AHRQ Guide to Comparative Reporting (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Sheryl Davies, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (140 KB; Plugin Software Help).

Slide 1

AHRQ Quality Indicators (QI) Guide to Comparative Reporting

AHRQ Annual Conference
September 10, 2008
Bethesda, MD
Presented by Sheryl Davies.

Slide 2

Overview of document

• User tool to select indicators.
• Indicators assigned to four tiers based on evidence.
• Gaps assessed for the following areas:
  • Importance.
  • Face Validity.
  • Coding/Criterion Validity.
  • Risk Adjustment.

Slide 3

Survey of Evidence

• Literature:
  • Present on Admission (POA), coding validity, preventability, correlation with cost, length of stay (LOS) or other indicators, impact of QI programs.
• AHRQ Validation Activities:
  • Chart review of coding validity.
  • Clinical Panel Review.
• National Quality Forum review.
• Examination of potential improvements.

Slide 4

Tiers

• Tier 1: Minor or no evidence gaps.
  • 1B Serious reportable events.
• Most suitable for comparative reporting/public accountability.
• Strongest evidence base.
• Established evidence in several areas.
• No substantial evidence against use for comparative reporting.
• Most endorsed by the National Quality Forum.

Slide 5

Tiers

• Tier 2: Moderate evidence gaps.
• Users may choose to utilize these indicators for comparative reporting.
• Some supporting evidence for use.
• Some minor evidence gaps.
• Indicator would be stronger with some additional evidence.
• Most not currently endorsed by the National Quality Forum.

Slide 6

Tiers

• Tier 3: Significant, but addressable, evidence gaps.
• Not currently suitable for comparative reporting, pending further development.
• At least one serious evidence gap or concern.
• Further development and validation work has been identified.
• Once further work is completed, indicators will be re-assigned to another tier.
• Indicators not currently endorsed by NQF.

Slide 7

Tiers

• Tier 4: Significant evidence gaps.
• Substantial gaps in evidence for use in comparative reporting.
• Gaps unlikely to be addressed with further development or validation.
• Not recommended for comparative reporting.
• Indicators are not currently endorsed by NGF.

Slide 8

Tier 1 Indicators

• IQIs
  • Esophageal Resection Volume (#01)*
  • Pancreatic Resection Volume (#02)*
  • Abdominal Aortic Aneurysm (AAA) Repair Volume (#04)*
  • Esophageal Resection Mortality (#08)*
  • Pancreatic Resection Mortality (#09)*
  • Abdominal Aortic Aneurysm (AAA) Repair Mortality (#11)*
  • AMI Mortality (#15 and #32)
  • CHF Mortality (#16)*
  • Acute Stroke Mortality (#17)*
  • Hip Fracture Mortality (#19)*
  • Pneumonia Mortality (#20)*
  • Incidental Appendectomy in the Elderly (#24)*
  • Bi-lateral Catheterization (#25)*

• NQF endorsed.

Slide 9

Tier 1 Indicators

• Pediatric Quality Indicators (PDIs):
  • Accidental Puncture or Laceration (#01)*
  • Decubitus Ulcer (#02)*
  • Iatrogenic Pneumothorax (#05)*
  • Pediatric Heart Surgery Mortality (#06)*
  • Pediatric Heart Surgery Volume (#07)*
  • Postoperative Wound Dehiscence (#11)*
  • Blood Stream Infection in Neonates (#02)*
• Patient Safety Indicators (PSIs):
  • Death among Surgical Inpatients with Treatable Serious Complications (#04)*
  • Iatrogenic Pneumothorax (#06)*
  • Postoperative Hip Fracture (#08)
  • Postoperative Wound Dehiscence (#14)*
  • Accidental Puncture or Laceration (#15)*
  • Obstetrical (OB) Trauma with and without Instrument (#18 and #19)

Slide 10

Tier 1B Indicators

• PSIs:
  • Death in Low Mortality Diagnosis Related Groups (DRGs)*
  • Transfusion Reaction.
  • Foreign Body Left in During Procedure.
• PDIs:
  • Transfusion Reaction.
  • Foreign Body Left in During Procedure.

• NQF endorsed.

Slide 11

Tier 2 Indicators

• Inpatient Quality Indicators (IQIs):
  • Hip Replacement Mortality (#14).
• PDI:
  • Iatrogenic Pneumothorax in Neonates.
  • Postoperative Hemorrhage or Hematoma (#08).
  • Postoperative Respiratory Failure (#09).
  • Postoperative Sepsis (#10).
• PSI:
  • Postoperative Hemorrhage or Hematoma (#09).
  • Postoperative Physiologic and Metabolic Derangement (#10).
  • Postoperative Respiratory Failure (#11).
  • Postoperative Deep Vein Thrombosis or Pulmonary Embolism (DVT/PE) (#12)*
  • Postoperative Sepsis (#13).
  • Birth Trauma (#17)*

• NQF endorsed.

Slide 12

Tier 3 Indicators

• IQIs:
  • Coronary Artery Bypass Grafting (CABG) Mortality (#12).
  • Craniotomy Mortality (#13).
  • Gastrointestinal (GI) Hemorrhage Mortality (#18).
• PDIs/Neonatal Quality Indicators (NQIs):
  • Hospital Acquired Vascular Catheter Related Infections (#12).
  • Neonatal Mortality.
• PSIs:
  • Decubitus Ulcer (#03).
  • Hospital Acquired Vascular Catheter Related Infections (#07).

Slide 13

Tier 4 Indicators

• IQIs:
  • CABG Volume (#05).
  • Percutaneous Transluminal Coronary Angioplasty (PTCA) Volume (#06).
  • Carotid Endarterectomy Volume (#07).
  • Cesarean Delivery (#21 and #33).
  • Vaginal Birth After Cesarean (VBAC) Delivery (#22 and #34).
  • Laparoscopic Cholecystectomy (#23).
  • PTCA Mortality (#30).
  • Carotid Endarterectomy Mortality (#31).
• PSIs:
  • Complications of Anesthesia (#01).
  • OB Trauma-Cesarean Delivery (#20).

Slide 14

Applying Guidance to your Own Report

• Guidance document is a source of information, users need to weigh their own situation to select indicators.
• AHRQ QI Reporting Template.
• Know your purpose.
  • Tier 2 indicators may be more useful for some purposes than others.

Slide 15

Applying Guidance to Your Own Support: Data

• Know your data.
  • Potential data checks.
    • Rates and variation in POA.
    • Procedure dates, Elective vs. Non-elective, E-codes.
    • "Hospitals Like Mine" Tool—HCUPnet.
  • AHRQ Tools:
    • Medical record review.
      • Audit.
      • Individual hospitals.