1. Agency for Healthcare Research and Quality Advancing Excellence in Health Care http://www.ahrq.gov http://www.ahrq.gov A Web-Based Tool for Quality and Utilization Reporting Visit our Web site at: http://www.monahrq.ahrq.gov http://www.monahrq.ahrq.gov For technical assistance and to get on the MONAHRQ mailing list, email: monahrq@ahrq.gov

2. Advancing Excellence in Health Care MONAHRQ – My Own Network, powered by AHRQ Transforming your health care data into information about health, costs, and quality of care.

3. Advancing Excellence in Health Care Overview Introduction to MONAHRQ Introduction to MONAHRQ One state’s experience: NevadaCompareCare One state’s experience: NevadaCompareCare The future of MONAHRQ The future of MONAHRQ Anne Elixhauser, AHRQ Joseph Greenway, Director, Center for Health Information Analysis Carol Sniegoski, AHRQ

4. Advancing Excellence in Health Care Rationale Why should it be so expensive to generate and put out basic information? Why should it be so expensive to generate and put out basic information? Why should information be so hard to get? Why should information be so hard to get? Why does every organization have to reinvent the wheel? Why does every organization have to reinvent the wheel?

5. Advancing Excellence in Health Care From Data to Information to Action Hospital discharge data can generate valuable health care information Information can be used to make decisions Hospital discharge data are already being collected Utilization and costs of care in hospitals Quality of care in hospitals Rates of diseases in particular areas Rates of procedures in particular areas Preventable hospital stays that indicate breakdowns in care

6. Advancing Excellence in Health Care So how to proceed? AHRQ tools could be bundled into a single product (many based on hospital discharge data) AHRQ tools could be bundled into a single product (many based on hospital discharge data) Incorporate other tools and data Incorporate other tools and data QIs QIs WinQI WinQI HCUPnet HCUPnet Clinical Classification Software Clinical Classification Software Cost-to-charge ratios Cost-to-charge ratios Reporting template Reporting template ZIP codes ZIP codes Population data Population data DRG grouper DRG grouper

7. Advancing Excellence in Health Care Currently based on hospital discharge data Host user downloads MONAHRQ software from AHRQ website Software Host user creates local website on their own server Host user makes website available Host user applies software to own data locally How does MONAHRQ work... Internally to better understand own data and to answer questions Internally to better understand own data and to answer questions To member organizations, e.g., through a password protected site To member organizations, e.g., through a password protected site Publicly to provide information to the community Publicly to provide information to the community

8. Advancing Excellence in Health Care The End User Website Select the information you want: QUALITY INDICATORS AVOIDABLE HOSPITALIZATIONS RATES UTILIZATION

9. Advancing Excellence in Health Care Two quality paths to choose from One path for the lay public and one path for analysts and the health care profession.

10. Advancing Excellence in Health Care Select a health topic AHRQ Quality Indicators grouped into health topics that have been consumer- tested for salience and understandability.

11. Advancing Excellence in Health Care Select specific Quality Indicators Specific AHRQ Quality Indicators under a health topic– select all or choose indicators of interest.

12. Advancing Excellence in Health Care Select hospitals Select hospitals from the entire dataset or from specific regions. Default in MONAHRQ is to list hospitals by name, but names can be masked.

13. Advancing Excellence in Health Care Consumer path on Quality Indicators* * Synthetic data Arrays information on up to four hospitals for the indicators selected. Click on any indicator and get detailed information in graphic form.

14. Advancing Excellence in Health Care Details in graphic form* * Synthetic data Get details for each hospital in rank order, compared to the state average.

15. Advancing Excellence in Health Care Detailed path on Quality Indicators The detailed path provides more information for each indicator.

16. Advancing Excellence in Health Care Overall results for the state* * Synthetic data Information on specific indicators for the entire dataset: numerators denominators observed, expected and risk-adjusted rates confidence intervals Click on indicator for hospital-specific information

17. Advancing Excellence in Health Care Results by individual hospital* * Synthetic data Information by hospital on: numerators denominators observed, expected and risk-adjusted rates confidence intervals Institution names can be masked or unmasked.

18. Advancing Excellence in Health Care Click to see data graphically* * Synthetic data Risk-adjusted rate by hospital compared to state average

19. Advancing Excellence in Health Care Utilization path Utilization statistics (similar to information from HCUPnet)

20. Advancing Excellence in Health Care Utilization across all conditions, entire state* * Synthetic data All conditions for the entire database, listed by number of discharges Click on any column header to re-sort by: charges/costs LOS or condition/procedure

21. Advancing Excellence in Health Care Utilization on individual conditions… Can also search for utilization information on individual conditions

22. Advancing Excellence in Health Care … for individual hospitals

23. Advancing Excellence in Health Care Detailed utilization for all hospitals* * Synthetic data Information on: numbers of discharges, charges, costs, length of stay for all hospitals individually. National, regional, and state benchmarks included.

24. Advancing Excellence in Health Care More details for individual hospitals* * Synthetic data The same information is available for individual hospitals, by age group gender payer race

25. Advancing Excellence in Health Care Potentially Avoidable Hospitalizations

26. Advancing Excellence in Health Care Ambulatory care sensitive conditions Potentially Avoidable Hospitalizations – AHRQ’s Prevention Quality Indicators (PQIs – ambulatory care sensitive conditions) and …

27. Advancing Excellence in Health Care Other area-level indicators … Area-level patient safety and procedure rates

28. Advancing Excellence in Health Care 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

29. Advancing Excellence in Health Care Potential cost savings – reducing preventable admissions* Details on avoidable admissions by county, including cost savings. Can download to Excel. * Synthetic data

30. Advancing Excellence in Health Care Rates of Conditions and Procedures Path Rates of health conditions and procedures – Use county populations as the denominator in prevalence rates

31. Advancing Excellence in Health Care Groupings of diagnoses and procedures Can get information on prevalence of conditions or procedures by DRG, MDC, or CCS

32. Advancing Excellence in Health Care Search function Search by keyword

33. Advancing Excellence in Health Care Tabular results by county* * Synthetic data For all counties in the state: numbers of discharges and rate per 100,000 population. Sort by column headers. Click on Map to view graphic display.

34. Advancing Excellence in Health Care Map of rates by county* * Synthetic data Rates for specific conditions and procedures by county – Highest rates in dark blue, lowest rates in light blue

35. Advancing Excellence in Health Care How do you get there?

36. Advancing Excellence in Health Care Import Data Wizard The Import Data Wizard takes you through a step-by- step process of: importing your data, mapping it to the format required by MONAHRQ, analyzing the data, and defining your hospitals and regions.

37. Advancing Excellence in Health Care Select your data file

38. Advancing Excellence in Health Care Map data elements You map your data to the format required by MONAHRQ by clicking and dragging data elements.

39. Advancing Excellence in Health Care Map input values You then define your data elements to values understood by MONAHRQ (based on UB04 standard).

40. Advancing Excellence in Health Care Load your data

41. Advancing Excellence in Health Care Run analysis

42. Advancing Excellence in Health Care Hospital load* You can mask hospital names and assign Cost to Charge Ratios if you have CMS provider ID. * Synthetic data

43. Advancing Excellence in Health Care Build your website

44. Advancing Excellence in Health Care The Website Wizard takes you through a step-by-step process of processing your data and building your website. MONAHRQ Website Wizard

45. Advancing Excellence in Health Care Cell suppression and other parameters Set thresholds for cell suppression (to protect confidentiality) and other parameters.

46. Advancing Excellence in Health Care Can specify which QIs to include. Measures endorsed by the National Quality Forum are identified. Select which measures to include in website

47. Advancing Excellence in Health Care Customize your website Specify your website: where it should be stored which pages you want to include specifics about the style insert your logo what the website calls your data

48. Advancing Excellence in Health Care