Using AHRQ Quality Indicators Denise Remus PhD, RN Senior Research Scientist Agency for Healthcare Research and Quality (AHRQ)

HI Key: HCUP partner No inpatient data States With Inpatient Databases, 2002 TX WV KY NC VT RI NE MN AL DC MT ID MS Data, not in HCUP AK NV ND SD WY NM OH IN LA AROK NH

AHRQ QI Objectives  Provide a tool to:  Highlight potential quality concerns  Identify areas for further study  Enable trending of quality over time  Facilitate transparency through comparative information  Facilitate decision making by consumers, purchasers, and policy makers  Maximize existing resources by complimenting other measurement efforts

Current QI Modules Prevention Quality Indicators Prevention Quality Indicators Inpatient Quality Indicators Inpatient Quality Indicators Patient Safety Indicators Patient Safety Indicators Ambulatory care sensitive conditions Ambulatory care sensitive conditions Mortality following procedures Mortality following procedures Mortality for medical conditions Mortality for medical conditions Utilization of procedures Utilization of procedures Volume of procedures Volume of procedures Post-operative complications Post-operative complications Iatrogenic conditions Iatrogenic conditions

QI Guidance Document Guidance for Using the AHRQ Quality Indicators for Hospital-level Public Reporting or Payment Prevention Inpatient Patient Safety Quality Indicators Quality Indicators Quality Indicators

Texas Health Care Information Council

Niagara Health Quality Coalition

Selected Hospital Reporting Website Addresses (Texas Hospital Report) (Texas Hospital Report) (Niagara Quality Report) (Niagara Quality Report) reporting_summit_052604/index.html (Summary of Hospital Public Reporting Sites) reporting_summit_052604/index.html (Summary of Hospital Public Reporting Sites) reporting_summit_052604/index.html reporting_summit_052604/index.html

Pay for Performance Initiatives Using AHRQ QI’s Premier Hospital Quality Quality-In-Sights ® Hospital Incentive DemonstrationIncentive Program Sponsor: CMSAnthem Blue Cross Blue Shield of Virginia Duration:3 Years3 Years Approach:Payment incentives andAligns financial incentives with disincentives to top and achievement of specific bottom 20%performance goals Measures:Includes 2 AHRQ PatientIncludes 2 AHRQ Patient Safety Indicators in two Safety Indicators, for PSIs patient groups (total of 4)focus is root cause analysis for quality improvement

QI Guidance Document Goal: Help potential users answer questions about if, when, and how to use the QIs for these new purposes. Goal: Help potential users answer questions about if, when, and how to use the QIs for these new purposes. Major Sections Major Sections – Science behind the measures – Selection factors – Potential users – Recommendations for selection and application

AHRQ QI’s: Next Steps AHRQ QI’s: Next Steps Continued measure development and refinement Continued measure development and refinement – Pediatric QI’s – Evaluate and improve risk adjustment User enhancements User enhancements – More comparative data – New simplified and enhanced software – Expanded communication/user support