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Overview of Organization & Comparative Quality Data

Ron Spingarn, Deputy DirectorHealthcare Information Division

Email: rspingar@oshpd.ca.govPhone: (916) 326-3801

University of California at Davis

June 18, 2010

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OSHPD

FacilitiesDevelopment

WorkforceDevelopment

Administration

Cal-MortgageLoan

Insurance

HealthcareInformation

TechnicalAdvisory

Committee

Health DataTransparency

& EffectivenessCommittee

CA Health Policy& Data Advisory

Commission

(Coronary)Clinical

AdvisoryPanel

HealthProfessionsEducation

Foundation

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Data Flow from Facilities

Inpatient Facilities (443):- Acute Care Hosp. (386)

- Chemical Dependency Hosp. (6)- Acute Psych. Hosp. (30)

- Psych. Facilities (21)Emergency Department (322)

Ambulatory Surgery (574):- Acute Care (375)

- Surgical Clinic (hosp.) (115)- Surgical Clinic (non-hosp.) (84)

Utilization Data (4,715):- Skilled Nursing (1,144)

- Hospices (281)- Community & Free Clinics (983)

- Dialysis Clinics (401)- Surgical Clinics (209)-Home Health (1,215)

- Hospitals (510)Financial Data: Inpatient Facilities

(447)HealthcareInformation

Division

ClinicalData &

ResearchPatient

DischargeData

DataProducts

AggregateFinancial &Utilization

Data Coronary Artery Bypass Graft Surgery Hosp. (121)

Cardiac Surgeons (284)

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Licensed or Regulated Data Sources

Healthcare Practioners

Healthcare Facilities

Dept of Public Health (DPH)

Consumer Affairs

Primary Care Clinics

Hospitals

OSHPDHealthcare Information

Division

County-level Vital Statistics

(birth & death) From DPH

Specialty Clinics

Long Term Care

Hospices/Home Health Agencies

Legend

Patient-Level Data

Facility-Level (Financial & Utilization) Data

Rev 3/4/2009

Physicians (Cardiac Surgeons)

State Hospitals

Veteran Affairs

Developmental Services

Mental Health

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Requests for OSHPD Data

Peter McNair, and Hal Luft, UCSF :Readmissions That are the Sequelae of Hospital Acquired Conditions;Realigning Hospital Incentives by Bundling Readmissions and Outlier Costs into Prospective Payments and Engaging Insurers

Craig Newgard, MD, MPH, Oregon Health & Science University:Improving Pre Hospital Trauma Triage: Generating a Cost-Effective and Resource-Efficient Mechanism for the Field Triage of Injured Persons

 Ashish Jha, MD, MPH, Harvard :

Postpartum Readmission: Reasons, Risk Factors & Regional Variation

Andrew D. Racine, M.D., Albert Einstein College of Medicine:The Impact of Palivizumab on Hospitalization Rates for Bronchiolitis in California

 Mitchell Berman, M.D., Columbia University:

Outcome After Treatment of Cerebrovascular Disease, Outcome of Patients with Parkinson's Disease Following General Anesthesia

Examples:

Data Use Agreement Information - Contact:Jonathan Teague, Email: jteague@oshpd.ca.gov Phone: (916) 326-3805

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Quality Measures’ Reporting Levels by OSHPD

Area-LevelInpatient UtilizationPrevention Quality

Hospital-LevelInpatient MortalityInpatient Volume & UtilizationPediatric QualityPatient SafetyCoronary Artery Bypass Graft SurgeryMaternal Outcomes*Hip Fracture Repair Mortality*

Surgeon-LevelCoronary Artery Bypass Graft Surgery

*not yet released OSHPD measures in redAHRQ measures in blue

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AHRQ Quality Indicators Reported by OSHPDMortality Inpatient (15 available measures)

2006 – 2007: 8 reported 2008: 4 new (12 total)Volume and Utilization Inpatient (13 available measures)2005 – 2008: 11 reported

Area-Level Utilization Inpatient (4 available measures)2005 – 2008: all reported

Area-Level Patient Safety (7 available measures)2005 – 2008: 4 reported

Area-Level Prevention Quality (14 available measures)2005 – 2008: all reported

Area-Level Pediatric (5 available measures)2005 - 2008: all reported

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7 Measures of Conditions Available through OSHPD

8 Measures of Procedures Available through OSHPD

2006-2007 data reported: Acute Stroke Gastrointestinal Hemorrhage Hip Fracture

Beginning in 2008: Acute Myocardial Infarction

(AMI) Pneumonia Congestive Heart Failure

Release not planned: AMI without transfer cases

2006-2007 data reported: Esophageal Resection Pancreatic Resection Craniotomy Carotid Endarterectomy Percutaneous Transluminal Coronary Angioplasty

Beginning in 2008: Abdominal Aortic Aneurysm

Repair

Release not planned: Hip Replacement Coronary Artery Bypass GraftSurgery

AHRQ Inpatient Mortality Indicators

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AHRQ Inpatient Volume & Utilization Indicators

Volume Indicators: All measures reported by OSHPD, since 2005Esophageal ResectionPancreatic ResectionAbdominal Aortic Aneurysm RepairCarotid EndarterectomyCoronary Artery Bypass Graft SurgeryPercutaneous Transluminal Coronary Angioplasty

Utilization Indicators: 7 available; 5 reported by OSHPD since 2005Cesarean Delivery RateCesarean Delivery Rate – PrimaryVaginal Birth After Cesarean (VBAC) Rate, AllVaginal Birth After Cesarean (VBAC) Rate, UncomplicatedLaparoscopic Cholecystectomy

Under Consideration: Bi-lateral cardiac catheterization & Incidental appendectomy in elderly

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AHRQ Prevention Quality Indicators(Area-Level Measures)

Diabetes Short-term Complications Perforated Appendix Diabetes Long-term Complications Chronic Obstructive Pulmonary Disease (COPD) Hypertension Congestive Heart Failure (CHF)Low Birth Weight

Dehydration Bacterial Pneumonia Urinary Tract Infections Angina without Procedure Uncontrolled Diabetes Adult Asthma Lower-extremity Amputations among Patients with Diabetes

All 14 available measures reported by OSHPD since 2005:

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AHRQ Pediatric Quality Indicator (Area-Level Measures)All 5 available area-level rates reported by OHSPD since 2005:

Asthma Admission RateDiabetes Short-Term Complication Rate Gastroenteritis Admission Rate Perforated Appendix Admission Rate Urinary Tract Infection Admission Rate

AHRQ Utilization RatesAll 4 available area-level rates reported by OSHPD since 2005:

Coronary Artery Bypass Graft Surgery

Percutaneous Transluminal Coronary Angioplasty

Hysterectomy

Laminectomy or Spinal Fusion

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Patient Safety Indicators,Area-Level Rates (7 available)

4 reported by OSHPD beginning with 2005 data:

Iatrogenic Pneumothorax, Secondary Diagnosis Field

Selected Infections due to Medical Care, Secondary Diagnosis Field

Postoperative Wound Dehiscence

Postoperative Hemorrhage or Hematoma

No plans/undecided about Accidental Puncture/Laceration, Foreign Object Left in Body & Transfusion Reaction