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CheckPoint IQI Presentation, May 2007


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  • The quality and patient safety program includes the aggregation and analysis of data to support patient care, hospital management, and the quality management program and participation in external databases
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CheckPoint IQI Presentation, May 2007

  1. 1. AHRQ Quality Indicators: History and Application May-June 2007
  2. 2. Indicator Development <ul><li>AHRQ – Agency for Healthcare Research and Quality ( </li></ul><ul><li>Originally developed by the Health Care Utilization Project of AHRQ in the early 1990s </li></ul><ul><li>Expanded and refined by AHRQ’s Evidence Practice Center at UCSF and Stanford </li></ul><ul><li>Goal : Accessible, reliable indicators of quality </li></ul>
  3. 3. Three Types of Measures <ul><li>Volume of Inpatient Procedures </li></ul><ul><ul><li>A link has been demonstrated between the number of procedures performed and outcomes </li></ul></ul><ul><li>In-hospital Mortality </li></ul><ul><ul><li>Examines outcomes following procedures and for common medical conditions </li></ul></ul><ul><li>Utilization </li></ul><ul><ul><li>Procedures for which questions have been raised about overuse, underuse, and misuse </li></ul></ul>
  4. 4. WHAIC Indicator Reports 2003-2005 <ul><li>Required per HFS 120.26 and contract with WI Department of Administration </li></ul><ul><ul><li>Based on hospital data collected by the “department” </li></ul></ul><ul><ul><li>Reformatted to be consistent with nationally recognized quality indicators </li></ul></ul><ul><ul><li>Presents variations in the delivery of inpatient care at individual hospitals without identifying hospitals </li></ul></ul>
  5. 5. Accessing WHAIC Quality Indicator Reports
  6. 6. Limitations <ul><li>Variation among hospitals in the coding of diagnoses and procedures </li></ul><ul><li>Conditions present on admission are not currently identified </li></ul><ul><li>Lack of specificity in ICD- 9 -CM coding </li></ul><ul><li>Limitations of data content </li></ul>
  7. 7. Hospice Care <ul><li>In general, included </li></ul><ul><li>Hospitals instructed to exclude records of patients admitted to hospice care </li></ul><ul><li>Includes records of patients with a DNR order ( at this time ) if not hospice </li></ul><ul><li>Records with condition code “P1” may be excluded in the future </li></ul>
  8. 8. Annual Improvements Annual Coding Updates 35 Dx Fields with 35 POA Fields – apply to 2008 discharges (optional) Composite Measures – IP Mortality for procedures and conditions (optional) Two New Rate Selections – Population rate and observed/expected ratio (optional)
  9. 9. Advantages of Administrative Data <ul><li>Accessible </li></ul><ul><li>No extra work for hospitals </li></ul><ul><li>Data subject to several edit checks/no separate WHA audit required </li></ul><ul><li>Indicators selected can be measured accurately with discharge data </li></ul>
  10. 10. Validation Studies <ul><li>Summary Evidence on the IP Quality Indicators – </li></ul><ul><ul><li>Inpatient Quality Indicators Guide Version 3.0 </li></ul></ul><ul><ul><li>(February 2006) pages 14-70 </li></ul></ul><ul><ul><li>AHRQ Summary Statement on Comparative Hospital Public Reporting </li></ul></ul><ul><ul><li>RAND Evaluation of the use of AHRQ and Other Quality Indicators </li></ul></ul>
  11. 11. CheckPoint Indicators <ul><li>Mortality Rates – Medical Services </li></ul><ul><li>Acute heart attack </li></ul><ul><li>Acute heart attack without transfer cases </li></ul><ul><li>Acute stroke </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Gastrointestinal hemorrhage </li></ul><ul><li>Hip fracture </li></ul><ul><li>Pneumonia </li></ul>
  12. 12. CheckPoint Indicators <ul><li>Mortality Rates – Procedures </li></ul><ul><li>Abdominal aortic aneurysm (AAA) repair </li></ul><ul><li>Coronary artery bypass graft (CABG) </li></ul><ul><li>Carotid endarterectomy (CEA) </li></ul><ul><li>Craniotomy </li></ul><ul><li>Esophageal resection </li></ul><ul><li>Hip replacement </li></ul><ul><li>Pancreatic resection </li></ul><ul><li>Percutaneous transluminal coronary angioplasty (PTCA) </li></ul><ul><li>  </li></ul>
  13. 13. CheckPoint Indicators <ul><li>Volume Measures </li></ul><ul><li>Abdominal aortic aneurysm repair (AAA) </li></ul><ul><li>Carotid endaterectomy (CEA) </li></ul><ul><li>Coronary artery bypass graft (CABG) </li></ul><ul><li>Esophageal resection </li></ul><ul><li>Pancreatic resection </li></ul><ul><li>Percutaneous transluminal coronary angioplasty (PTCA) </li></ul>
  14. 14. CheckPoint Indicator <ul><li>Utilization </li></ul><ul><li>  </li></ul><ul><li>Incidental appendectomy among the elderly </li></ul><ul><li>  </li></ul>
  15. 15. IQI Calculations and Reporting for CheckPoint <ul><li>Mortality and Utilization – 30 cases in the denominator </li></ul><ul><li>Volume – 5 cases </li></ul><ul><li>Will be initially reported for calendar year 2005 and then updated on an annual basis </li></ul><ul><li>Will be reported using the observed/expected ratio </li></ul>
  16. 16. Indicators Excluded by WHAIC <ul><li>Volume </li></ul><ul><ul><li>Pediatric Heart Surgery </li></ul></ul><ul><li>Mortality – Procedures </li></ul><ul><ul><li>Esophageal Resection </li></ul></ul><ul><ul><li>Pancreatic Resection </li></ul></ul><ul><ul><li>Pediatric Heart Surgery </li></ul></ul>
  17. 17. Indicators Excluded by WHAIC <ul><li>Utilization </li></ul><ul><ul><li>Bilateral Cardiac Catheterization </li></ul></ul><ul><ul><li>Vaginal Birth After Cesarean, all </li></ul></ul><ul><ul><li>Laparoscopic Cholecystectomy </li></ul></ul>
  18. 18. Indicators Excluded by CheckPoint <ul><li>Utilization Indicators </li></ul><ul><li>Cesarean delivery rate </li></ul><ul><li>Primary Cesarean delivery rate </li></ul><ul><li>Vaginal Birth After Cesarean, uncomplicated </li></ul>
  19. 19. IQI Approval Process for CheckPoint Reporting <ul><li>Proposal presented to CheckPoint Measures Team </li></ul><ul><li>Teleconference to Hospital Quality Staff </li></ul><ul><li>Proposal Finalized and Approved by WHA Board in October 2006 </li></ul>
  20. 20. CheckPoint Approval Process for IQIs <ul><li>Hospital CEO completes a form indicating whether WHA is authorized to report these measures </li></ul><ul><li>Form can be faxed or mailed to WHA, due back June 29 </li></ul><ul><li>Authorization can be updated at any time </li></ul>
  21. 21. Hospital Authorization for CheckPoint IQIs <ul><li>Per Hospital, Signed by CEO </li></ul><ul><li>Please indicate if your hospital will participate in the reporting of Inpatient Quality Indicators (Inpatient Mortality, Volume, and Utilization): </li></ul><ul><li>      Yes, I would like to participate in reporting Inpatient Mortality, Volume and Utilization Measures </li></ul><ul><li>  </li></ul><ul><li>      No, I would not like to participate in reporting Inpatient Mortality, Volume and Utilization Measures at this time </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>
  22. 22. CheckPoint Timeline for IQIs <ul><li>June 29, 2007 Authorization forms due back to WHA </li></ul><ul><li>Aug 17, 2007 Hospital preview of IQIs in </li></ul><ul><li>CheckPoint </li></ul><ul><li>Aug 31, 2007 IQIs publicly released in CheckPoint </li></ul>
  23. 23. CheckPoint Report Display <ul><li>Mortality and Utilization will be reported in symbols </li></ul><ul><li>Symbols will represent: </li></ul><ul><ul><ul><li>As expected </li></ul></ul></ul><ul><ul><ul><li>Better than expected </li></ul></ul></ul><ul><ul><ul><li>Worse than expected </li></ul></ul></ul><ul><li>Volume will be reported as a number </li></ul>
  24. 24. Potential Uses of IQIs <ul><li>Quality Improvement </li></ul><ul><li>Pay for Performance </li></ul><ul><li>Benchmarking </li></ul><ul><li>Consumer Education on Healthcare Risks </li></ul><ul><li>Research </li></ul>
  25. 25. Communication <ul><li>WHA Press Release(s) – August 31, 2007 </li></ul><ul><li>Write-up in Valued Voice – August 31, 2007 </li></ul><ul><li>Hospital communication to their communities? </li></ul>
  26. 26. Where does the data come from? Today , next and the future …
  27. 27. Questions? <ul><li>WHA Contacts: </li></ul><ul><ul><li>Dana Richardson [email_address] </li></ul></ul><ul><ul><li>Kathleen Caron [email_address] </li></ul></ul>