1. Preventable Hospitalization Costs and Mapping Tool John Bott Center for Delivery, Organization, and Markets July 21, 2010

2. 2 Opportunity for Improvement Annual national cost: $30B* Annual national cost: $30B* Represents issues of prevention, primary care, access, and care coordination Represents issues of prevention, primary care, access, and care coordination To reduce avoidable hospitalizations, need to know details: To reduce avoidable hospitalizations, need to know details: – What types of care have the most room for improvement? * Based on a composite of the AHRQ Prevention Quality Indicators using 2006 data and dollars as reported in the National Healthcare Quality Report (2009).

3. 3 Currently, all AHRQ Quality Indicators (QIs) are based on electronic hospital discharge data, which draw upon readily available data elements Currently, all AHRQ Quality Indicators (QIs) are based on electronic hospital discharge data, which draw upon readily available data elements The AHRQ QIs examine care: The AHRQ QIs examine care: – Directly: Inpatient hospital setting – Indirectly: Hospital data as a window on the community The Preventable Hospitalization Costs and Mapping Tool measures quality of care at the area level, not the provider or hospital level The Preventable Hospitalization Costs and Mapping Tool measures quality of care at the area level, not the provider or hospital level AHRQ Quality Indicators

4. 4 History In 2007, AHRQ released the Preventable Hospitalization Costs and Mapping Tool: In 2007, AHRQ released the Preventable Hospitalization Costs and Mapping Tool: – Area-level QIs – Potentially avoidable costs for each area- level AHRQ QI In 2009, AHRQ began updating, revising, and integrating the tool into MONAHRQ and it is no longer available as separate software In 2009, AHRQ began updating, revising, and integrating the tool into MONAHRQ and it is no longer available as separate software

5. 5 Main Functions Creates maps that show rates of hospital admission for selected health problems by county Creates maps that show rates of hospital admission for selected health problems by county Calculates potential cost savings that may occur if hospital admissions for selected health problems are reduced: Calculates potential cost savings that may occur if hospital admissions for selected health problems are reduced: – Each county – Statewide

6. 6 Cost Calculations Costs are based on cost-to-charge ratios to reflect hospital costs Costs are based on cost-to-charge ratios to reflect hospital costs – Variable based on payer type Costs are based on the time period of data used in the analysis Costs are based on the time period of data used in the analysis – Like most things in life, costs rise over time Costs are only for the inpatient component of the bill Costs are only for the inpatient component of the bill – To reflect the full cost of the discharge, the professional component needs to be added

7. 7 AHRQ QIs in the Mapping Tool All AHRQ Prevention Quality Indicators (PQIs) Chronic Lung Conditions Chronic Lung Conditions – PQI 5 Chronic Obstructive Pulmonary Disease Admission Rate – PQI 15 Adult Asthma Admission Rate Diabetes Diabetes – PQI 1 Diabetes Short-Term Complications Admission Rate – PQI 3 Diabetes Long-Term Complications Admission Rate – PQI 14 Uncontrolled Diabetes Admission Rate – PQI 16 Lower Extremity Amputation Rate Among Diabetic Patients

8. 8 AHRQ QIs in the Mapping Tool AHRQ PQIs (cont.) Heart Conditions Heart Conditions – PQI 7 Hypertension Admission Rate – PQI 8 Congestive Heart Failure Admission Rate – PQI 13 Angina Without Procedure Admission Rate Other Conditions Other Conditions – PQI 2 Perforated Appendix Admission Rate – PQI 9 Low Birth Weight Rate – PQI 10 Dehydration Admission Rate – PQI 11 Bacterial Pneumonia Admission Rate – PQI 12 Urinary Tract Infection Admission Rate

9. 9 AHRQ QIs in the Mapping Tool Area-Level AHRQ Inpatient Quality Indicators (IQIs) Area-Level AHRQ Inpatient Quality Indicators (IQIs) – IQI 26 Coronary Artery Bypass Graft – IQI 27 Percutaneous Transluminal Coronary Angioplasty – IQI 28 Hysterectomy – IQI 29 Laminectomy or Spinal Fusion

10. 10 AHRQ QIs in the Mapping Tool Area-Level AHRQ Patient Safety Indicators (PSIs) Area-Level AHRQ Patient Safety Indicators (PSIs) – PSI 21 Foreign Body Left in During Procedure – PSI 22 Iatrogenic Pneumothorax – PSI 23 Central Line-Associated Bloodstream Infection – PSI 24 Postoperative Wound Dehiscence – PSI 25 Accidental Puncture or Laceration – PSI 26 Transfusion Reaction – PSI 27 Postoperative Hemorrhage or Hematoma

11. 11 AHRQ’s PQI Composites in the Mapping Tool Overall Composite Overall Composite – All AHRQ PQIs Acute Care Composite Acute Care Composite – PQI 10 Dehydration Admission Rate – PQI 11 Bacterial Pneumonia Admission Rate – PQI 12 Urinary Tract Infection Admission Rate

12. 12 AHRQ’s PQI Composites in the Mapping Tool Chronic Conditions Composite Chronic Conditions Composite – PQI 1 Diabetes Short-Term Complications Admission Rate – PQI 3 Diabetes Long-Term Complications Admission Rate – PQI 5 Chronic Obstructive Pulmonary Disease Admission Rate – PQI 7 Hypertension Admission Rate – PQI 8 Congestive Heart Failure Admission Rate – PQI 9 Low Birth Weight Rate – PQI 13 Angina Without Procedure Admission Rate – PQI 14 Uncontrolled Diabetes Admission Rate – PQI 15 Adult Asthma Admission Rate – PQI 16 Lower Extremity Amputation Rate Among Diabetic Patients

13. Potentially Avoidable Hospitalizations 13

14. Ambulatory Care Sensitive Conditions Potentially Avoidable Hospitalizations – AHRQ’s Prevention Quality Indicators (PQIs – ambulatory care sensitive conditions) and … 14

15. Other Area-Level Indicators … Area-level patient safety and procedure rates 15

16. Map of Rates by County* * Synthetic data Rates for avoidable admissions by county: Highest rates in dark blue, lowest rates in light blue Click on Summary Table for more details. 16

17. Potential Cost Savings – Reducing Preventable Admissions* Details on avoidable admissions by county, including cost savings. Can download to Excel. * Synthetic data 17

18. Source of Comparative Results HCUPnet: HCUPnet: – Individual measure rates by year – National figures for comparison – Regional figures for comparison: Northeast Northeast Midwest Midwest South South West West Website: http://hcupnet.ahrq.gov Website: http://hcupnet.ahrq.gov 18

19. Examples of Potential Use Targeting priorities and interventions: Targeting priorities and interventions: – By clinical area – By geography Tracking and studying the impact of interventions Tracking and studying the impact of interventions Identifying best practices Identifying best practices Participating in public reporting at various geographic levels Participating in public reporting at various geographic levels Establishing budgets for preventable hospitalization efforts Establishing budgets for preventable hospitalization efforts 19

20. Future Work Quality improvement toolkit is being developed to assist in reducing potentially avoidable hospitalizations as defined by the AHRQ PQIs Quality improvement toolkit is being developed to assist in reducing potentially avoidable hospitalizations as defined by the AHRQ PQIs – Expected release: Early 2011 Currently exploring adding analytic capacity at the ZIP Code level Currently exploring adding analytic capacity at the ZIP Code level Adding remaining AHRQ QIs Adding remaining AHRQ QIs – Over the course of the next year 20