Using AHRQ Composites (Text Version)

AHRQ 2008 Annual Conference

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, AHRQ Speakers, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (556 KB; Plugin Software Help).

Slide 1

Using Agency for Healthcare Research Quality (AHRQ) Quality Indicator (QI) Composites

• AHRQ Annual Conference 2008.

Slide 2

What is a composite?

• Composite measures are combinations of two or more components measures.
• Component measures may be outcome (mortality, morbidity, proxy), process, structure, patient experience, cost or conjunctive (and/or) combinations of each other.

Slide 3

Purpose of a composite

• Advantages of a composite:
  • Improved statistical precision through increasing the effective sample size.
  • Simultaneous consideration of more than one component measure.
    • Optimal when more then one component is important.
    • Do not know in advance which component is most important.

Slide 4

Purpose of a composite

• Two mechanisms of performance improvement to achieve the goal of the composite (e.g. reduce post-operative mortality, adverse events, etc.):
  • Reward effort.
    • Quality improvement, pay-for-performance.
  • Recognize ability.
    • Comparative reporting, selective contracting.

Slide 5

AHRQ QI Composites

• Four composite measures:
  • Mortality for selected procedures.
  • Mortality for selected conditions.
  • Patient safety for selected indicators.
  • Pediatric patient safety for selected indicators.
• Developed with the composite workgroup:
  • Reports available on AHRQ QI Web site.

Slide 6

AHRQ QI Composites

• Common methodology:
  • The scale is a reliability-adjusted observed-to-expected ratio.
  • The aggregation approach is a weighted average of these ratios.
  • The weights are user defined, but generally the proportion of numerator events.
  • Overall or for specific populations.

Slide 7

National Quality Forum (NQF)

• Composite Measure Evaluation Framework.
  • NQF Member comments due September 11, 2008, by 6:00 PM ET.
• Importance, scientific acceptability, usability, feasibility.
  • Components NQF-endorsed or assessed to have met the individual measure criteria.

Slide 8

Public Reporting and PPV

• Table shows:
  • Hospital—Patients—Rate—Events.
  • A—1,000—0.050—50.0
  • B—1,000—0.025—25.0
  • Total—2,000—(blank)—75.0

Slide 9

Public Reporting and PPV

• Table shows:
  • Hospital—Patients—Rate—PPV—Events.
  • A—1,000—0.050—0.500—25.0—25.0
  • B—1,000—0.025—0.500—12.5—12.5
  • Total—2,000—(blank)—(blank)—37.5

Slide 10

Public Reporting and Positive Predictive Value (PPV)

• Bar graph shows "Variance in PPV" (percentages here are approximate based on where the tops of bars appear to be).
  • 0.20: 4%
  • 0.30: 13%
  • 0.40: 20%
  • 0.50: 26%
  • 0.60: 20%
  • 0.70: 13%
  • 0.80: 3%

Slide 11

Public Reporting and PPV

• Tables show:
  • Hospital—Patients—Rate—E(PPV)*—Events.
  • A—1,000—0.050—0.500—25.0
  • B—1,000—0.025—0.500—12.5
  • Total—2,000—(blank)—(blank)—37.5
  • Hospital—Patients—Rate—E(PPV)*—Events.
  • A—900—0.050—0.500—22.5
  • B—1,100—0.025—0.500—13.8
  • Total—2,000—(blank)—(blank)—36.3
  • With variance

Slide 12

Public Reporting and PPV

• How good is good enough?
• Goal of improving quality as measured by overall population outcomes.
• Demand elasticity:
  • Change in Q for change in signal.
• Provider rate and variance.
• Relationship between PPV and PPV variance.