Advancing Healthcare Quality in Iowa: Past, Present, and Future Perspectives

1. Iowa Healthcare Collaborative- Past, Present, and Future Use of AHRQ Quality IndicatorsLance Roberts2009 AHRQ Annual ConferenceSeptember 24, 2009 100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800 Office: 515.283.9330 • Fax: 515.698.5130 http://www.ihconlie.org

2. Past – Historical Perspective 2004 • Iowa Hospital Association (hospitals) and the Iowa Medical Society (doctors) form IHC • Cornerstones • Promote Responsible Public Reporting – “Iowa Report” • Supportive State Policy – IHA collects data, IHC research • Align and Equip Providers on Quality and Value • Engage the Community for Clinical Improvement • Raise the Standard of Care

3. Public Reporting Policy • Responsible Public Reporting Policy • Engage stakeholders – Data Committee • Importance to measure and report - (STEEEP), variation, or overall poor performance • Scientific acceptability of measure properties • NQF – endorsement • AHRQ Tiering • Usability – understandable, useful for decision making • Feasibility – data are readily available, low burden

4. Historical Perspective • 2005 Iowa Report • 10 AHRQ QIs – aggregate Iowa performance compared to US, Midwest, Low/High US states • 2008 Iowa Report • 16 Hospital-level and 18 aggregate QIs

5. Iowa Report – From Data/Measuresto Clinical Domains Provider-focused Public Report Clinical Category - Measures: Cardiovascular Conditions – Heart Attack Cardiovascular Conditions – Heart Failure Cardiovascular Conditions – Stroke Pneumonia Condition Hip Fracture Medical and Surgical – Patient Safety Postoperative Care Prevention of Blood Clots Prevention of Healthcare-Associated Infections Utilization Obstetric / Neonatal Care Pediatric – Patient Safety Patient Experience in Hospital – HCAHPS Survey Provider Private Report AHRQ Quality Indicators Clinical Category Clinical Category Clinical Category Data / Research Base AHRQ CMS Primary Sources Data Sources: HCUP - Nationwide Inpatient Sample (NIS), Iowa State Inpatient Databases (SID) CMS Hospital Compare – Hospital Quality Initiative Iowa Healthcare Collaborative - Primary Data Collection: Healthcare-Associated Infection (HAI) Prevention

6. AHRQ Quality Indicator

7. Private Hospital Reports –AHRQ Quality Indicators

8. Collaborative QualityImprovement Opportunities • Iowa Stakeholders • Maternal Birth-related Trauma • Multiple year underperformer • Research – Roberts, Ely, Ward; Factors Contributing to Maternal Birth-related Trauma, 2007 • Difficult to convene an Obstetrical Trauma Workgroup • Hospitals/Systems involved in QI – using hospital-level QI reports and our research

9. Collaborative QualityImprovement Opportunities • Iowa Stakeholders • Anesthesiologists • Another specialty interested in measurement and QI • PSI 1 Descriptive Statistics – 2002-2006 SID • Descriptive study of adverse events • E9386 – “Peripheral Nerve and Plexus Blocking Anesthetics” • Sharing list of NQF-endorsed anesthesia-related measures • Demotion of PSI 1 – Complications of Anesthesia

10. Collaborative Quality Improvement Opportunities Collaborative QualityImprovement Opportunities • Iowa Stakeholders • Emergency Care – Aortic Aneurysm/Dissection • Cardiologists • Reaction to media reports • Interest in comparative private/public reporting

11. What Does Future Look Like? • AHRQ’s Tools that May Assist Collaboratives / States • Consumer Reporting Tools - MONAHRQ • Pilot - Adding clinical data to administrative data • ER – PSIs, PQIs • Efficiency measures (potentially all-payer readmission) • Health Plan • Medicaid Home and Community- Based Services2007 State Snapshots: Methods. Derived from 2007 National Healthcare Quality Report. March 2008. Rockville, MD: Agency for Healthcare Research and Quality. http://statesnapshots.ahrq.gov/.

12. What Does Future Look Like? • Value – “Business Case” and “Value” of collaborative QI efforts • Working with AHRQ researchers and tools - Iowa SID, NIS, HCUP Cost-to-Charge Ratio files • Matching Software – match patients with adverse event to similar patients without • Are adverse events associated to excess …. • LOS ? From 2004 to 2007 – Avoided approx. 929 days • Mortality ? Avoided Approx. 10 – 16 deaths • Charges ? Avoided Approx. $3.9 million • Cost ? • How many events are Present on Admission (POA)?

13. AHRQ Support / Tools We Value • AHRQ QI Support • An efficient mode to receive help on use of tools • E.g. – PSI 3 - Decubitus Ulcer • AHRQ Quality Indicator Learning Institute (QILI) • An effective collaborative for AHRQ QI Users • Affected our Data Committee Policies • Tiering, NQF-endorsement, Coding issues, Validation • Included information in reports to Iowa legislature

14. How Else Can AHRQ Help? • Healthcare-Associated Infections – gaining a lot of attention • CAUTI • C-Diff - • Iowa trend is similar to National trend • potential 2008 attributable cost savings if Iowa C-Diff • reduced by 10% $1.5 - $2.2 Million • Iowa IP’s – use SID/NIS if possible!! • Research will help shape • Iowa Statewide HAI Plan Costs based on CDC Report: Scott, DR (CDC), The Direct Medical Costs of Hais in US Hospitalls and the Benefits of Prevention. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

15. How Else Can AHRQ Help? • Improve Documentation • Use of AHRQ Support Line may be reduced if documentation is improved • Continue AHRQ QILI • Focus on equipping users for responsible public reporting • Highlight/integrate other supportive tools – HCUP software, statistical briefs, State Snapshots, AHRQ HAI webpage

16. Thank You 100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1800 Office: 515.283.9330 • Fax: 515.698.5130 http://www.ihconlie.org