transparency for quality improvement efforts at the kentucky cabinet for health and family services...

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.


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/


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


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


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


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


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


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


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


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


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



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



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




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




GIS Mapping: Using HCUP Data

& AHRQ Mapping Software

County-Level Quality Improvement Data


Louisville

Frankfort Lexington


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


Source: BRFSS & Diabetes Guide


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


Contact Information

“I’m sorry I couldn’t be with you.”

-Trudi Matthews

[email protected]

859-333-8067 (cell)


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)

transparency for quality improvement efforts at the kentucky cabinet for health and family services...

Documents

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ahrq diabetes guide

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napercent kentucky

quality http

kentucky cabinet

diabetes guidebe productive

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