Preventable Hospitalization Costs and Preventable Hospitalization Costs and Mapping ToolMapping Tool

John BottJohn Bott

Center for Delivery, Organization, and MarketsCenter for Delivery, Organization, and Markets

July 21, 2010July 21, 2010

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Opportunity for ImprovementOpportunity for Improvement

Annual national cost: $30B*Annual national cost: $30B* Represents issues of Represents issues of

prevention, primary care, prevention, primary care, access, and care access, and care coordinationcoordination

To reduce avoidable To reduce avoidable hospitalizations, need to hospitalizations, need to know details:know details:– What types of care have the What types of care have the

most room for improvement? most room for improvement?

* Based on a composite of the AHRQ Prevention Quality Indicators using 2006 data and dollars as reported in the National Healthcare Quality Report (2009).

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Currently, all AHRQ Quality Indicators (QIs) are Currently, all AHRQ Quality Indicators (QIs) are based on electronic hospital discharge data, based on electronic hospital discharge data, which draw upon readily available data elementswhich draw upon readily available data elements

The AHRQ QIs examine care:The AHRQ QIs examine care:

– Directly: Inpatient hospital setting Directly: Inpatient hospital setting

– Indirectly: Hospital data as a window on the Indirectly: Hospital data as a window on the community community

The Preventable Hospitalization Costs and The Preventable Hospitalization Costs and Mapping Tool measures quality of care at the Mapping Tool measures quality of care at the area level, not the provider or hospital levelarea level, not the provider or hospital level

AHRQ Quality IndicatorsAHRQ Quality Indicators

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History

In 2007, AHRQ released the Preventable In 2007, AHRQ released the Preventable Hospitalization Costs and Mapping Tool:Hospitalization Costs and Mapping Tool:

– Area-level QIsArea-level QIs

– Potentially avoidable costs for each area- Potentially avoidable costs for each area- level AHRQ QIlevel AHRQ QI

In 2009, AHRQ began updating, revising, and In 2009, AHRQ began updating, revising, and integrating the tool into MONAHRQ and it is integrating the tool into MONAHRQ and it is no longer available as separate softwareno longer available as separate software

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Main FunctionsMain Functions

Creates mapsCreates maps that show rates of hospital that show rates of hospital admission for selected health problems admission for selected health problems by countyby county

Calculates potential cost savingsCalculates potential cost savings that that may occur if hospital admissions for may occur if hospital admissions for selected health problems are reduced:selected health problems are reduced:– Each countyEach county

– StatewideStatewide

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Cost CalculationsCost Calculations

Costs are based on cost-to-charge ratios to Costs are based on cost-to-charge ratios to reflect hospital costsreflect hospital costs– Variable based on payer typeVariable based on payer type

Costs are based on the time period of data used Costs are based on the time period of data used in the analysisin the analysis– Like most things in life, costs rise over timeLike most things in life, costs rise over time

Costs are only for the inpatient component of the Costs are only for the inpatient component of the billbill– To reflect the full cost of the discharge, the To reflect the full cost of the discharge, the

professional component needs to be addedprofessional component needs to be added

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AHRQ QIs in the Mapping ToolAHRQ QIs in the Mapping Tool

All AHRQ Prevention Quality Indicators (PQIs)All AHRQ Prevention Quality Indicators (PQIs)

Chronic Lung ConditionsChronic Lung Conditions– PQI 5 Chronic Obstructive Pulmonary Disease Admission PQI 5 Chronic Obstructive Pulmonary Disease Admission

RateRate

– PQI 15 Adult Asthma Admission RatePQI 15 Adult Asthma Admission Rate

DiabetesDiabetes– PQI 1 Diabetes Short-Term Complications Admission RatePQI 1 Diabetes Short-Term Complications Admission Rate

– PQI 3 Diabetes Long-Term Complications Admission RatePQI 3 Diabetes Long-Term Complications Admission Rate

– PQI 14 Uncontrolled Diabetes Admission RatePQI 14 Uncontrolled Diabetes Admission Rate

– PQI 16 Lower Extremity Amputation Rate Among Diabetic PQI 16 Lower Extremity Amputation Rate Among Diabetic PatientsPatients

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AHRQ QIs in the Mapping ToolAHRQ QIs in the Mapping Tool

AHRQ PQIs (cont.)AHRQ PQIs (cont.) Heart ConditionsHeart Conditions

– PQI 7 Hypertension Admission RatePQI 7 Hypertension Admission Rate

– PQI 8 Congestive Heart Failure Admission RatePQI 8 Congestive Heart Failure Admission Rate

– PQI 13 Angina Without Procedure Admission RatePQI 13 Angina Without Procedure Admission Rate

Other ConditionsOther Conditions– PQI 2 Perforated Appendix Admission RatePQI 2 Perforated Appendix Admission Rate

– PQI 9 Low Birth Weight RatePQI 9 Low Birth Weight Rate

– PQI 10 Dehydration Admission RatePQI 10 Dehydration Admission Rate

– PQI 11 Bacterial Pneumonia Admission RatePQI 11 Bacterial Pneumonia Admission Rate

– PQI 12 Urinary Tract Infection Admission RatePQI 12 Urinary Tract Infection Admission Rate

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AHRQ QIs in the Mapping ToolAHRQ QIs in the Mapping Tool

Area-Level AHRQ Inpatient Quality Area-Level AHRQ Inpatient Quality Indicators (IQIs)Indicators (IQIs)– IQI 26 Coronary Artery Bypass GraftIQI 26 Coronary Artery Bypass Graft

– IQI 27 Percutaneous Transluminal IQI 27 Percutaneous Transluminal Coronary Angioplasty Coronary Angioplasty

– IQI 28 HysterectomyIQI 28 Hysterectomy

– IQI 29 Laminectomy or Spinal FusionIQI 29 Laminectomy or Spinal Fusion

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AHRQ QIs in the Mapping Tool

Area-Level AHRQ Patient Safety Indicators Area-Level AHRQ Patient Safety Indicators (PSIs)(PSIs)– PSI 21 Foreign Body Left in During ProcedurePSI 21 Foreign Body Left in During Procedure

– PSI 22 Iatrogenic Pneumothorax PSI 22 Iatrogenic Pneumothorax

– PSI 23 Central Line-Associated Bloodstream PSI 23 Central Line-Associated Bloodstream InfectionInfection

– PSI 24 Postoperative Wound DehiscencePSI 24 Postoperative Wound Dehiscence

– PSI 25 Accidental Puncture or LacerationPSI 25 Accidental Puncture or Laceration

– PSI 26 Transfusion ReactionPSI 26 Transfusion Reaction

– PSI 27 Postoperative Hemorrhage or HematomaPSI 27 Postoperative Hemorrhage or Hematoma

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AHRQ’s PQI Composites in AHRQ’s PQI Composites in the Mapping Toolthe Mapping Tool

Overall CompositeOverall Composite– All AHRQ PQIsAll AHRQ PQIs

Acute Care CompositeAcute Care Composite– PQI 10 Dehydration Admission RatePQI 10 Dehydration Admission Rate

– PQI 11 Bacterial Pneumonia Admission PQI 11 Bacterial Pneumonia Admission RateRate

– PQI 12 Urinary Tract Infection Admission PQI 12 Urinary Tract Infection Admission RateRate

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AHRQ’s PQI Composites in AHRQ’s PQI Composites in the Mapping Toolthe Mapping Tool

Chronic Conditions CompositeChronic Conditions Composite– PQI 1 Diabetes Short-Term Complications Admission RatePQI 1 Diabetes Short-Term Complications Admission Rate

– PQI 3 Diabetes Long-Term Complications Admission RatePQI 3 Diabetes Long-Term Complications Admission Rate

– PQI 5 Chronic Obstructive Pulmonary Disease Admission RatePQI 5 Chronic Obstructive Pulmonary Disease Admission Rate

– PQI 7 Hypertension Admission RatePQI 7 Hypertension Admission Rate

– PQI 8 Congestive Heart Failure Admission RatePQI 8 Congestive Heart Failure Admission Rate

– PQI 9 Low Birth Weight RatePQI 9 Low Birth Weight Rate

– PQI 13 Angina Without Procedure Admission RatePQI 13 Angina Without Procedure Admission Rate

– PQI 14 Uncontrolled Diabetes Admission RatePQI 14 Uncontrolled Diabetes Admission Rate

– PQI 15 Adult Asthma Admission RatePQI 15 Adult Asthma Admission Rate

– PQI 16 Lower Extremity Amputation Rate Among Diabetic PatientsPQI 16 Lower Extremity Amputation Rate Among Diabetic Patients

Potentially Avoidable Potentially Avoidable HospitalizationsHospitalizations

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Ambulatory Care Sensitive Ambulatory Care Sensitive ConditionsConditions

Potentially Avoidable Hospitalizations – AHRQ’s Prevention Quality Indicators

(PQIs – ambulatory care sensitive conditions) and …

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Other Area-Level IndicatorsOther Area-Level Indicators

… Area-level patient safety and procedure rates

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Map of Rates by County*Map of Rates by County*

* Synthetic data

Rates for avoidable admissions by county:

Highest rates in dark blue, lowest rates in light blue

Click on Summary Table for more details.

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Potential Cost Savings –Potential Cost Savings –Reducing Preventable Admissions*Reducing Preventable Admissions*

Details on avoidable admissions by county, including cost savings.

Can download to Excel.

* Synthetic data

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Source of Comparative ResultsSource of Comparative Results

HCUPnet:HCUPnet:

– Individual measure rates by yearIndividual measure rates by year

– National figures for comparisonNational figures for comparison

– Regional figures for comparison: Regional figures for comparison:

NortheastNortheast

MidwestMidwest

SouthSouth

WestWest

Website: http://hcupnet.ahrq.govWebsite: http://hcupnet.ahrq.gov

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Examples of Potential UseExamples of Potential Use

Targeting priorities and interventions:Targeting priorities and interventions:– By clinical areaBy clinical area

– By geographyBy geography

Tracking and studying the impact of Tracking and studying the impact of interventionsinterventions

Identifying best practicesIdentifying best practices

Participating in public reporting at various Participating in public reporting at various geographic levelsgeographic levels

Establishing budgets for preventable Establishing budgets for preventable hospitalization effortshospitalization efforts

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Future WorkFuture Work

Quality improvement toolkit is being Quality improvement toolkit is being developed to assist in reducing potentially developed to assist in reducing potentially avoidable hospitalizations as defined by the avoidable hospitalizations as defined by the AHRQ PQIsAHRQ PQIs– Expected release: Early 2011Expected release: Early 2011

Currently exploring adding analytic capacity at Currently exploring adding analytic capacity at the ZIP Code levelthe ZIP Code level

Adding remaining AHRQ QIs Adding remaining AHRQ QIs – Over the course of the next yearOver the course of the next year

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