On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, “AHRQ – Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov”
Slide 2
Colleagues
This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left. The header and body of the slide are separated by a light blue horizontal line that traverses 80 percent of the slide from the left.
The presentation uses a template of a blue slide, with a small image in the top left corner of the of the Department of Health & Human Services and AHRQ logos.
- AHRQ
- Dwight McNeill, PhD
- Ed Kelley, ScD
- Ernest Moy, MD, MPH
- Roxanne Andrews, PHD
- TH
- Kelly McDermott, MA
- Karen Ho, M.S.
- David Adamson, PhD
- CSG
- Trudi Matthews, MA
- Jenny Sewell
Slide 3
AHRQ's Goals
- Motivate leaders of quality improvement
- State policymakers
- Employers
- Create products that help leaders take action
Slide 4
Guides & Workbooks (G&Ws)
- Diabetes Care Quality Improvement:
- A Resource Guide for State Action
- A Workbook for State Action
- http://www.ahrq.gov/qual/diabqualoc.htm
- Asthma Care Quality Improvement:
- Why these?
- What areas are your weakest?
Slide 5
Why? Variation in quality (asthma)
This slide contains three scatterplots. The first scatterplot shows hospital admission for pediatric asthma under age 18 (PQI 4). The plot shows a large distribution of points, ranging from the best-in class average of approximately 60 hospital admissions per 100,000 population to over 300 hospital admissions, which is far above the national average of 175 admissions.
The second plot shows hospital admission for adult asthma age 18-64 (PQI 15). Data is not as varied as for pediatric asthma. Still, the data varies from the best-in class average of 55 hospital admissions to 150 admissions. The national average is 110 hospital admissions per 100,000 population.
The third scatterplot shows hospital admission for adult asthma age 65 and older (PQI modified). The data range from the best-in class average of 120 hospital admissions to 225 admissions, with the national average at 175 admissions per 100,000 population.
The source of the data is the Asthma Guide.
Slide 6
Why? Difficult to synthesize research on quality and costs (asthma)
The slide contains a bar graph. Along the x-axis is utilization, broken into ED visits, hospitals stays, and outpatient visits; missed work/school days; and medication cost. The categories are broken into randomized controlled, all controlled, and without a control group. Along the y-axis is percent change from quality improvement.
Utilization
ED Visits
- Randomized controlled: -5%
- All controlled: -7%
- Without a control group: -30%
Hospital Stays
- Randomized controlled: -30%
- All controlled: -40%
- Without a control group: -73%
Outpatient Visits
- Randomized controlled: -25%
- All controlled: -25%
- Without a control group: -52%
Missed work/school days
- Randomized controlled: -55%
- All controlled: -55%
- Without a control group: -51%
Medication Cost
- Randomized controlled: 5%
- All controlled: 5%
- Without a control group: 40%
Source: Asthma Calculator
Slide 7
What's in Guides/Workbooks?
- Guides: Provide information on:
- Motivation – Making the case
- Framework – Strategy for state-led QI
- Scan – State QI activities
- Data – Measuring quality of care
- Implications – Moving ahead to action
- Workbooks help you make your case
- Work through the module exercises
- Assemble data on prevalence, cost, and potential savings
- Provide critical information to a State work group
Slide 8
AHRQ Partners for G&Ws
The slide contains a table with three columns and seven rows. The columns are titled, “Advisors,” “Diabetes,” and “Asthma.”
- The federal advisor for diabetes is the CDC. The federal advisor for asthma is the CDC and the NHLBI.
- The state (public health) advisor for diabetes is AR, WA. The state (public health) advisor for asthma is OR, NY, WA.
- The state (data orgs) advisor for diabetes is GA, MA, MI, WA. The state (data orgs) for asthma is GA, NY, and PA.
- The state (lawmakers) advisor for diabetes is KS, OH, NY, MN, WA. There are no state (lawmakers) advisors for asthma.
- The advisor of advocates for diabetes is the ADA. The advisor of advocates for asthma is AAA, ALA, ATS.
- There is no advisor of QI groups for diabetes. The advisor of QI groups for asthma is JCAHO.
- There is no advisor of clinician researchers for diabetes. There are several advisors of clinician researchers for asthma.
Slide 9
1. Making the Case
- Why should states make asthma or diabetes a priority for QI initiatives?
- Increasing prevalence
- Significant disparities
- State variation
- Potential cost savings
- Quality improvement opportunity
- In the workbook:
- How to estimate prevalence by sub-groups
- Resources for state data
- How to estimate costs of asthma/diabetes care
On the right slide of the graph is an image entitled, “Age-Standardized Prevalence of Diagnosed Diabetes per 100 Adult Population by State, 1994 and 2002.” The image is of map of the United States in 1994 and a map of the United States in 2002. The maps show that in 1994, prevalence was most between 4-5.9%. In 2002, prevalence has increased dramatically, with rates now mostly over 6%.
Slide 10
2. Strategy for State-led Quality Improvement
This slide has an image of three concentric circles, which are divided into thirds. The image shows that the strategy for quality improvement rests on planning, doing, and assessing.
The process is as follows:
- Provide leadership to create a vision
- Work in partnership with key stakeholders
- Implement improvement by leading partners to create interventions and assess impact
In the Workbook, worksheets for planning a state QI program are included.
Slide 11
3. Scan State Activities
- Review module on national and specific state activities
- Investigate your own state's activities
- Learn from what other states have done
In Workbook:
- A checklist for summarizing your state's activities
The slide contains an image of pages from the workbook.
Slide 12
4. Data & Measures: The Keys to Improvement
- Motto: “You can't change what you can't measure”
- Measures: Learn the standard measures for the disease
- State data: Do an inventory of relevant data
- National data: Assemble benchmarks (Tip: don't be satisfied with “average”)
In the Workbook:
- List of state data sources (hands-on session)
- How to compare to the best-in-class (hands-on session)
- And much more…
Slide 13
4. Data & Measures: Types and Examples
- Process: Performance indicators based on clinical care guidelines
- Doctor visit every 6 months
- Written asthma management plan
- Outcome: Health status, the ultimate objective
- Mortality rates
- Hospitalization rates
- Contextual Factors: Difficult to change
- Access – percent uninsured
- Prevalence – percent with diabetes or asthma
Slide 14
4. Data & Measures
Process Improvement Should Relate to Outcomes
The slide contains an image of an arrow. The text inside the arrow reads, “Daily medications for patients with persistent asthma.”
The arrow is pointing to an octagon that reads, “Reduced asthma hospitalizations in the total population.”
Slide 15
4. Data & Measures: Benchmarks for Asthma Quality Improvement
This slide is identical to slide 5 of this presentation. This slide contains three scatterplots. The first scatterplot shows hospital admission for pediatric asthma under age 18 (PQI 4). The plot shows a large distribution of points, ranging from the best-in class average of approximately 60 hospital admissions per 100,000 population to over 300 hospital admissions, which is far above the national average of 175 admissions.
The second plot shows hospital admission for adult asthma age 18-64 (PQI 15). Data is not as varied as for pediatric asthma. Still, the data varies from the best-in class average of 55 hospital admissions to 150 admissions. The national average is 110 hospital admissions per 100,000 population.
The third scatterplot shows hospital admission for adult asthma age 65 and older (PQI modified). The data range from the best-in class average of 120 hospital admissions to 225 admissions, with the national average at 175 admissions per 100,000 population.
The source of the data is the Asthma Guide.
Slide 16
5. Take the Opportunity: Have an Impact on Quality of Care
THE QI CYCLE:
- Plan: Identify issue, stakeholders, goals (topics)
- Do:
- Select change agents
- Providers – Societies, IHI, etc.
- Health plans – NCQA
- Employers – Firms/coalitions
- States – Who in state?
- Guide & support with resources
- Assess: Evaluate, modify, test, & reassess
- Implement successes broadly
- Use the QI Cycle to assess and modify implementations
Slide 17
The Workbook Steps for States
- Make your case: Assess avoidable hospitalizations, prevalence, costs, and potential saving related to the disease
- Understand state-led quality improvement:
- Apply the 3 steps – leadership, partnership, and improvement
- Identify national resources to help
- Review relevant programs of QI in your state
- Understand measurement and data:
- Learn about measures for the disease
- Assess available data for state and local estimates; identify gaps
- Find national benchmarks to compare your state against
- Summarize your state's case for disease quality improvement and identify next steps to action (e.g., set preliminary goals)
Slide 18
Questions?
Rosanna Coffey, PhD
Rosanna.Coffey@thomson.com
301-309-3829
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