)


  • Measures being used now:
               •   Prevention Quality Indicators
               •   Inpatient Quality Indicators    AHRQ Quality Indicators
               •   Patient Safety Indicators
               •   CMS Hospital Compare




Cabinet for Health and Family Services
Slide #7
                     Kentucky and Health Status

  • Kentucky: among worst health outcomes in US:
        – 2nd highest death and disability rates
        – 6th highest obesity prevalence


  • Diabetes:
        – 7th highest adult diabetes prevalence
        – Some Eastern counties nearly double national
          diabetes rates




Cabinet for Health and Family Services
Slide #8
           Obtained from Diabetes Guide:
      KY Compared to Worst/Best-in-Class States


                                    Percent of Population with Diabetes

          7.0%

          6.0%

          5.0%

          4.0%

          3.0%

          2.0%

          1.0%

          0.0%
                    Kentucky Tennessee     Missouri   Alaska    Utah      Colorado   Minnesota




Cabinet for Health and Family Services
Slide #9
          Obtained from the Diabetes Guide

                        Estimates of the Direct, Indirect and Total Cost (billions)
                                           Burden of Diabetes

            $6.000

            $5.000
            $4.000
                                                                                      Indirect Cost
            $3.000
                                                                                      Direct Medical Costs
            $2.000

            $1.000

            $0.000                                          h
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Cabinet for Health and Family Services
Slide #10
 Estimated Using Ideas from the Diabetes Guide
                 + HCUP Data

                                                  Hospital Admission Rates for Uncontrolled
                                                                 Diabetes, 2006

                                           4.00
                                                      3.30        3.20
      per 10,000 Ky residents age 18 and




                                                                             2.86       2.67    2.71
                                           3.00
                          over




                                           2.00

                                           1.00

                                           0.00
                                                     2002        2003        2004       2005    2006
                                                    N=1022      N=1002      N=902      N=851   N=871
Cabinet for Health and Family Services
Slide #11
    New Display Using Diabetes Guide Data
                                                   Comparison of Hospital Admission Rates for
                                                   Uncontrolled Diabetes for US, KY, and Best
                                                               Performing States*
                                              35
      per 100,000 residents age 18 and over




                                              30

                                              25




                                                                                                                                             Washington, 7.5
                                                                  Kentucky, 32.8




                                                                                                                                                                           Kentucky, 31.7




                                                                                                                                                                                                                                                      Washington, 5.9
                                              20                                                    Oregon, 8.3




                                                                                                                                                                                            Colorado, 5.8
                                                                                   Colorado, 5.3




                                                                                                                              Vermont, 6.0




                                                                                                                                                                                                             Oregon, 6.4
                                                      US , 25.4




                                                                                                                                                                                                                                       Vermont, 3.3
                                                                                                                                                               US , 23.8
                                              15
                                                                                                                  Utah, 6.5




                                                                                                                                                                                                                           Utah, 4.2
                                              10

                                               5

                                               0
                                                                                                   2002                                                                                                     2003
  *Rates are risk adjusted for age and gender




Cabinet for Health and Family Services
Slide #12
 Estimated Using Ideas from the Diabetes Guide
                 + HCUP Data

                                                  Hospital Admission Rates for Short-term
                                                     Complications of Diabetes, 2006
      per 10,000 Ky residents age 18 and




                                                               6.4                 6.6       6.2
                                           7.00
                                                     6.1                 6.3
                                           6.00
                                           5.00
                                           4.00
                      over




                                           3.00
                                           2.00
                                           1.00
                                           0.00
                                                    2002      2003      2004      2005       2006
                                                   N=1887    N=2018    N=1995    N=2092     N=1997

Cabinet for Health and Family Services
Slide #13
 Estimated Using Ideas from the Diabetes Guide
                 + HCUP Data

                                                    Hospital Admission Rates for Long-term
                                                       Complications of Diabetes, 2006
                                                       12.7
       per 10,000 Ky residents age 18 and




                                                                 12.5
                                            14.00
                                                                          12.3      12.4      12.0
                                            12.00
                                            10.00
                                             8.00
                       over




                                             6.00
                                             4.00
                                             2.00
                                             0.00
                                                      2002      2003      2004      2005      2006
                                                     N=3924    N=3909    N=3882    N=3948    N=3846

Cabinet for Health and Family Services
Slide #14
 New Display Using Diabetes Guide Data

                                                  Comparison of Hospital Admission Rates for Short-
                                                    term Complication of Diabetes for US, KY, and
                                                             Best Performing States*
                                                  70
          per 100,000 residents age 18 and over




                                                  60

                                                  50




                                                                                                                                                                                                   Kentucky, 64.6
                                                                   Kentucky, 61.0




                                                  40




                                                                                                                                                                                                                                                                                                     Washington, 40.2
                                                                                                                                                                     Washington, 39.3
                                                        US, 50.9




                                                                                                                                                                                        US, 51.1




                                                                                                                                                                                                                                                     Nebraska, 38.1
                                                                                                                     Nebraska, 36.0
                                                                                                                                      Oregon, 40.4




                                                                                                                                                                                                                                   Minnesota, 35.8
                                                                                                   Minnesota, 34.0




                                                                                                                                                                                                                                                                      Oregon, 37.8
                                                  30




                                                                                                                                                                                                                    Hawaii, 36.6
                                                                                                                                                     Vermont, 31.0
                                                                                    Hawaii, 31.6




                                                                                                                                                                                                                                                                                     Vermont, 30.1
                                                  20

                                                  10

                                                   0
                                                                                                   2002                                                                                                                            2003
      *Rates are risk adjusted for age and gender


Cabinet for Health and Family Services
Slide #15
    New Display Using Diabetes Guide Data

                                                      Comparison of Hospital Admission Rates for Long-
                                                      term Complication of Diabetes for US, KY, and Best
                                                                     Performing States*
                                                      140.0
              per 100,000 residents age 18 and over




                                                      120.0

                                                      100.0
                                                                  Kentucky, 125.9




                                                                                                                            Kentucky, 123.2
                                                       80.0




                                                                                                                              US, 115.4
                                                                    US, 113.8




                                                              Nebraska, 79.5
                                                              Colorado, 81.7




                                                                                                                       Nebraska, 69.3
                                                                                                                       Colorado, 69.6
                                                       60.0   Oregon, 74.7




                                                                                                                                                              Washington, 66.9
                                                                                                                        Oregon, 70.2
                                                                                                                          Iowa, 78.6
                                                                                                    Washington, 67.2
                                                               Iowa, 78.0




                                                                                    Vermont, 64.0
                                                               Utah, 71.2




                                                                                                                                              Vermont, 61.2
                                                                                                                         Utah, 70.3
                                                       40.0

                                                       20.0

                                                        0.0
                                                                        2002                                                     2003
           *Rates are risk adjusted for age and gender




Cabinet for Health and Family Services
Slide #16
    County-Level Quality Improvement Data


                                    GIS Mapping:
                                    Using HCUP Data
                                       &
                              AHRQ Mapping Software




Cabinet for Health and Family Services
Slide #17
                                                 Frankfort   Lexington


                                         Louisville




Cabinet for Health and Family Services
Slide #18
Cabinet for Health and Family Services
Slide #19
Cabinet for Health and Family Services
Slide #20
Cabinet for Health and Family Services
Slide #21
    New Display Using Diabetes Guide Data

                                    Percent of Adults (in 2001) who received:

   90.0%
   80.0%
   70.0%
   60.0%                                                                              Kentucky
   50.0%                                                                              National Average
   40.0%                                                                              Best-in-Class Average
   30.0%                                                                              Healthy People 2010 Goal
   20.0%
   10.0%
    0.0%
              HbA1c testing        Retinal eye   Foot examination   Flu vaccination
                                   examination

                                                                           Source: BRFSS & Diabetes Guide

                                                        Target areas
Cabinet for Health and Family Services
Slide #22
                                         Conclusion
      • Governor committed to transparency
        efforts
      • Transparency (Data & Measurement) is
        first step to quality improvement
      • Diabetes Guide critical tool for how best to
        present our data
      • KY must take more steps to facilitate
        quality improvement
      • The Guides give us credibility in our QI
        efforts


Cabinet for Health and Family Services
Slide #23
                                Contact Information

                  “I’m sorry I couldn’t be with you.”
                                     -Trudi Matthews

                             tlmatthews@juno.com
                               859-333-8067 (cell)




Cabinet for Health and Family Services
Slide #24
                 For Policy Discussion Roundtable:
            States Involved in AHRQ Activities on Asthma
   • Learning Partnership – Disparities in Pediatric Asthma
      – Pilot testing state-led model: AZ, MD, MI, NJ, OR, RI
      – Activities with States:
               • Learning institutes
               • Planning support
               • Technical assistance (e.g., Cultural competency training)
   • Specific Examples:
      – Michigan Asthma Coalition:
               • Trained on asthma disparities ; collecting data on children’s disparities
               • Stimulated asthma ROI calculator -- decision on county program
         – Oregon:
               • Used GIS mapping to target high prevalence counties to reduce
                 asthma disparities among low-income children (for telemedicine?)
         – Rhode Island
               • Rhode Island Healthy Homes: Developed assessment tool to
                 identify children with asthma in low-income housing (w/ housing
                 authority) & refer to community health centers and DOH)

Cabinet for Health and Family Services
Slide #25

								
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