transparency for quality improvement efforts at the kentucky cabinet for health and family services...
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Transparency for Quality Improvement Efforts
at the Kentucky Cabinet for Health and Family Services (CHFS)
Trudi Matthews, MASenior Policy AdvisorOffice of the Secretary
Cabinet for Health and Family ServicesSlide #2
Trudi Matthews et al.
Cabinet for Health and Family ServicesSlide #3
Kentucky Legislation & Policy
• 2005 law (HB 278) Secretary’s Advisory Committee on Transparency
• Transparency 2006 law (HB 380) on public release of cost and quality data
• Health Care Information Center Website:– Launched March 2007 – Data on avoidable hospitalizations & inpatient
quality– Consumers can compare KY hospitals on
quality – http://chfs.ky.gov/ohp/healthdata/
Cabinet for Health and Family ServicesSlide #4
Cabinet for Health and Family ServicesSlide #5
How did KY staff use the AHRQ Tools?
• AHRQ Diabetes Guide and Workbook helped direct staff to:– Look at chronic diseases & focus on diabetes – Assemble most recent data in formats of the
Diabetes Guide– Be productive in the analysis phase– Interpret data with better understanding– Achieve credibility by using national measures
and AHRQ methods
Cabinet for Health and Family ServicesSlide #6
Data Sources
The Kentucky CHFS collects: • UB-92 inpatient records:
– 600,000 per year– All Kentucky hospitals
• Outpatient surgery records:– Hospital-based– Some ambulatory surgery centers
• Public Health Data – BRFSS, Vital Statistics, etc.
• Medicaid & State employee claims
• Procedures & Diagnoses
• Volume• Length of stay• Charges • HCUP Partner
Cabinet for Health and Family ServicesSlide #7
Quality Measures
• Non-proprietary consensus-based sources:• AHRQ: Agency for Healthcare Research and Quality• CMS: Centers for Medicare and Medicaid Services• Others (JCAHO, NQF, etc.)
• Measures being used now:• Prevention Quality Indicators• Inpatient Quality Indicators• Patient Safety Indicators• CMS Hospital Compare
AHRQ Quality Indicators
Cabinet for Health and Family ServicesSlide #8
Kentucky and Health Status
• Kentucky: among worst health outcomes in US: – 2nd highest death and disability rates – 6th highest obesity prevalence
• Diabetes: – 7th highest adult diabetes prevalence– Some Eastern counties nearly double national
diabetes rates
Cabinet for Health and Family ServicesSlide #9
Percent of Population with Diabetes
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Kentucky Tennessee Missouri Alaska Utah Colorado Minnesota
Obtained from Diabetes Guide: KY Compared to Worst/Best-in-Class States
Cabinet for Health and Family ServicesSlide #10
Estimates of the Direct, Indirect and Total Cost (billions) Burden of Diabetes
$0.000
$1.000
$2.000
$3.000
$4.000
$5.000
$6.000
Indirect Cost
Direct Medical Costs
Obtained from the Diabetes Guide
Cabinet for Health and Family ServicesSlide #11
Hospital Admission Rates for Uncontrolled Diabetes, 2006
3.30 3.202.86 2.712.67
0.00
1.00
2.00
3.00
4.00
2002N=1022
2003N=1002
2004N=902
2005N=851
2006N=871
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
Cabinet for Health and Family ServicesSlide #12
Comparison of Hospital Admission Rates for Uncontrolled Diabetes for US, KY, and Best
Performing States*
US
, 2
5.4
US
, 2
3.8
Ke
ntu
cky, 3
2.8
Ke
ntu
cky, 3
1.7
Co
lora
do
, 5
.3
Co
lora
do
, 5
.8
Ore
go
n, 8
.3
Ore
go
n, 6
.4
Uta
h, 6
.5
Uta
h, 4
.2
Ve
rmo
nt, 6
.0
Ve
rmo
nt, 3
.3
Wa
sh
ing
ton
, 7
.5
Wa
sh
ing
ton
, 5
.9
0
5
10
15
20
25
30
35
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
Cabinet for Health and Family ServicesSlide #13
Hospital Admission Rates for Short-term Complications of Diabetes, 2006
6.26.66.3
6.46.1
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
2002N=1887
2003N=2018
2004N=1995
2005N=2092
2006N=1997
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
Cabinet for Health and Family ServicesSlide #14
Hospital Admission Rates for Long-term Complications of Diabetes, 2006
12.012.412.312.512.7
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
2002N=3924
2003N=3909
2004N=3882
2005N=3948
2006N=3846
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
Cabinet for Health and Family ServicesSlide #15
Comparison of Hospital Admission Rates for Short-term Complication of Diabetes for US, KY, and
Best Performing States*U
S, 5
0.9
US
, 51
.1
Ke
ntu
cky,
61
.0
Ke
ntu
cky,
64
.6
Ha
wa
ii, 3
1.6
Ha
wa
ii, 3
6.6
Min
nesota
, 34.0
Min
nesota
, 35.8
Ne
bra
ska
, 36
.0
Ne
bra
ska
, 38
.1
Ore
go
n, 4
0.4
Ore
go
n, 3
7.8
Verm
ont, 3
1.0
Verm
ont, 3
0.1
Wa
shin
gto
n, 3
9.3
Wa
shin
gto
n, 4
0.2
0
10
20
30
40
50
60
70
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
Cabinet for Health and Family ServicesSlide #16
Comparison of Hospital Admission Rates for Long-term Complication of Diabetes for US, KY, and Best
Performing States*
US
, 11
3.8
US
, 11
5.4
Ke
ntu
cky,
12
5.9
Ke
ntu
cky,
12
3.2
Co
lora
do
, 81
.7
Co
lora
do
, 69
.6
Iow
a, 7
8.0
Iow
a, 7
8.6
Ne
bra
ska
, 79
.5
Ne
bra
ska
, 69
.3
Ore
go
n, 7
4.7
Ore
go
n, 7
0.2
Uta
h, 7
1.2
Uta
h, 7
0.3
Ver
mon
t, 6
4.0
Ver
mon
t, 6
1.2
Washin
gto
n,
66.9
Washin
gto
n,
67.2
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
Cabinet for Health and Family ServicesSlide #17
GIS Mapping: Using HCUP Data
& AHRQ Mapping Software
County-Level Quality Improvement Data
Cabinet for Health and Family ServicesSlide #18
Louisville
Frankfort Lexington
Cabinet for Health and Family ServicesSlide #19
Cabinet for Health and Family ServicesSlide #20
Cabinet for Health and Family ServicesSlide #21
Cabinet for Health and Family ServicesSlide #22
Percent of Adults (in 2001) who received:
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
HbA1c testing Retinal eyeexamination
Foot examination Flu vaccination
Kentucky
National Average
Best-in-Class Average
Healthy People 2010 Goal
Target areas
New Display Using Diabetes Guide Data
Source: BRFSS & Diabetes Guide
Cabinet for Health and Family ServicesSlide #23
Conclusion
• Governor committed to transparency efforts
• Transparency (Data & Measurement) is first step to quality improvement
• Diabetes Guide critical tool for how best to present our data
• KY must take more steps to facilitate quality improvement
• The Guides give us credibility in our QI efforts
Cabinet for Health and Family ServicesSlide #24
Contact Information
“I’m sorry I couldn’t be with you.”
-Trudi Matthews
tlmatthews@juno.com
859-333-8067 (cell)
Cabinet for Health and Family ServicesSlide #25
For Policy Discussion Roundtable: States Involved in AHRQ Activities on Asthma
• Learning Partnership – Disparities in Pediatric Asthma – Pilot testing state-led model: AZ, MD, MI, NJ, OR, RI– Activities with States:
• Learning institutes• Planning support• Technical assistance (e.g., Cultural competency training)
• Specific Examples:– Michigan Asthma Coalition:
• Trained on asthma disparities ; collecting data on children’s disparities • Stimulated asthma ROI calculator -- decision on county program
– Oregon: • Used GIS mapping to target high prevalence counties to reduce
asthma disparities among low-income children (for telemedicine?)– Rhode Island
• Rhode Island Healthy Homes: Developed assessment tool to identify children with asthma in low-income housing (w/ housing authority) & refer to community health centers and DOH)
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