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AHRQ Patient Safety Measurement: Overview; Patient Safety Indicators Example Irene Fraser, Ph.D., Director Center for Delivery, Organization and Markets.

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Presentation on theme: "AHRQ Patient Safety Measurement: Overview; Patient Safety Indicators Example Irene Fraser, Ph.D., Director Center for Delivery, Organization and Markets."— 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 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 Scope, uniformity, affordability of enhanced claims data Clinical depth of medical records Clinical depth of medical records Potential “new world” of the EHR Potential “new world” of the EHR But 3 need to join the same universe But 3 need to join the same universe

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

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

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

8 MONAHRQ Output a healthcare reporting website You host the site: Public, private, your choice Download MONAHRQ from monahrq.ahrq.gov Load your local hospital discharge data MONAHRQ runs on your desktop Free MONAHRQ tool for public reporting, analysis (My Own Network Powered by AHRQ) Select customization options * Hospital Compare measures, HCAHPS survey measures, AHRQ Quality Indicators, others? Load sets of pre-calculated measures* 8

9 Six States Now Use MONAHRQ Nevada MONAHRQ site HawaiiHawaii NevadaNevada MaineMaine IndianaIndiana KentuckyKentucky UtahUtah

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

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 Work w/ NQF to add measures to EMR, clinically enrich current measures Support HIEs Support HIEs Research, pilots on adding clinical to claims data Research, pilots on adding clinical to claims data ARRA grants to continue this work ARRA grants to continue this work HIT-Value Conference: “Creating a Plan to Get the Best from Both Worlds” HIT-Value Conference: “Creating a Plan to Get the Best from Both Worlds” New measures for using enhanced data 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) 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) 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. Lab data toolkit addresses all facets of the data collection process.http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/lvback.jsp POA toolkit will include business case for POA (including example HAC reports), and tools to improve quality of data 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 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) 2. Validation of New QI Measure Sets 3. Submission of New QI Measures to NQF* 4. Tool Development 5. Maintenance, Enhancement & Technical Support Measure of Sets 6. Assessment Retire Maintain & Enhance Harmonize Co-steward

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


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