1. Agency For Healthcare Quality and Research Quality Indicators NH Health Care QA Commission AHRQ Subcommittee Report July 31, 2009

2. AHRQ Subcommittee Scott Goodwin Stephanie Wolf-Rosenblum Sue Majewski Anne Diefendorf Valerie Neill Erin Wigmore Pam Duchene Gloria Thorington Rachel Rowe

3. AHRQ Quality Indicators Agency for Healthcare Research and Quality (AHRQ), research arm of U.S. Department of Health and Human Services Developed Quality Indicators to use hospital administrative data to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time.  Inpatient Quality Indicators  Patient Safety Indicators  Prevention Quality Indicators  Pediatric Quality Indicators

4. CMS Use of AHRQ Indicators Public reporting of select Inpatient Quality and Patient Safety Indicators by Centers for Medicare and Medicaid Services (CMS) on Hospital Compare web site mid-year 2010 Others using AHRQ indicators:  Slightly more than half of the US population has access to public reports using AHRQ QIs through state initiatives, including Vermont and Massachusetts (AHA)  Healthgrades Rating Service  CareChex (Trident System

5. CMS Use of AHRQ Indicators Patient Safety Indicators  PSI 4 – Death among surgical patients  PSI 6 – Iatrogenic wound dehiscence  PSI 14 – Postoperative wound dehiscence  PSI 15 – Accidental puncture/laceration  PSI Composite – Complications/patient safety PSI 3 - Decubitus ulcer; PSI 6 - Liatrogenic penumothorax; PSI 7 - Infection due to medical care; PSI 8 - Post-op hip fracture; PSI 9 - Post-op hemorrhage or hematoma; PSI 10 - Post-op physio-metabolic derangement; PSI 11 - Post-op respiratory failure; PSI 12 - Post-op pulmonary embolism or deep vein thrombosis; PSI 13 - Post-op sepsis; PSI 14 - Post-op wound dehiscence; PSI 15 – Accidental Puncture/Laceration

6. CMS Use of AHRQ Indicators Inpatient Quality Indicators (IQI)  IQI 11 – Abdominal aortic aneurysm repair mortality rate with volume  IQI 19 – Hip fracture mortality rate  IQI Composite 1 – Inhospital mortality rates IQI 8 - Esophageal resection; IQI 9 - Pancreatic resection ; IQI 11 - AAA repair; IQI 12 - Coronary artery bypass; IQI 13 - Craniotomy; IQI 14 - Hip replacement; IQI 30 - Percutaneous coronary angioplasty; IQI 31 - Carotid endarterectomy;  IQI Composite 2 – Inhospital mortality rates IQI 15 - AMI, IQI 16 - CHF, IQI 17 - Stroke, IQI 18 - GI hemorrhage, IQI 19 - Hip fracture, pneumonia

7. AHRQ Statement on Administrative Data “Although quality assessments based on administrative data cannot be definitive, they can be used to flag potential quality problems and success stories, which can then be further investigated and studied. Hospital associations, individual hospitals, purchasers, regulators, and policymakers at the local, State, and Federal levels can use readily available hospital administrative data to begin the assessment of quality of care.”

8. Administrative Data Produced by federal government, state governments, and private health care insurers Includes demographic characteristics, diagnoses of patients, codes for procedures Readily available, inexpensive to acquire, computer readable, encompass large populations. (Annals of Internal Medicine)

9. Administrative Data Gaps in clinical information and billing context compromise the ability to derive valid quality appraisals from administrative data. Limited insight into the quality of processes of care, errors of omission or commission, and the appropriateness of care. Current administrative data are probably most useful as screening tools that highlight areas in which quality should be investigated in greater depth. (Annals of Internal Medicine)

10. AHRQ Subcommittee Assessment Use of administrative data to assess safety and quality is problematic as it is designed for registration and billing and there is no validation MedPar data availability, consistency and national coverage makes it attractive to companies/states rating hospitals but with significant time lapse between collection and reporting Duplication of CMS data results using AHRQ software is technically difficult and unreliable

11. AHRQ Subcommittee Proposal Monitor the development of AHRQ software Monitor the use of administrative data by CMS and others Use existing software in individual facilities as a basis to evaluate current performance Evaluate the full list of AHRQ PSI/IQI to identify opportunities for improvement for the NH QA Commission