transparency for quality improvement efforts at the kentucky cabinet for health and family services...
TRANSCRIPT
![Page 1: Transparency for Quality Improvement Efforts at the Kentucky Cabinet for Health and Family Services (CHFS) Trudi Matthews, MA Senior Policy Advisor Office](https://reader035.vdocuments.mx/reader035/viewer/2022062409/56649ce05503460f949aa058/html5/thumbnails/1.jpg)
Transparency for Quality Improvement Efforts
at the Kentucky Cabinet for Health and Family Services (CHFS)
Trudi Matthews, MASenior Policy AdvisorOffice of the Secretary
![Page 2: Transparency for Quality Improvement Efforts at the Kentucky Cabinet for Health and Family Services (CHFS) Trudi Matthews, MA Senior Policy Advisor Office](https://reader035.vdocuments.mx/reader035/viewer/2022062409/56649ce05503460f949aa058/html5/thumbnails/2.jpg)
Cabinet for Health and Family ServicesSlide #2
Trudi Matthews et al.
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Cabinet for Health and Family ServicesSlide #3
Kentucky Legislation & Policy
• 2005 law (HB 278) Secretary’s Advisory Committee on Transparency
• Transparency 2006 law (HB 380) on public release of cost and quality data
• Health Care Information Center Website:– Launched March 2007 – Data on avoidable hospitalizations & inpatient
quality– Consumers can compare KY hospitals on
quality – http://chfs.ky.gov/ohp/healthdata/
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Cabinet for Health and Family ServicesSlide #4
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Cabinet for Health and Family ServicesSlide #5
How did KY staff use the AHRQ Tools?
• AHRQ Diabetes Guide and Workbook helped direct staff to:– Look at chronic diseases & focus on diabetes – Assemble most recent data in formats of the
Diabetes Guide– Be productive in the analysis phase– Interpret data with better understanding– Achieve credibility by using national measures
and AHRQ methods
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Cabinet for Health and Family ServicesSlide #6
Data Sources
The Kentucky CHFS collects: • UB-92 inpatient records:
– 600,000 per year– All Kentucky hospitals
• Outpatient surgery records:– Hospital-based– Some ambulatory surgery centers
• Public Health Data – BRFSS, Vital Statistics, etc.
• Medicaid & State employee claims
• Procedures & Diagnoses
• Volume• Length of stay• Charges • HCUP Partner
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Cabinet for Health and Family ServicesSlide #7
Quality Measures
• Non-proprietary consensus-based sources:• AHRQ: Agency for Healthcare Research and Quality• CMS: Centers for Medicare and Medicaid Services• Others (JCAHO, NQF, etc.)
• Measures being used now:• Prevention Quality Indicators• Inpatient Quality Indicators• Patient Safety Indicators• CMS Hospital Compare
AHRQ Quality Indicators
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Cabinet for Health and Family ServicesSlide #8
Kentucky and Health Status
• Kentucky: among worst health outcomes in US: – 2nd highest death and disability rates – 6th highest obesity prevalence
• Diabetes: – 7th highest adult diabetes prevalence– Some Eastern counties nearly double national
diabetes rates
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Cabinet for Health and Family ServicesSlide #9
Percent of Population with Diabetes
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Kentucky Tennessee Missouri Alaska Utah Colorado Minnesota
Obtained from Diabetes Guide: KY Compared to Worst/Best-in-Class States
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Cabinet for Health and Family ServicesSlide #10
Estimates of the Direct, Indirect and Total Cost (billions) Burden of Diabetes
$0.000
$1.000
$2.000
$3.000
$4.000
$5.000
$6.000
Indirect Cost
Direct Medical Costs
Obtained from the Diabetes Guide
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Cabinet for Health and Family ServicesSlide #11
Hospital Admission Rates for Uncontrolled Diabetes, 2006
3.30 3.202.86 2.712.67
0.00
1.00
2.00
3.00
4.00
2002N=1022
2003N=1002
2004N=902
2005N=851
2006N=871
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
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Cabinet for Health and Family ServicesSlide #12
Comparison of Hospital Admission Rates for Uncontrolled Diabetes for US, KY, and Best
Performing States*
US
, 2
5.4
US
, 2
3.8
Ke
ntu
cky, 3
2.8
Ke
ntu
cky, 3
1.7
Co
lora
do
, 5
.3
Co
lora
do
, 5
.8
Ore
go
n, 8
.3
Ore
go
n, 6
.4
Uta
h, 6
.5
Uta
h, 4
.2
Ve
rmo
nt, 6
.0
Ve
rmo
nt, 3
.3
Wa
sh
ing
ton
, 7
.5
Wa
sh
ing
ton
, 5
.9
0
5
10
15
20
25
30
35
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
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Cabinet for Health and Family ServicesSlide #13
Hospital Admission Rates for Short-term Complications of Diabetes, 2006
6.26.66.3
6.46.1
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
2002N=1887
2003N=2018
2004N=1995
2005N=2092
2006N=1997
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
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Cabinet for Health and Family ServicesSlide #14
Hospital Admission Rates for Long-term Complications of Diabetes, 2006
12.012.412.312.512.7
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
2002N=3924
2003N=3909
2004N=3882
2005N=3948
2006N=3846
per
10,
000
Ky
resi
den
ts a
ge
18 a
nd
o
ver
Estimated Using Ideas from the Diabetes Guide + HCUP Data
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Cabinet for Health and Family ServicesSlide #15
Comparison of Hospital Admission Rates for Short-term Complication of Diabetes for US, KY, and
Best Performing States*U
S, 5
0.9
US
, 51
.1
Ke
ntu
cky,
61
.0
Ke
ntu
cky,
64
.6
Ha
wa
ii, 3
1.6
Ha
wa
ii, 3
6.6
Min
nesota
, 34.0
Min
nesota
, 35.8
Ne
bra
ska
, 36
.0
Ne
bra
ska
, 38
.1
Ore
go
n, 4
0.4
Ore
go
n, 3
7.8
Verm
ont, 3
1.0
Verm
ont, 3
0.1
Wa
shin
gto
n, 3
9.3
Wa
shin
gto
n, 4
0.2
0
10
20
30
40
50
60
70
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
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Cabinet for Health and Family ServicesSlide #16
Comparison of Hospital Admission Rates for Long-term Complication of Diabetes for US, KY, and Best
Performing States*
US
, 11
3.8
US
, 11
5.4
Ke
ntu
cky,
12
5.9
Ke
ntu
cky,
12
3.2
Co
lora
do
, 81
.7
Co
lora
do
, 69
.6
Iow
a, 7
8.0
Iow
a, 7
8.6
Ne
bra
ska
, 79
.5
Ne
bra
ska
, 69
.3
Ore
go
n, 7
4.7
Ore
go
n, 7
0.2
Uta
h, 7
1.2
Uta
h, 7
0.3
Ver
mon
t, 6
4.0
Ver
mon
t, 6
1.2
Washin
gto
n,
66.9
Washin
gto
n,
67.2
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
2002 2003
per
100,0
00 r
esid
en
ts a
ge 1
8 a
nd
over
*Rates are risk adjusted for age and gender
New Display Using Diabetes Guide Data
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Cabinet for Health and Family ServicesSlide #17
GIS Mapping: Using HCUP Data
& AHRQ Mapping Software
County-Level Quality Improvement Data
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Cabinet for Health and Family ServicesSlide #18
Louisville
Frankfort Lexington
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Cabinet for Health and Family ServicesSlide #19
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Cabinet for Health and Family ServicesSlide #20
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Cabinet for Health and Family ServicesSlide #21
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Cabinet for Health and Family ServicesSlide #22
Percent of Adults (in 2001) who received:
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
HbA1c testing Retinal eyeexamination
Foot examination Flu vaccination
Kentucky
National Average
Best-in-Class Average
Healthy People 2010 Goal
Target areas
New Display Using Diabetes Guide Data
Source: BRFSS & Diabetes Guide
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Cabinet for Health and Family ServicesSlide #23
Conclusion
• Governor committed to transparency efforts
• Transparency (Data & Measurement) is first step to quality improvement
• Diabetes Guide critical tool for how best to present our data
• KY must take more steps to facilitate quality improvement
• The Guides give us credibility in our QI efforts
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Cabinet for Health and Family ServicesSlide #24
Contact Information
“I’m sorry I couldn’t be with you.”
-Trudi Matthews
859-333-8067 (cell)
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Cabinet for Health and Family ServicesSlide #25
For Policy Discussion Roundtable: States Involved in AHRQ Activities on Asthma
• Learning Partnership – Disparities in Pediatric Asthma – Pilot testing state-led model: AZ, MD, MI, NJ, OR, RI– Activities with States:
• Learning institutes• Planning support• Technical assistance (e.g., Cultural competency training)
• Specific Examples:– Michigan Asthma Coalition:
• Trained on asthma disparities ; collecting data on children’s disparities • Stimulated asthma ROI calculator -- decision on county program
– Oregon: • Used GIS mapping to target high prevalence counties to reduce
asthma disparities among low-income children (for telemedicine?)– Rhode Island
• Rhode Island Healthy Homes: Developed assessment tool to identify children with asthma in low-income housing (w/ housing authority) & refer to community health centers and DOH)