1. Iowa Healthcare Collaborative - Past, Present, and Future Use of AHRQ Quality Indicators Lance Roberts 2009 AHRQ Annual Conference September 24, 2009 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1800 Office: 515.283.9330 Fax: 515.698.5130 http://www.ihconlie.org

2. 2004 Iowa Hospital Association (hospitals) and the Iowa Medical Society (doctors) form IHC Cornerstones  Promote Responsible Public Reporting – “Iowa Report”  Supportive State Policy – IHA collects data, IHC research  Align and Equip Providers on Quality and Value  Engage the Community for Clinical Improvement  Raise the Standard of Care Past – Historical Perspective

3. Public Reporting Policy Responsible Public Reporting Policy  Engage stakeholders – Data Committee  Importance to measure and report - (STEEEP), variation, or overall poor performance  Scientific acceptability of measure properties NQF – endorsement AHRQ Tiering  Usability – understandable, useful for decision making  Feasibility – data are readily available, low burden

4. Historical Perspective 2005 Iowa Report 10 AHRQ QIs – aggregate Iowa performance compared to US, Midwest, Low/High US states 2008 Iowa Report 16 Hospital-level and 18 aggregate QIs

5. Provider-focused Public Report Clinical Category - Measures: Cardiovascular Conditions – Heart Attack Cardiovascular Conditions – Heart Failure Cardiovascular Conditions – Stroke Pneumonia Condition Hip Fracture Medical and Surgical – Patient Safety Postoperative Care Prevention of Blood Clots Prevention of Healthcare-Associated Infections Utilization Obstetric / Neonatal Care Pediatric – Patient Safety Patient Experience in Hospital – HCAHPS Survey Provider Private Report AHRQ Quality Indicators Data / Research Base AHRQ CMS Primary Sources Data Sources: HCUP - Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID) CMS Hospital Compare – Hospital Quality Initiative Iowa Healthcare Collaborative - Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention Clinical Category Iowa Report – From Data/Measures to Clinical Domains

6. AHRQ Quality Indicator

7. Private Hospital Reports – AHRQ Quality Indicators

8. Collaborative Quality Improvement Opportunities Iowa Stakeholders  Maternal Birth-related Trauma  Multiple year underperformer  Research – Roberts, Ely, Ward; Factors Contributing to Maternal Birth-related Trauma, 2007  Difficult to convene an Obstetrical Trauma Workgroup  Hospitals/Systems involved in QI – using hospital-level QI reports and our research

9. Collaborative Quality Improvement Opportunities Iowa Stakeholders  Anesthesiologists  Another specialty interested in measurement and QI  PSI 1 Descriptive Statistics – 2002-2006 SID Descriptive study of adverse events E9386 – “Peripheral Nerve and Plexus Blocking Anesthetics”  Sharing list of NQF-endorsed anesthesia-related measures  Demotion of PSI 1 – Complications of Anesthesia

10. Collaborative Quality Improvement Opportunities Iowa Stakeholders  Emergency Care – Aortic Aneurysm/Dissection  Cardiologists  Reaction to media reports  Interest in comparative private/public reporting

11. What Does Future Look Like? AHRQ’s Tools that May Assist Collaboratives / States  Consumer Reporting Tools - MONAHRQ  Pilot - Adding clinical data to administrative data  ER – PSIs, PQIs  Efficiency measures (potentially all-payer readmission)  Health Plan  Medicaid Home and Community- Based Services2007 State Snapshots: Methods. Derived from 2007 National Healthcare Quality Report. March 2008. Rockville, MD: Agency for Healthcare Research and Quality. http://statesnapshots.ahrq.gov/.http://statesnapshots.ahrq.gov/

12. What Does Future Look Like? Value – “Business Case” and “Value” of collaborative QI efforts  Working with AHRQ researchers and tools - Iowa SID, NIS, HCUP Cost-to-Charge Ratio files Matching Software – match patients with adverse event to similar patients without  Are adverse events associated to excess ….  LOS ? From 2004 to 2007 – Avoided approx. 929 days  Mortality ? Avoided Approx. 10 – 16 deaths  Charges ? Avoided Approx. $3.9 million  Cost ?  How many events are Present on Admission (POA)?

13. AHRQ Support / Tools We Value AHRQ QI Support  An efficient mode to receive help on use of tools  E.g. – PSI 3 - Decubitus Ulcer AHRQ Quality Indicator Learning Institute (QILI)  An effective collaborative for AHRQ QI Users  Affected our Data Committee Policies o Tiering, NQF-endorsement, Coding issues, Validation  Included information in reports to Iowa legislature

14. How Else Can AHRQ Help? Healthcare-Associated Infections – gaining a lot of attention  CAUTI  C-Diff -  Iowa trend is similar to National trend  potential 2008 attributable cost savings if Iowa C-Diff –reduced by 10% $1.5 - $2.2 Million –Iowa IP’s – use SID/NIS if possible!! –Research will help shape –Iowa Statewide HAI Plan Costs based on CDC Report: Scott, DR (CDC), The Direct Medical Costs of Hais in US Hospitalls and the Benefits of Prevention. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

15. How Else Can AHRQ Help? Improve Documentation  Use of AHRQ Support Line may be reduced if documentation is improved Continue AHRQ QILI  Focus on equipping users for responsible public reporting  Highlight/integrate other supportive tools – HCUP software, statistical briefs, State Snapshots, AHRQ HAI webpage

16. Thank You 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1800 Office: 515.283.9330 Fax: 515.698.5130 http://www.ihconlie.org