1. Advancing Excellence in Health Care 2.0 ETA December 2010 Carol Sniegoski AHRQ Annual Conference September 27, 2010 Preview:

2. Advancing Excellence in Health Care Future MONAHRQs (Estimated) Jan Feb Mar Apr May Jun Jul Aug SepJun Jul Aug Sep Oct Nov Dec 2 0 1 02 0 1 1 MONAHRQ 1.0 47 AHRQ QIs Hospital rates and costs Area rates and costs MONAHRQ 2.0 More AHRQ QIs More measures Updated user interface MONAHRQ 3.0 TBD MONAHRQ 2.1 FY11 coding updates Even more AHRQ QIs MONAHRQ 1.1 FY10 coding updates Additional AHRQ QIs

3. Advancing Excellence in Health Care MONAHRQ 1.0 Hospital Quality Path Hospital Utilization Path Area Preventable Hospitalizations Path Area Rates Path Many AHRQ Inpatient QIs (provider level) Many AHRQ Patient Safety QIs (provider level) AHRQ Inpatient QIs (area level) AHRQ Patient Safety QIs (area level) AHRQ Prevention QIs Procedure and condition rates and costs by area Procedure and condition rates and costs by hospital

4. Advancing Excellence in Health Care MONAHRQ 2.0 Hospital Utilization Path Area Preventable Hospitalizations Path Area Rates Path Hospital Quality Path All AHRQ Inpatient QIs (provider level) All AHRQ Patient Safety QIs (provider level) Hospital Compare inpatient measures AHRQ Inpatient QIs (area level) AHRQ Patient Safety QIs (area level) AHRQ Prevention QIs Procedure and condition rates and costs by area Procedure and condition rates and costs by hospital

5. Advancing Excellence in Health Care Quick Guide: AHRQ Quality Indicators in MONAHRQ AHRQ Inpatient QIs AHRQ Patient Safety QIs 2.0 (2010)   AHRQ Neonatal QIs AHRQ Pediatric QIs  3.0 (2011)     AHRQ Prevention QIs  1.0 (2010)        included some included not included

6. Advancing Excellence in Health Care Quick Guide: Hospital Compare Measures in MONAHRQ CMS Process Measures, Inpatient CMS Outcome Measures (30-Day Mortality and Readmissions) CMS Hospital Acquired Conditions ( Sep 2010 ) Surgical care improvement Heart attack Heart failure Pneumonia Children’s asthma care Heart attack Heart failure Pneumonia CMS Structural Measures CMS Outpatient Imaging Efficiency Measures Medicare Payment and Volume Information 2.01.0       HCAHPS Measures CMS Process Measures, Outpatient   included some included not included

7. Advancing Excellence in Health Care Hospital Compare Measure Results and MONAHRQ MOHAHRQ 1.0 model: Step 1 You download MONAHRQ Step 2 You load your data You calculate measure results Step 3 You generate a Website Step 4 Calculate your own measure results

8. Advancing Excellence in Health Care Hospital Compare Measure Results and MONAHRQ MOHAHRQ 2.0 model: Calculate your own measure results You download CMS measure results You load CMS measure results You link hospitals Load precalculated measure results Step 1 You download MONAHRQ Step 2 You load your data You calculate measure results Step 3 You generate a Website Step 4 and/or

9. Advancing Excellence in Health Care Handling Hospital Compare Measure Results We download the publicly available Hospital Compare measure results file from CMS We clean, format, and test the file to make sure it works with MONAHRQ We post the cleaned file to the MONAHRQ site You go to the MONAHRQ site and download the cleaned CMS measure results file You load the CMS measure results file and/or your own administrative data into MONAHRQ and generate a website

10. Advancing Excellence in Health Care Update Cycles CMS inpatient process measure results* CMS inpatient outcome measure results* HCAHPS results* Annual refresh dates MONAHRQ software updates FY coding updates Updates to internal supplemental files * According to information in document “Hospital.pdf,” version dated 03/09/10, in the Hospital Compare downloadable database Mar Jun Sep Dec      

11. Advancing Excellence in Health Care New Look and Feel: Home Page New hospital quality path

12. Advancing Excellence in Health Care New Search Page Select health topic Tab between consumer and professional paths Select hospitals

13. Advancing Excellence in Health Care New Hospital Search Select radius in miles Enter ZIP code Search by ZIP code or by region Find hospitals

14. Advancing Excellence in Health Care New Hospital Search Select Hospitals for Comparison Hospital list appears Select one or more hospitals

15. Advancing Excellence in Health Care New Health Topic Search Select health topic Topic description appears

16. Advancing Excellence in Health Care New Search Page Select Hospitals for Comparison Submit to go to classification table page

17. Advancing Excellence in Health Care New Classification Table Consumer path: red / yellow / green icons Professional path: numbers with confidence intervals Two-way scrolling

18. Advancing Excellence in Health Care New Classification Table Tab for outcome measures Tab for process measures Tab between subgroups

19. Advancing Excellence in Health Care New Classification Table Sortable column for each indicator New classification icons Above average Average Below average Top 10% Above median Below median Switch between benchmarks: input file and national

20. Advancing Excellence in Health Care New Classification Table Professional path: drill down to either bar charts or detailed statistics Consumer path: drill down to bar charts view

21. Advancing Excellence in Health Care MONAHRQ Learning Network Goals Facilitate MONAHRQ adoption Gather feedback Timeframe Through June 2011 Participants MONAHRQ adopters and serious potential adopters Progress Recruitment complete: 32 committed participants Kickoff meeting after NAHDO conference, October 14

22. Advancing Excellence in Health Care MONAHRQ Learning Network HCUP Partner CVE Other Other State Government Other University Individual Hospital

23. Advancing Excellence in Health Care MONAHRQ Learning Network HCUP Partner CVE Other Other State Government Other University Individual Hospital MONAHRQ Learning Network Participant Locations

24. Advancing Excellence in Health Care MONAHRQ Website www.monahrq.ahrq.gov

25. Advancing Excellence in Health Care MONAHRQ Website www.monahrq.ahrq.gov

26. Advancing Excellence in Health Care Websites Generated Using MONAHRQ

27. Advancing Excellence in Health Care Websites Generated Using MONAHRQ

28. Advancing Excellence in Health Care Websites Generated Using MONAHRQ

29. Advancing Excellence in Health Care Questions? monahrq.ahrq.gov

30. Advancing Excellence in Health Care Questions?

31. Advancing Excellence in Health Care Websites Generated Using MONAHRQ

32. Advancing Excellence in Health Care Data Refresh Cycles CMS process measures* Quarterly (Sep, Dec, Mar, Jun) 12 months CMS mortality and readmissions measures* Annually (Jun) 36 months HCAHPS patient experience measures* 12 months Refresh rateData periodData lag Quarterly (Sep, Dec, Mar, Jun) 9 months 12 months Census data for population denominators in area rates and area-level AHRQ QIs 12 months Annually (?) ? months * According to information in document “Hospital.pdf,” version dated 03/09/10, in the Hospital Compare downloadable database

33. Advancing Excellence in Health Care MONAHRQ Learning Network HCUP Partner CVE Other Other State Government Other University Individual Hospital

34. Advancing Excellence in Health Care MONAHRQ Learning Network HCUP Partner CVE Other Other State Government Other University Individual Hospital

35. Advancing Excellence in Health Care MONAHRQ Learning Network HCUP Partner CVE Other Other State Government Other University Individual Hospital HCUP Partner CVE Other Other State Government Other University Individual Hospital

36. Advancing Excellence in Health Care Quick Guide: AHRQ Quality Indicators in MONAHRQ AHRQ Inpatient QIs* AHRQ Patient Safety QIs* 1.1 (Oct/Nov 2010) 2.0 (Dec 2010) IQI 2 IQI 5 IQI 9 IQI 12 IQI 13 IQI 18 IQI 19 IQI 20 IQI 21 IQI 33 IQI 34 PSI 3 PSI 5 PSI 7 PSI 9 PSI 16     AHRQ Neonatal QIs AHRQ Pediatric QIs All    2.1 (April/May 2011)     AHRQ Prevention QIs All   1.0 (Jun 2010)     * Any individual AHRQ QIs not listed are already included in MONAHRQ 1.0   included some included not included

37. Advancing Excellence in Health Care Quick Guide: Hospital Compare Measures in MONAHRQ CMS Process Measures, Inpatient CMS Outcome Measures (30-Day Mortality and Readmissions) CMS Hospital Acquired Conditions ( Sep 2010 ) Surgical care improvement Heart attack Heart failure Pneumonia Children’s asthma care Heart attack Heart failure Pneumonia CMS Structural Measures Cardiac Surgery Registry Participation CMS Outpatient Imaging Efficiency Measures Medicare Payment and Volume Information 2.0 (Dec 2010) 3.0 (Sep 2011) 1.x          HCAHPS Measures CMS Process Measures, Outpatient (Jun 2010)

38. Advancing Excellence in Health Care Data Update Cycles CMS inpatient process measure results* 12 months CMS inpatient outcome measure results*36 months HCAHPS results*12 months Annual refresh datesData period Data lag 9 months 12 months MONAHRQ software updates FY coding updates Census data area rates area-level AHRQ QIs Risk-adjustment data provider-level AHRQ QIs FIPS data areas and maps 12 months, including yearly historical data since 1996 ? months * According to information in document “Hospital.pdf,” version dated 03/09/10, in the Hospital Compare downloadable database Mar Jun Sep Dec      

39. Advancing Excellence in Health Care Update Cycles CMS inpatient process measure results* 12 months CMS inpatient outcome measure results*36 months HCAHPS results*12 months Annual refresh datesData period Data lag 9 months 12 months MONAHRQ software updates FY coding updates Updates to internal supplemental files 12 months, including yearly historical data since 1996 ? months * According to information in document “Hospital.pdf,” version dated 03/09/10, in the Hospital Compare downloadable database Mar Jun Sep Dec      