Session 3C:Session 3C:Overview of the AHRQ Quality Overview of the AHRQ Quality

IndicatorsIndicators

Thursday, September 27, 2007Thursday, September 27, 2007

3:30 pm to 5:00 pm ET 3:30 pm to 5:00 pm ET

Session OverviewSession Overview

Research, rational and processes used to Research, rational and processes used to develop indicatorsdevelop indicators– Development Process: Neonatal, Patrick RomanoDevelopment Process: Neonatal, Patrick Romano– Establishing the Validity of the AHRQ QI/NQF Establishing the Validity of the AHRQ QI/NQF

process, Pat Zrelakprocess, Pat Zrelak

Tools for the interpretation and useTools for the interpretation and use– QI Mapping Tool, Melanie ChanskyQI Mapping Tool, Melanie Chansky– Use of the QI’s, Jeff GeppertUse of the QI’s, Jeff Geppert

Information on how ICD-9 coding practices Information on how ICD-9 coding practices impacts the indicatorsimpacts the indicators– Expectations of next release, Sheryl DaviesExpectations of next release, Sheryl Davies

AHRQ Quality IndicatorsAHRQ Quality Indicators

Provides a tool utilizing data collected Provides a tool utilizing data collected routinely in the delivery of hospital care to:routinely in the delivery of hospital care to:– identify potential quality concernsidentify potential quality concerns– identify areas that need further study and identify areas that need further study and

investigationinvestigation– track changes over timetrack changes over time

Facilitate decision making by federal, state Facilitate decision making by federal, state and local policy makers; healthcare leaders; and local policy makers; healthcare leaders; clinicians; etc. clinicians; etc.

Variety of usesVariety of uses Maximizes existing resourcesMaximizes existing resources

Structure of AHRQ QIStructure of AHRQ QI

Definitions based onDefinitions based on– ICD-9-CM diagnosis and procedure codes ICD-9-CM diagnosis and procedure codes – Often along with DRG, MDC, sex, age, procedure dates, Often along with DRG, MDC, sex, age, procedure dates,

admission type, admission source, discharge dispositionadmission type, admission source, discharge disposition Numerator is the number of cases “flagged” with the outcome Numerator is the number of cases “flagged” with the outcome

of interest of interest Denominator is the population at risk Denominator is the population at risk The observed rate is numerator / denominatorThe observed rate is numerator / denominator Volume counts for selected proceduresVolume counts for selected procedures

Four QI ModulesFour QI Modules

Prevention Quality Indicators (PQI)Prevention Quality Indicators (PQI)– Identify “ambulatory care sensitive Identify “ambulatory care sensitive

conditions” (ACSCs) in adult populationsconditions” (ACSCs) in adult populations good outpatient care can potentially prevent good outpatient care can potentially prevent

the need for hospitalizationthe need for hospitalization early intervention can prevent complications or early intervention can prevent complications or

more severe disease more severe disease

Prevention Quality Indicators Prevention Quality Indicators (PQI)(PQI)

Adult Asthma Adult Asthma Angina w/o ProcedureAngina w/o Procedure Bacterial PneumoniaBacterial Pneumonia Chronic Obstructive Chronic Obstructive

Pulmonary DiseasePulmonary Disease DehydrationDehydration Diabetes Short Term Diabetes Short Term

complicationscomplications Diabetes Long-term Diabetes Long-term

complicationscomplications

HypertensionHypertension Low Birth WeightLow Birth Weight Rate of Lower-Rate of Lower-

extremity Amputation extremity Amputation among people with among people with diabetesdiabetes

Perforated AppendixPerforated Appendix Urinary Tract InfectionUrinary Tract Infection Uncontrolled DiabetesUncontrolled Diabetes Congestive Heart Congestive Heart

FailureFailure

Inpatient Quality Indicators (IQI)Inpatient Quality Indicators (IQI)

Reflect quality of care inside hospitalsReflect quality of care inside hospitals Inpatient mortality for certain procedures and Inpatient mortality for certain procedures and

medical conditionsmedical conditions Mortality varies for procedure or condition across Mortality varies for procedure or condition across

institutionsinstitutions Evidence that high mortality may be associated with Evidence that high mortality may be associated with

deficiencies in qualitydeficiencies in quality

IQI Mortality Indicators for Inpatient IQI Mortality Indicators for Inpatient Procedures and ConditionsProcedures and Conditions

ProceduresProcedures– Abdominal Aortic Abdominal Aortic

AneurysmAneurysm– Esophageal ResectionEsophageal Resection– Coronary Artery Bypass Coronary Artery Bypass

Graft Graft – Carotid EndarterectomyCarotid Endarterectomy– CraniotomyCraniotomy– Pancreatic ResectionPancreatic Resection– Hip ReplacementHip Replacement– PTCAPTCA

ConditionsConditions– Acute Myocardial Acute Myocardial

Infarction (AMI)Infarction (AMI)– AMI, without transfer AMI, without transfer

casescases– Congestive Heart Congestive Heart

FailureFailure– Acute Stroke Acute Stroke

MortalityMortality– Gastrointestinal Gastrointestinal

HemorrhageHemorrhage– Hip FractureHip Fracture– PneumoniaPneumonia

IQIsIQIs

Utilization of procedures Utilization of procedures – Examines procedures with varying use across Examines procedures with varying use across

hospitalshospitals– Potential overuse, underuse or misusePotential overuse, underuse or misuse

IndicatorsIndicators Bilateral Cardiac Catheterization RateBilateral Cardiac Catheterization Rate Cesarean Delivery RateCesarean Delivery Rate Incidental Appendectomy in the Elderly RateIncidental Appendectomy in the Elderly Rate Laparoscopic Cholecystectomy RateLaparoscopic Cholecystectomy Rate Primary Cesarean Delivery RatePrimary Cesarean Delivery Rate Vaginal birth after Cesarean Rate (VBAC)Vaginal birth after Cesarean Rate (VBAC) VBAC rate, uncomplicatedVBAC rate, uncomplicated

IQIsIQIs

Area-level UtilizationArea-level Utilization– Reflect the rate of hospitalization in the Reflect the rate of hospitalization in the

area for specific proceduresarea for specific procedures– Use age and gender adjusted population-Use age and gender adjusted population-

based denominatorbased denominator

IndicatorsIndicators Coronary artery bypass graft (CABG) rateCoronary artery bypass graft (CABG) rate Hysterectomy rateHysterectomy rate Laminectomy or spinal fusion rateLaminectomy or spinal fusion rate PTCA area ratePTCA area rate

IQIsIQIs

Volume of procedures Volume of procedures – Indirect measures of qualityIndirect measures of quality– Counts of admissionsCounts of admissions– Evidence suggesting that hospitals that perform Evidence suggesting that hospitals that perform

more of an intensive, complex procedure have more of an intensive, complex procedure have better outcomesbetter outcomes

IndicatorsIndicators Abdominal Aortic Aneurysm RepairAbdominal Aortic Aneurysm Repair Carotid Endarterectomy Carotid Endarterectomy Coronary Artery Bypass GraftCoronary Artery Bypass Graft Esophageal ResectionEsophageal Resection Pancreatic ResectionPancreatic Resection Percutaneous Transluminal CoronaryPercutaneous Transluminal Coronary Angioplasty (PTCA)Angioplasty (PTCA)

Patient Safety Indicators (PSI)Patient Safety Indicators (PSI)

Identify adverse events that patients Identify adverse events that patients experience as a result of exposure to the experience as a result of exposure to the health care systemhealth care system

These events are likely amenable to These events are likely amenable to prevention by changes at the system or prevention by changes at the system or provider level.provider level.

Area Level PSIArea Level PSI

Cases of potentially preventable complications Cases of potentially preventable complications that occur in given area either during that occur in given area either during hospitalization or resulting in subsequent hospitalization or resulting in subsequent hospitalizationhospitalization

IndicatorsIndicators– Accidental Puncture or LacerationAccidental Puncture or Laceration– Foreign Body Left in During a ProcedureForeign Body Left in During a Procedure– Iatrogenic PneumothoraxIatrogenic Pneumothorax– Postoperative Hemorrhage and HematomaPostoperative Hemorrhage and Hematoma– Postoperative Wound DehiscencePostoperative Wound Dehiscence– Selected Infections Due to Medical CareSelected Infections Due to Medical Care– Transfusion ReactionTransfusion Reaction

Provider-Level PSIProvider-Level PSI

Accidental puncture or LacerationAccidental puncture or Laceration Birth Trauma-Injury to neonateBirth Trauma-Injury to neonate Complications of anesthesiaComplications of anesthesia Death in low-mortlaity DRG’sDeath in low-mortlaity DRG’s Decubitus UlcerDecubitus Ulcer Failure to RescueFailure to Rescue Foreign body left during procedureForeign body left during procedure Iatrogenic pneumothoraxIatrogenic pneumothorax Obstetric Trauma-Vaginal with and Obstetric Trauma-Vaginal with and

without instrumentwithout instrument Obstetric Trauma-Cesarean deliveryObstetric Trauma-Cesarean delivery

Postoperative Hip FracturePostoperative Hip Fracture Postoperative Hemorrhage and Postoperative Hemorrhage and

HematomaHematoma Postoperative Physiological and Postoperative Physiological and

Metabolic DerangementsMetabolic Derangements Postoperative Pulmonary Embolism Postoperative Pulmonary Embolism

or Deep Vein Thrombosisor Deep Vein Thrombosis Postoperative SepsisPostoperative Sepsis Postoperative Wound DehiscencePostoperative Wound Dehiscence Selected Infections Due to Medical Selected Infections Due to Medical

CareCare Transfusion ReactionTransfusion Reaction

Measure of potentially preventable complication for Measure of potentially preventable complication for patients who received their initial care and the patients who received their initial care and the complication of care within the same hospitalizationcomplication of care within the same hospitalization Include only cases where a secondary diagnosis code Include only cases where a secondary diagnosis code flags a potentially preventable complicationflags a potentially preventable complication

Pediatric Quality Indicators (PDI)Pediatric Quality Indicators (PDI)

Identify potentially preventable complications Identify potentially preventable complications tailored for the pediatric population tailored for the pediatric population – Age under 18Age under 18– Not in MDC 14 (Pregnancy, Childbirth and the Not in MDC 14 (Pregnancy, Childbirth and the

Puerperium)Puerperium)– Not in Adult Diagnostic Related GroupsNot in Adult Diagnostic Related Groups

Provider Level and Area-Level Provider Level and Area-Level IndicatorsIndicators

Provider LevelProvider Level– Accidental Puncture and LacerationAccidental Puncture and Laceration– Decubitus UlcerDecubitus Ulcer– Foreign Body Left During procedureForeign Body Left During procedure– Iatrogenic pneumothorax in neonate Iatrogenic pneumothorax in neonate – and non-neonateand non-neonate– Pediatric heart surgery mortalityPediatric heart surgery mortality– Pediatric heart surgery volumePediatric heart surgery volume– Postoperative hemorrhage & hematomaPostoperative hemorrhage & hematoma– Postoperative respiratory failurePostoperative respiratory failure– Postoperative sepsisPostoperative sepsis– Postoperative wound dehiscencePostoperative wound dehiscence– Selected Infections due to medical careSelected Infections due to medical care– Transfusion reactionTransfusion reaction

Area LevelArea Level– Asthma Admission RateAsthma Admission Rate– Diabetes Short-term Diabetes Short-term

ComplicationsComplications– Gastroenteritis AdmissionGastroenteritis Admission– Perforated Appendix Perforated Appendix

AdmissionAdmission– Urinary Tract InfectionUrinary Tract Infection

AHRQ QI User Support ResourcesAHRQ QI User Support Resources

Electronic NewsletterElectronic Newsletter

QI ListservQI Listserv

www.qualityindicators.ahrq.gov/signup.htmwww.qualityindicators.ahrq.gov/signup.htm QI Support Web Site QI Support Web Site

www.qualityindicators.ahrq.govwww.qualityindicators.ahrq.gov Support Email Support Email

support@qualityindicators.ahrq.govsupport@qualityindicators.ahrq.gov Support Telephone (voicemail) Support Telephone (voicemail)

(888) 512-6090(888) 512-6090