Improve Patient Care and the Bottom Line with AHRQ QIs Hans Cassagnol, MD, Upstate University Hospital & Diane Stollenwerk, MPP, AHRQ QI Project Team July 9, 2018
Learning Objectives Gain insight from SUNY Upstate Medical hospital system, as they use AHRQ QIs to identify areas to improve and clinical actions that need investigation, then track the impact on patient care and the bottom line Explore how the AHRQ QIs are typically used in hospital and health system settings to inform quality improvement and promote evidencebased best practices to improve patient safety and health outcomes Learn about free tools from AHRQ that can be immediately used to transform raw hospital data into quality indicator results, then structure a multi-pronged quality program to engage clinicians and the C-suite 3
Agenda Our Approach Today Quick Overview of AHRQ QIs (5 minutes) Hans Cassagnol, MD SUNY Upstate University Hospital (15 minutes) Case Study Themes and Free Tools (10 minutes) Questions and Group Discussion (20 minutes) 4
AHRQ QI Modules Module: What the module reflects: Examples: Patient Safety Indicators (PSIs) Inpatient Quality Indicators (IQIs) Quality of hospital care for adults Focus on potentially avoidable complications and errors that occur during a hospital inpatient stay Quality of hospital care for adults Inpatient mortality for medical conditions Inpatient mortality for surgical procedures Utilization of procedures for which there are questions of overuse, underuse, or misuse Volume of procedures with evidence that higher hospital volume of procedures may be associated with lower mortality Pressure ulcers Postoperative sepsis Pneumonia mortality Bilateral cardiac catheterization Prevention Quality Indicators (PQIs) Pediatric Quality Indicators (PDIs) Includes neonatal development indicators, NQIs Hospitalization for ambulatory care sensitive conditions that reflect access to and quality of outpatient care Quality of hospital care for children 18 years and younger and neonates (NQIs) Potential complications and errors resulting from a hospital admission for children and adolescents Potentially avoidable hospitalizations among children 5 Asthma Low birth weight Neonatal mortality Postop. sepsis
Ensuring Quality of the Quality Indicators Annual updates to align with coding changes Rigorous testing with every annual update to assess reliability, validity, alignment with evolving evidence base National Quality Forum (NQF) endorsement for many AHRQ QIs Additional testing performed Extensive review of testing, feasibility, use Improvements to QIs driven by Testing User feedback NQF and other expert feedback Evolving evidence base 6
About Upstate University Hospital Upstate Medical University Upstate University Hospital Downtown Campus Upstate Golisano Children s Hospital Upstate Cancer Center Upstate University Hospital Community Campus University Hospital in Syracuse is part of SUNY Upstate Medical University and is the only academic medical center in Central New York. As a medical enterprise SUNY Upstate serves 1.8 million people, covering one-third of the state. University Hospital in Syracuse is the hub of SUNY Upstate s clinical activities. Half of the 10,000 SUNY Upstate employees are connected to clinical care. University Hospital s New York State Designated Centers include: University Hospital At a Glance Upstate Stroke Center Upstate Level 1 Trauma Center Clark Burn Center Upstate Designated AIDS Center New York State Designated SAFE site Upstate New York Poison Center 735 Licensed Inpatient Beds 77 Hospital-based Specialty Clinics 43 Medical Residency Programs Only Pediatric ICU and Emergency Dept 36,000 Inpatient Admissions 103,619 Emergency Dept Visits 365,050 Hospital Clinic Visits 12,642 Ambulatory Surgeries
Health System Quality s Goals Improve patient safety through implementation of PSI s Improve Upstate Medical University s ranking in the University Health Consortium Minimize/eliminate negative financial impact of quality indicators
Outcome vs. Structure/Process Module: Patient Safety Indicators (PSIs) Inpatient Quality Indicators (IQIs) What the module reflects Quality of hospital care for adults Focus on potentially avoidable complications and errors that occur during a hospital inpatient stay Quality of hospital care for adults Inpatient mortality for medical conditions Inpatient mortality for surgical procedures Utilization of procedures for which there are questions of overuse, underuse or misuse Volume of procedures with evidence that higher hospital volume of procedures may be associated with lower mortality
Champions and Core Teams Each PSI linked to a team o Physician Lead o Unit Manager / Director o Front Line Staff o IT / Abstractor Support o Data Analytic Support (Monthly Reports) o Monthly Leadership Conference Call o Specialty Specific Scorecards
Timely Reports and Feedback Clinical Documentation Efforts Coding Improvement around PSI s Champion / Team Review of PSI s o Opportunities for Improvement o Trending PSI s o Process Redesign Feedback to Providers and Teams
Upstate University Hospital Improvement Indicator Ending year 2015 Last 4 Quarters PSI 03: Pressure ulcer (O/E) 9.26 5.44 PSI 06: Iatrogenic pneumothorax (O/E) 1.41 0.69 PSI 09: Post operative hemorrhage or hematoma (O/E) 0.44 0.26 PSI 11: Post operative respiratory failure (O/E) 1.67 0.37 PSI 13: Post operative sepsis (O/E) 1.21 0.66 PSI 90: Patient safety for selected indicators composite (O/E 1.3 0.95 Surgical site infection (Colon) CMS SIR 2.26 1.29 Surgical site infection (Hysterectomy) CMS SIR 3 0.71 Surgical site infection (Hip) SIR 1.92 0.85 Rate hospital 0-10 (% 9-10) 63.00% 68.50%
Upstate University Hospital Financial Performance Program FFY 2018 (% earned) FFY 2019 (% earned) Value Based Purchasing (VBP) Program 78.2% 88.6% Excellus BlueCross BlueShield Health 97% 96% Insurance MVP Health Care n/a 100% Note: for Excellus and MVP, the data is reflective of calendar years 2016 and 2017
Themes from AHRQ QI Case Studies: Common Aspects of Hospital Use the AHRQ QIs Forming & Storming Use of AHRQ QIs Builds Trust in Evidence-Based Measurement Norming Improve Data and Clinical Documentation Improve Communication Across Clinical Team Performing Better Patient Safety & Health Outcomes Better Bottom Line Better Informed Clinicians
Examples of Impact: AHRQ QI Case Studies CHRISTUS Health In less than 2 years, reduced overall harm events by 22%, including 54% reduction in Central Venous Catheter-related Blood Stream Infections (PSIs 07) and 41% reduction in rates of postoperative respiratory failure (PSI 011) Cleveland Clinic In less than 5 years, moved results for accidental puncture or laceration (PSI 15) from the lowest quartile compared to peer institutions to the top quartile Essentia Health In less than 2 years, reduced the accidental puncture or laceration rate (PSI 15) from 1.2 events per 1000 to 0.07
Examples of Impact: AHRQ QI Case Studies Keck Medical Center of the University of Southern California In 2 years, improved results by 50% or more for 7 PSIs, including an 88% reduction in the occurrence of postoperative respiratory failure (PSI 11) University of Pittsburgh Medical Center Over 6 years, reduced the rate of accidental puncture or laceration (PSI 15) from 8.26 per 1,000 patients to just 1.56 per 1,000 patients Vanderbilt University Medical Center Improved overall performance on the PSIs by 28% Yale New Haven Health System In 2 years, reduced expense per equivalent discharge by 4.6%
AHRQ QI Case Studies Organization profile (location, number of facilities, clinical staff, etc.) Background How they use the AHRQ Quality Indicators What activities they engaged in to improve results Data and descriptions of results achieved Contact name for follow-up if interested To find them, search for AHRQ QI Case Studies or go to: http://www.qualityindicators.ahrq.gov/resources/case_studies.aspx
What Does the AHRQ QI Software Do? Readily available data: Hospital Administrative Data ICD9/ICD10 dx and procedure codes Present on admission flags MDC APR-DRGs Insight into Quality: Hospital -Safety -Mortality -Procedure volume Community -Access to care -Quality outpatient care SAS WinQI with SQL server QI Software Available Free of Charge at: http://www.qualityindicators.ahrq.gov/
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AHRQ QI Software 21
Implementation Guidance Use the AHRQ QI Toolkit Assess readiness to change Apply QIs to your data Detailed guidance Understand your rates Trends and comparisons Identify quality improvement priorities Implement improvements Monitor progress Analyze return-on-investment (ROI) Available at: http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html 22
Getting Started AHRQ QI website: www.qualityindicators.ahrq.gov Free software: www.qualityindicators.ahrq.gov/software FAQ, Support & Email Updates: www.qualityindicators.ahrq.gov/faqs_support Or send an email to: QIsupport@ahrq.hhs.gov Advancing Use AHRQ Hospital QI Toolkit: www.ahrq.gov/professionals/systems/hospital/qitoolkit Includes ROI tool List of NQF-Endorsed AHRQ QIs http://www.qualityindicators.ahrq.gov/modules/list_a hrq_qi.aspx Plus other resources including benchmark data tables and all technical specifications 23
DISCUSSION Thank you! For future questions or comments, contact that AHRQ QI Support Team anytime at: QIsupport@ahrq.hhs.gov 24