Transparency for Quality Improvement Efforts in the Commonwealth of Kentucky
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Transparency for Quality Improvement Efforts in the Commonwealth of Kentucky Trudi Matthews, MA AHRQ State Health Care Quality Improvement Workshop Phoenix, AZ January 17, 2008
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Transparency for Quality Improvement Efforts in the Commonwealth of Kentucky. Trudi Matthews, MA AHRQ State Health Care Quality Improvement Workshop Phoenix, AZ January 17, 2008. Kentucky Legislation & Policy. 2005 law (HB 278) Secretary’s Advisory Committee on Transparency - PowerPoint PPT Presentation
Transcript of Transparency for Quality Improvement Efforts in the Commonwealth of Kentucky
Transparency for Quality Improvement Efforts
in the Commonwealth of Kentucky
Trudi Matthews, MAAHRQ State Health Care Quality
Improvement WorkshopPhoenix, AZ
January 17, 2008
Cabinet for Health and Family ServicesSlide #2
Kentucky Legislation & Policy
• 2005 law (HB 278) Secretary’s Advisory Committee on Transparency
• 2006 law (HB 380) Transparency law required release of cost and quality data
• Health Care Information Center Website:– Launched March 2007 – Data on inpatient procedure quality &
avoidable hospitalizations – Consumers can compare KY hospitals on
quality – http://chfs.ky.gov/ohp/healthdata/
Cabinet for Health and Family ServicesSlide #4
How did Ky staff use the AHRQ Tools?
• AHRQ Diabetes Guide and Workbook helped CHFS front line 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
Cabinet for Health and Family ServicesSlide #5
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
De-identified
Cabinet for Health and Family ServicesSlide #6
Quality Measures
• Non-proprietary consensus-based sources:• AHRQ: Agency for Healthcare Research and Quality• CMS: Centers for Medicare and Medicaid Services• JCAHO: Joint Commission for Accreditation of Healthcare
Organization
• Measures:• Inpatient Quality Indicators• Patient Safety Indicators• Prevention Quality Indicators• Other (e.g., CMS Hospital Compare)
AHRQ QIs (Quality Indicators)
Cabinet for Health and Family ServicesSlide #7
Focus on Diabetes
• 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
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
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
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
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
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
Cabinet for Health and Family ServicesSlide #13
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
Cabinet for Health and Family ServicesSlide #14
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
Cabinet for Health and Family ServicesSlide #15
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
Cabinet for Health and Family ServicesSlide #16
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
Cabinet for Health and Family ServicesSlide #17
Percent Differences between Kentucky and Other Averages
-25.0%
-20.0%
-15.0%
-10.0%
-5.0%
0.0%
5.0%
10.0%
15.0%
20.0%
HbA1c testing Retinal eyeexamination
Foot examination Flu vaccination
National Average
Best-in-Class Average
Healthy People 2010 Goal
Better
Worse
New Display/Estimates Using Diabetes Guide Data
Cabinet for Health and Family ServicesSlide #18
GIS Mapping: Using HCUP Data
& AHRQ Mapping Software
County-Level Quality Improvement Data
Cabinet for Health and Family ServicesSlide #19
Louisville
Frankfort Lexington
Cabinet for Health and Family ServicesSlide #23
Conclusion
• Kentucky leaders committed to transparency efforts
• Transparency (Data & Measurement) is first step to quality improvement
• Diabetes Guide critical tool for how best to present analyze our data
• We need now to take more steps to facilitate quality improvement in KY
• The Guide gives us credibility in our QI efforts
Trudi L. Matthews, MADirector of Policy & Public Relations
at HealthBridge, Former Senior Policy AdvisorCHFS Office of the Secretary
