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Irene Fraser, Ph.D., Director

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Presentation on theme: "Irene Fraser, Ph.D., Director"— Presentation transcript:

1 AHRQ Patient Safety Measurement: Overview; Patient Safety Indicators Example
Irene Fraser, Ph.D., Director Center for Delivery, Organization and Markets AHRQ Annual Meeting September 10, 2012

2 Transparency and public reporting
Three Paths to Safety, Quality and Value– Good Measures and Data Are Central for Each Transparency and public reporting Pay-for-performance and payment reform Provider-based redesign and quality improvement Also important for state and national tracking

3 AHRQ Roles in Patient Safety Measures and Data
Develops and maintains measures Quality Indicators (Patient Safety module) Patient Safety Organizations and Common Formats CHIPRA Tracks progress, provides data for analysis Healthcare Cost and Utilization Project (HCUP) National Healthcare Quality and Disparities Reports State Snapshots Maintains Measure Clearinghouse Creates tools: e.g. MONAHRQ Applies tools to quality improvement Partnership for Patients Million Hearts Campaign Collaborates to align measures

4 Challenge for Measures & Data: Need to Integrate Best from 3 Worlds
Scope, uniformity, affordability of enhanced claims data Clinical depth of medical records Potential “new world” of the EHR But 3 need to join the same universe

5 Quality Indicators Measures developed by AHRQ for use with all-payer billing data About 50 endorsed by NQF Under continuous review and improvement Used extensively by states CMS using in Hospital Compare, VBP Used in Partnership for Patients, Million Hearts Campaign

6 AHRQ QI Modules Inpatient QIs Prevention QIs Pediatric Patient
Mortality, Utilization, Volume Prevention QIs Avoidable Hospitalizations / Other Avoidable Conditions 32 hospital & area level measures, 2 composites 14 area level measures, 3 composites 14 NQF endorsed measures, 3 composites 13 NQF endorsed measures & 1 composite Patient Safety QIs Complications, Unexpected Death 25 hospital & area level measures, 1 composite 20 hospital & area level measures, 1 composite Pediatric & Neonatal QIs 11 NQF endorsed measures & 1 composite Complications, Unexpected Death 10 NQF endorsed measures & 1 composite

7 Two-thirds of the US Has Access to a Public Report in their State Using AHRQ’s Quality Indicators to Report Hospital Quality WI WA IA NY ME MN VT IL OR OH NH MA NV RI NJ MD CA KY UT MS CO AZ FL OK LA TX 26 states use for hospital-level reports Additional states report area-level measures

8 Free MONAHRQ tool for public reporting, analysis
(My Own Network Powered by AHRQ) Download MONAHRQ from Load your local hospital discharge data MONAHRQ Load sets of pre-calculated measures* Select customization options Output a healthcare reporting website QI software is an important dissemination tool. Few (if any?) other measure developers supply such a tool. Lets QI users calculate QIs using their own data. -- Helps organizations use their own data. -- Calculates QIs locally – AHRQ does not handle data or measure results. -- Minimizes resources needed to calculate QIs. -- Helps ensure QIs are calculated correctly and consistently. -- Helps ensure use of state-of-the-art measures: AHRQ is responsible for research and updates, all users benefit. MONAHRQ runs on your desktop You host the site: Public, private, your choice * Hospital Compare measures, HCAHPS survey measures, AHRQ Quality Indicators, others? 8

9 Six States Now Use MONAHRQ
Hawaii Nevada Maine Indiana Kentucky Utah Nevada MONAHRQ site

10 New Toolkit Supports Efforts To Improve Quality and Safety
Guides hospitals in using the AHRQ Inpatient and Patient Safety Quality Indicators™ to improve care Explains the quality improvement process and offers tools “Introduction and Roadmap” helps various users identify the best resources for their needs Available at

11 Meeting Challenge Requires Multiple Bridges
Between… HIT World EMR World Clinical data Health Info. Exchanges Measure developers Medicare and Medicaid data And… Quality world Claims data world Claims data State data orgs. Data developers Private payer data

12 AHRQ Work to Bridge these Divides
Work w/ NQF to add measures to EMR, clinically enrich current measures Support HIEs Research, pilots on adding clinical to claims data ARRA grants to continue this work HIT-Value Conference: “Creating a Plan to Get the Best from Both Worlds” New measures for using enhanced data

13 Enhancing Clinical Robustness of Billing Data
Research: Adding a few clinical data elements (especially POA and lab values) significantly improves quality assessment using billing data (Pine, et al, JAMA 2007) Data Pilots ( ) Established feasibility of linking electronic clinical lab data to billing data and collecting POA in 3 states (FL, MN, VA) Toolkits for other states Lab data toolkit addresses all facets of the data collection process. POA toolkit will include business case for POA (including example HAC reports), and tools to improve quality of data State-wide grant initiatives Six projects will expand clinical linkages and improve race and ethnicity data funded under ARRA Measures: Enhancing Quality Indicators to include POA and Lab Values

14 Process for Developing and Maintaining an AHRQ Quality Indicator
1. Development of New QI Measure Sets (or Improvement of Existing Sets) Retire Co-steward 2. Validation of New QI Measure Sets 6. Assessment Harmonize Maintain & Enhance 5. Maintenance, Enhancement & Technical Support Measure of Sets 3. Submission of New QI Measures to NQF* 4. Tool Development

15 Patient Safety Indicators: Looking Ahead
Major goals Continue to improve existing measures Add new ones (e.g. Emergency Department) Move to ICD10 provides opportunity for further precision, advances Work to mobilize best of all measurement approaches in aligned effort.

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