Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 1

INSTRUCTIONS FOR USING THIS TOOL –DELETE THIS SLIDE BEFORE PRESENTATION

• Use this PowerPoint presentation as a template for your presentation.

• Replace the charts with charts that you create with your data (use the Excel workbook from Tool B.3a for guidance) and replace the red text with your hospital’s information.

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 2

The Toolkit for Using the AHRQ Quality Indicators

Results and Discussion of Data Analysis

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 3

Source: www.qualityindicators.ahrq.gov/Default.aspx and AHRQ Quality Indicator Toolkit Literature Review.

• AHRQ QIs can be used to flag potential problems in quality of care.

• AHRQ QIs can be used to assess performance and compare against peer hospitals.

• Examples of hospital use of AHRQ QIs in the literature have examined the impact of:

– Health information technology on quality of care.– Hospital board quality committees on quality of care.– The effectiveness of nurse staffing on care delivered.

How can the AHRQ QIs be used in quality assessment?

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 4

Relative to a sample of similar hospitals, Your Hospital has similar or better performance on most of the IQIs.

Your Hospital's Performance Relative to National Averages

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Inpatient Quality IndicatorsNationalAverage

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Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 5

Relative to a sample of similar hospitals, Your Hospital has similar or better performance on many of the PSIs. However, Pressure Ulcers (PSI 03) occur at higher rates than the national average – this may be an area where Your Hospital should focus quality improvement efforts.

Your Hospital's Performance Relative to National Averages

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Patient Safety Indicators NationalAverage

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Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 6

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NQI 2NQI 3 PDI 1 PDI 5 PDI 6 PDI10

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Pediatric Quality Indicators National Average

Relative to a sample of similar hospitals, Your Hospital has similar or better performance on most of the PDIs.

Your Hospital's Performance Relative to National Averages

Rate Higher than National Average

(Worse)

Rate Lower than National Average

(Better)

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 7

• In this example, we will examine the rates of Pressure Ulcers (PSI 03) and how this particular hospital performed over time.

• Determine which indicator(s) you would like to focus on, and fill in these slides based on that indicator and your hospital’s data.

• Based on the information that you would like to present, you may choose not to use all of the slides available here.

DELETE THIS SLIDE BEFORE PRESENTATION

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 8

• Based on a review of Your Hospital’sperformance on the PSIs, we have decided to focus on the following indicators:

– Pressure Ulcers (PSI 03)–

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Indicators that Require Attention

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 9

• You may want to include information about the indicator as background information.

• Go to www.qualityindicators.ahrq.gov/ or see the Fact Sheets in this toolkit (Tools A.1a, A.1b, A.1c) to obtain this information.

DELETE THIS SLIDE BEFORE PRESENTATION

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 10

ICD-10-CM = International Classification of Diseases, 10th Revision; DRG = diagnosis-related group.Source: www.qualityindicators.ahrq.gov/Modules/PSI_TechSpec.aspx.

• Numerator: Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any secondary ICD-10-CM diagnosis codes for pressure ulcer and any secondary ICD-10-CM diagnosis codes for pressure ulcer stage III or IV (or unstageable).

• Denominator: Surgical or medical discharges, for patients ages 18 years and older. Surgical and medical discharges are defined by specific DRG or MS-DRG codes.

• DELETE THIS TEXT BEFORE PRESENTATION: Replace this information with information about your chosen indicators. Copy this slide and repeat as necessary.

A PSI Example: Pressure Ulcer (PSI 03)

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 11

Comparing Performance Over Time

*Note: Use caution comparing rates before and after 2014. Rates before the 4th quarter of 2014 are calculated using ICD-9-CM diagnosis codes; rates calculated during the 4th quarter of 2014 and later use ICD-10-CM. The rates should be similar but may not yield a perfect comparison between years.

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Examining Observed Rates of Pressure Ulcers (PSI 03)

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 12

Slides below are only applicable for ICD-9 versions of the software. Currently the ICD-10 software does not calculate expected, risk-adjusted, or smoothed rates, but will in the future.

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 13

Comparing Observed Performance to Expected Performance Over Time

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Comparing Observed Rates of Pressure Ulcers (PSI 03) to Expected Rates

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Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 14

Comparing Risk-Adjusted and Smoothed Rates Over Time

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Risk-Adjusted and Smoothed Rates of Pressure Ulcers (PSI 03)

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Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 15

Evaluating Case Mix Relative to Other Hospitals

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Comparing Expected Rates of Pressure Ulcers (PSI 03) to National Average Rates To Compare Case Mix

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National Average

Toolkit for Using the AHRQ Quality IndicatorsHow To Improve Hospital Quality and Safety

Tool B.3b Slide 16

Comparing Hospital’s Performance to National Performance Over Time

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Comparing Risk-Adjusted Rates of Pressure Ulcers (PSI 03) to National Average Rates

Risk-Adjusted Rate

Risk-Adjusted (LowerConfidence Interval Bound)

Risk-Adjusted (UpperConfidence Interval Bound)

National Average