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. Transparency and public reporting
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
Clinical depth of medical records
Potential “new world” of the EHR
But 3 need to join the same universe

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

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

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

8. Free MONAHRQ tool for public reporting, analysis
(My Own Network Powered by AHRQ)
Download MONAHRQ from monahrq.ahrq.gov
Load your local hospital discharge data
MONAHRQ
Load sets of
pre-calculated measures*
Select customization options
Output a healthcare reporting website
QI software is an important dissemination tool. Few (if any?) other measure developers supply such a tool.
Lets QI users calculate QIs using their own data.
-- Helps organizations use their own data.
-- Calculates QIs locally – AHRQ does not handle data or measure results.
-- Minimizes resources needed to calculate QIs.
-- Helps ensure QIs are calculated correctly and consistently.
-- Helps ensure use of state-of-the-art measures: AHRQ is responsible for research and updates, all users benefit.
MONAHRQ runs on your desktop
You host the site:
Public, private, your choice
* Hospital Compare measures, HCAHPS survey measures, AHRQ Quality Indicators, others? 8

9. Six States Now Use MONAHRQ
Hawaii
Nevada
Maine
Indiana
Kentucky
Utah
Nevada MONAHRQ site

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

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
Support HIEs
Research, pilots on adding clinical to claims data
ARRA grants to continue this work
HIT-Value Conference: “Creating a Plan to Get the Best from Both Worlds”
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)
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.
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
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)
Retire
Co-steward
2. Validation of New QI Measure Sets
6. Assessment
Harmonize
Maintain & Enhance
5. Maintenance, Enhancement & Technical Support Measure of Sets
3. Submission of New QI Measures to NQF*
4. Tool Development

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