Input Your Data--Output Your Web site: A Web-Based Tool for Quality and Utilization Reporting

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Anne Elixhauser, Mamatha Pancholi, and Jenny Schnaier made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (5.7 MB; Plugin Software Help).

Slide 1

Input Your Data—Output Your Web site: A Web-Based Tool for Quality and Utilization Reporting

Anne Elixhauser
Mamatha Pancholi
Jenny Schnaier

September 2008

Slide 2

Development Team

Leveraging the Expertise of Four Organizations

• AHRQ (logo only).
• Battelle: The Business of Innovation:
  • Convert existing WinQI Wizard.
  • Produce Quality Indicators (QIs).
  • Adapt Personalized Health Care (PHC) mapping tool.
  • Test the tool.
• Social & Scientific Systems, Inc., an employee-owned company:
  • Produce HCUPnet-like utilization queries.
  • Test the tool.
• Thomson Reuters:
  • Lead Web development and presentation.
  • Coordinate design efforts.
  • Test the tool.

Slide 3

Outline

The Efficiency and Quality Improvement Portal (EQUIP)

• What is EQUIP?
• Why is it important?
• Who is the audience?
• How will EQUIP work?
• When will it be deployed?

Slide 4

What: The Concept

A Web-based tool that provides local information on health care use, costs, volume, and quality.

• AHRQ creates and distributes software programs to generate Web-based query system, which leads to:
• Local organizations use programs to host a Web-based query system, which leads to:
• Local users access the Web-based query system to obtain health care information.

The big question was: is this feasible?

Note: Project presented and approved as part of Value Portfolio Supports Chartered Value Exchanges (CVEs).

Slide 5

Why: Rationale

Consumers need health care information to make informed choices.

• "What hospitals in my area perform heart surgery?"
• "How many bypass procedures are performed at hospital x versus hospital y?"
• "What is the quality of care for cardiac procedures at hospitals in my area?"
• "I don't have insurance, how much should I expect to pay?"

Currently, there is very limited health care data available to answer such questions.

Slide 6

Rationale

State/local organizations have resource limitations:

• Unable to develop comprehensive reporting system.
• AHRQ can provide support for these organizations.

Slide 7

HHS & AHRQ Missions

Logo for the Department of Health and Human Services (HHS), U.S.A.

Department of Health and Human Services Mission:
Protecting the health of all Americans and providing essential human services, specially for those who are least able to help themselves.

Logo for the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality Mission:
Improving the quality, safety, efficiency, and effectiveness of health care for all Americans.

Slide 8

From Data to Information to Action

• Hospital discharge data are already being collected.
• Hospital discharge data can generate valuable healthcare information.
• Consumers can use this information to make decisions.

Slide 9

Who: Two User Groups—Host and End User

Host: Organization Building the Web site

• State and local data organizations.
• Chartered Value Exchanges.
• Hospitals.
• Anyone with access to provider-level data.

End Users: People Using the Web site

• Consumers.
• Health Planners.
• Policy Makers.
• Media.
• Data Analysts/Researchers.

Multiple audiences but Consumers are the principal audience.

Slide 10

How: The Making of EQUIP...

The flowchart shows the process of creating EQUIP code.

• Step 1. Storyboard.
• Step 2. Iterative rapid development.
• Step 3. Continuous "Alpha" testing.
• Step 4. Beta Test: Larger number of testers.
• Step 5. EQUIP code.

Slide 11

Local EQUIP Web site

1. EQUIP code will be distributed to organizations that have access to hospital discharge data.
2. Host organization will implement code and load discharge data to create local EQUIP Web site on their own servers.
3. End users will access the EQUIP Web site to run queries about healthcare utilization, cost, and quality for local hospitals and areas.

Slide 12

General Considerations as Development Proceeds

Using a Smart Development and Design Approach

Slide 13

Customizable Features

• Modular:
  • User can choose which pieces to implement.
• Generate user-defined reports.
• Create maps of various measures.
• Drill down on specific issues by patient and area characteristics.
• Customizable Interface:
  • Users can insert their logo and organization name.

Slide 14

The Model: HCUPnet Quick, Free Access to Data

Screen shot of the homepage from the HCUPnet Web site.

Slide 15

AHRQ Quality Indicators

Three screen shots of AHRQ QI pages: "Guide to Inpatient Quality Indicators," "Guide to Prevention Quality Indicators," and "Guide to Patient Safety Indicators" are presented along with a sample AHRQ QI Fact Sheet entitled, "Pediatric Quality Indicators."

http://www.qualityindicators.ahrq.gov/

Slide 16

EQUIP = HCUPnet + QI + More

On the left side there is a small screen shot of the homepage from the HCUPnet Web site and underneath it is labeled: "Query Paths, Output Tables, Interface, Help and Definitions."

On the right side there is a small screen shot of the three QI pages and fact sheet and underneath it is labeled: "WinQI Tool, AHRQ QI Measures, Reporting Template, Mapping Tool."

Slide 17

A Brief Technical Overview

Screen shot of a diagram showing the process of the EQUIP Site Builder.

EQUIP Site Builder ("Wizard"): Moves host user through the process:

• Raw data from user.
• Programs that load data, map values, transform data, and build data cubes.
• SQL Server Database stores: Meta-data, transformed data, and data cubes:
  • Census data.
  • Comparison data.
  • Labels.
• Page writers, Graphics generators (for Utilization and QI data).
• Web System: Context and navigation page writers, Script writers & cascading style sheet writers.
• Web site query interface seen by end user:
  • HTML and .JPGs for QIs and Utilization information.
  • Navigation.
  • Formats.

Slide 18

EQUIP Paths

Three Paths

1. Utilization: Health Conditions and Procedures
   View information on patient conditions across hospitals, for a specific hospital, or across geographic areas.
2. Rates: Health Conditions and Procedures
   View statistics on the rates of hospitalizations for specific health conditions and procedures for geographic areas.
3. Quality Indicators for Hospitals and Areas
   View measures of quality for hospitals or areas based on the AHRQ Quality Indicators.

Slide 19

Three Paths: Example Questions They Will Answer

1. Utilization: Health Conditions and Procedures:
   • How many C-sections were performed at area hospitals?
   • What was the average charge?
   • How long do patients usually stay in this hospital for C-sections?
2. Rates: Health Conditions and Procedures:
   • What is the volume of coronary artery bypass graft (CABG) in this area?
   • What is the rate of pneumonia hospitalizations in this region?
   • What is the rate of blood transfusions in the state?
3. Quality Indicators for Hospitals and Areas:
   • How does the death rate for heart attack patients compare across four hospitals close to my home?
   • What is the rate of obstetric tearing after vaginal delivery in two hospitals close to my home?

Slide 20

A Peek at EQUIP—How will it work?

• The host user (e.g., local/State organization, an individual hospital) will download the AHRQ EQUIP Tool and generate a Web site.
• The end user (e.g., health consumers, analysts) will access the Web site created by the host user to obtain health care data.

Note: Example screen shots follow...

Slide 21

A Peek at EQUIP—A Working Draft: What the Host Sees

A screen shot of the "Quality Indicators Wizard" page from the EQUIP Site Builder.

To the right of the screen shot is the text:

• This tool is the existing AHRQ Quality Indicators Wizard.
• Is being expanded to build EQUIP.
• Import Data Wizard—initial screen.

Slide 22

Host User EQUIP Tool: Select File

A screen shot of the "Select Input File" page from the EQUIP Site Builder.

To the right of the screen shot is the text: Select input file

Slide 23

Host User EQUIP Tool: Load and Map Data

A screen shot of the "Input File Options" page from the EQUIP Site Builder. To the right of the screen shot is the text:

Select options for loading and mapping data.
This file stores all of the mappings for future use.

Slide 24

Host User EQUIP Tool: Map Data

A screen shot of the "Data Mapping" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Map input file variables to variables used by software."

Slide 25

Host User EQUIP Tool: Variable Summary

A screen shot of the "Mapping Quick Check" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Summary of variables."

Slide 26

Host User EQUIP Tool: Errors Checking

A screen shot of the "Data Errors Report" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Scan file and report errors."

Slide 27

Host User EQUIP Tool: Crosswalk

A screen shot of the "Crosswalk" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Map the values from the input data to standard values required by EQUIP."

Slide 28

Host User EQUIP Tool: SQL Server

A screen shot of the "Load Data" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Data are loaded into an SQL Server."

Slide 29

Host User EQUIP Tool: Summary Report

A screen shot of the "Data Load Summary" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Summary report."

Slide 30

Host User EQUIP Tool: Data Cubes

A screen shot of the "Generating Indicator Flags" page from the EQUIP Site Builder. To the right of the screen shot is the text: "Create data cubes."

Slide 31

End User Web site Interface

Repeat of a diagram showing the process of the EQUIP Site Builder (Slide 17) with the "Web site query interface seen by end user" text box highlighted.

Slide 32

A Peek at EQUIP—A Working Draft: What the End User Sees

A screen shot of the homepage that the end user would see.

To the right of the screen shot is the text: Select 1 of 3 Paths:

• Utilization
• Rates
• Quality Indicators

Slide 33

Utilization Path: Select Health Condition

A screen shot of the "Medical Specialty or Condition" page. To the right of the screen shot is the text:

Select to view data by service line or by health condition/procedure (DRG).
Allows easy access to the data through "view data now" feature.

Slide 34

Utilization Path: Select Hospital or Area

A screen shot of the "Hospital Selection" page. To the right of the screen shot is the text:

Select a specific hospital or an area.
Allows easy access to the data through "view data now" feature.
Allows download to Microsoft Excel of summary tables.

Slide 35

Utilization Path: Data by Diagnosis Related Group (DRG)

A screen shot of a page showing data by DRG. This particular one shows a table labeled "Statistics by Diagnosis Related Group."

An arrow from the text "Drill down for more information on a specific condition/procedure" points down to the column:

• Diagnosis Related Group: All conditions (i.e., normal newborn, vaginal delivery w/o complicating diagnoses, heart failure & shock, chest pain, psychoses, etc.)

Arrows from the text "Sort data by any of these columns" points down to the two following columns:

• Mean costs in dollars.
• Percent admitted through E.D.

Slide 36

Utilization Path: Drill Down to a Specific DRG

A screen shot of a specific DRG page. This particular one shows the "Statistics for 391 Normal Newborn (DRG 391)." An arrow points down the column entitled: "Detailed patient and payer characteristics for newborn hospital stays."

Slide 37

Utilization Path: Data for a Specific Hospital

A screen shot of a page containing data for a specific hospital. This particular one shows the "Statistics for Palisades Medical Center for All Patients.."

Slide 38

Utilization Path: Data for Hospitals in a Geographic Area

A screen shot of a page containing data for hospitals in a geographic area. This particular one shows the "Statistics for Newark Hospitals for 371 Cesarean Section w/o CC (DRG 371)." An arrow from the text "Hospitals grouped by Hospital Service Area (Dartmouth Atlas)" points down to the column labeled "Newark Hospitals."

Slide 39

Quality Path

Screen shots of three QI title pages and fact sheet and the homepage that the end user sees.

Note: A red arrow points from the screen shot of the three QI pages and fact sheet to the link for "Quality Indicators for Hospitals and Geographic Areas" on the homepage.

Slide 40

Quality Path: Consumer Report versus Detailed Statistics

A screen shot of the "Quality Indicators" page. To the right of the screen shot is the following text:

Two options:

Interested in

1. The report for consumers, or
2. Detailed quality statistics?

Allows user to download detailed data to Excel.

Slide 41

Quality Path: Health Topics

A screen shot of the "Health Topics" page showing Step 1: "Getting Started." To the right of the screen shot is the text:

Select one of ten quality health care topics:

1. Heart conditions.
2. Brain and nervous system.
3. Childbirth.
4. Hip replacement and hip fracture.
5. Operations for cancer of the esophagus and pancreas.
6. Other surgeries.
7. Other health conditions.
8. Medical complications of patients having an operation.
9. Medical complications of all patients.
10. Medical care for children.

Slide 42

Quality Path: Indicators

A screen shot of the "Indicators" page "Step 2: Quality of care for heart conditions." To the right of the screen shot is the text:

Select all indicators within a topic or specific indicators that comprise the topic.

Slide 43

Quality Path: Hospitals

A screen shot of the "Hospitals" page "Step 3: Choose hospitals to compare." To the right of the screen shot is the text:

Select a specific hospital or up to four hospitals in an area.

Allows easy access to the data through "view data now" feature.

Allows download to Microsoft Excel of summary tables.

Slide 44

Quality Path: Comparing QI Measures Across Four Hospitals

A screen shot of a page explaining how to compare hospital scores.

Slide 45

Preventable Hospitalization Costs Mapping Tool

A drawn map of California which shows the existing counties and their RA rate per 10,000 people for "Uncontrolled Diabetes Admission (2001, PQI14)." (Counties are color coded by rate.) There is a text box with the following text overlaid over the map:

Better understand geographical patterns of hospital admission rates.
Calculate potential cost savings if admission rates are reduced.

Slide 46

Output: Excel Spreadsheet with Cost Savings Estimate

A sample Excel spreadsheet showing cost savings estimates. The following features are highlighted:

• QI Name.
• County name, mean cost of admission for indicator, number of cases, and total cost.
• Potential cost savings if number of admissions were reduced by specified percentage.

Slide 47

The Last Path: Utilization Rates Path

A screen shot of the homepage with a red arrow pointing to the link for "Rates of Health Conditions and Procedures.." The following text points to the screen shot:

Utilization and QI Paths are under active development.

A third path, the Rates Path, is being designed.

Slide 48

WHEN: Timeline—9 months from Concept to Product

Screen shot of a timeline which shows:

• April 2008: Concept
• July 2008: First Build
• July-Dec. 2008: Continuous Builds
• January 2009: Beta Test

Note: Within the timeline is a dotted arrow showing Incremental Builds from July 2008 to January 2009

Incremental build throughout Summer and Fall using an iterative rapid application development methodology.

Target Completion Date of Phase 1: January 30, 2009.

Slide 49

Challenges

• Aggressive timeline.
• Variety of users will want to use the system:
  • Different system capabilities.
  • Different resource availability.
  • System needs to have minimum requirements.
  • Need to keep the cost of implementation low.
• Limited nature of static model versus dynamic model.

Slide 50

Phase 1 versus Subsequent Phases

EQUIP is an evolving tool—the current version is a prototype.

Phase 1

• 3 Paths:
  • Utilization
  • Rates
  • Quality
• Mapping capability
• National and regional benchmarks
• Static design

Subsequent Phases

• Additional Paths:
  • Hospital Compare
  • HCAHPS
• Evaluate other data sources.
• Provide links to other resources.
• Dynamic design:
  • Consider adding other federal data sources.
• Many more ideas... will also solicit user suggestions.

Slide 51

What makes EQUIP unique?

Empowers organizations and consumers to use data to make informed decisions

• Provides organizations with the ability to create/host their own Web site and upload their own data.
• Enables local organizations to do their own reporting using a standard, validated method.
• Allows users to draw together multiple data sources that provide information at the local level.

Slide 52

Questions?
Comments?
Suggestions?