Presentation on theme: "Paul J. Nietert, PhD Ruth G. Jenkins, MS Andrea M. Wessell, PharmD"— Presentation transcript:
1The Summary Quality Index (SQUID): A summary measure for multiple quality indicators in primary care Paul J. Nietert, PhDRuth G. Jenkins, MSAndrea M. Wessell, PharmDSarah T. Corley, MDSteven M. Ornstein, MDThe Medical University of South CarolinaAcademyHealth, Boston MA June 2005
2Accelerating Translation of Research Into Practice (A-TRIP) AHRQ-funded demonstration project to improve preventive services92 ambulatory care practices around the U.S.All practices use an electronic medical record.All are part of Practice Partner Research Network (PPRNet).Quarterly data extracts from each practice
4BackgroundQuality indicators are helpful tools for translating research into clinical practice.Providing feedback to clinicians on these indicators and assisting them with process change through on-site visits by our research staff have been shown to help them make system changes that improve the quality of the care they provide.
5A-TRIP MethodsWe provide practice reports, showing practice’s performance on 78 unique quality indicators from 8 clinical domains:HypertensionCHD and StrokeCancerImmunizationsInappropriate Rx in ElderlyMH/SARespiratory/Infectious DiseaseNutrition and Obesity
7The ChallengeAnalyzing improvements in 78 quality indicators presents challenges:Many measures are correlated with each otherLDL < 100 (CHD pts)LDL < 100 (DM pts)Some lab measures have different targets based upon morbidityBP < 130/80 (DM pts)BP < 140/90 (HTN pts)Some pts not eligible for some measures
8MethodsGoal: Design a method for summarizing the 78 quality measures that:Is clinically relevant and interpretableIs statistically soundAllows for the evaluation of QI efforts over time
9Possible SolutionsFor each pt, add all 78 indicator variables togetherBad idea! (Many pts not eligible for certain measures)Use principal component analysis techniques for analysisBad idea! (Too complicated to explain)Use the Summary Quality IndexGood idea!
10The SQUID: AlgorithmDefine processes and outcomes of interest, regardless of targetBP MonitoringLDL MonitoringHgbA1C MonitoringBP ControlLDL ControlHgbA1C Control78 indicators reduced to 32 processes & 5 outcomes
11The SQUID: AlgorithmCreate indicator variables (ei) that reflect whether pt is eligible for each process and outcome measurePAP Test (Women > 18 yrs old)FOBT (Men & Women > 50 yrs old)Create indicator variables (mi) that reflect whether pt has met the target for a process or outcome, given his/her demographics and/or morbidityIf pt has DM, then BP must be < 130/80If pt has HTN, BP must be < 140/90
12The SQUID: AlgorithmE = The number of measures for which the pt is eligible (denominator) = Σ eiM = The number of eligible measures for which the pt has met his/her morbidity-specific target (numerator) = Σ miCreate a pt-level SQUID =Create a practice-level SQUID = average of all pt-level SQUIDsME
13The SQUID: Interpretation A patient’s SQUID reflects the percentage of targets met out of the total number of targets for which he/she is eligible.A practice’s SQUID reflects the average percentage of targets achieved by their patients.
14Results: SQUIDs as of 4/1/05 Across the 92 physician practices, adult pts were eligible, on average, for 9.7 out of a total of 37 processes and outcomes.On average, pts met 3.7 of their eligible targets.Across all pts, the average SQUID was 31.5%.
17Notes SQUIDs can be used in patient-level or practice-level analyses. Because it is a continuous measure, and because of its relative normality, certain linear models may be appropriate.Examples:Mixed effects regression modelsGeneralized estimating equations models
18ConclusionsThe SQUID is an effective tool to aid in the evaluation of multiple quality indicators.Nice statistical propertiesClinically meaningfulIn future research studies and quality improvement efforts that include multiple quality indicators, the SQUID should be considered as a measure of overall quality.