AHRQ Quality Indicators SoftwareOverview of Changes to v5.0

August 20, 2015

Webinar Instructions

• The webinar will be recorded and will be available on the AHRQ QI website.

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• You may submit webinar questions via the question feature at any time, however all questions will be answered during the Q&A session. Your question will only be visible to the moderators.

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Today’s Presenters

Mamatha Pancholi, MS, Project Officer, Quality Indicators, AHRQ

Keith Bell, MPH, Health Data Decisions

Expert Panel:

Marguerite Barrett, MS, Truven Health Analytics (subcontractor)

David Douglass, Health Data Decisions

Vivek Kumar, Pantheon3

Agenda

1. Overview of Changes

2. Coding updates

3. Methodology changes

4. Details of changes to key measures

5. Questions and closing

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Overview of Changes

• Removal of E Codes

• POA Changes

• Code updates

• Removed Prediction Module

• Update to APR-DRG grouper

• Individual measure updates• User feedback

• Expert review

• Listing in presentation not exhaustive

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Coding Updates: E-Codes

• Facilitates ICD-10 compatibility

• Inconsistent reporting of E-codes

• Affected measures:► PDI 01, 03, 13► PSI 05, 08, 15, 16, 21, 25, 26

• E-codes minor aspect of indicator specification

• E-codes retained for “Self-inflicted injury” (exclusion for PSI 08)

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Coding Updates: POA

• Use standard coding► Y = Present on Admission► W = Clinically undetermined► POA exempt diagnoses assume POA = Y► N = Not present on admission► Anything else is considered not present

• POA = 1 is not present on admission

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Coding Updates: APR-DRG

• APR-DRGs used in IQI Risk Adjustment

• Update to v32► Limited license download available► Coding changes for FY2015

• v32 may be applied to older datasets

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Coding Updates: 2015 Revisions

• No changes due to ICD-9 Update

• MS-DRG and MDC► Five new MS-DRG► Updated corresponding MDC

• Minor revisions to measures (error, omission)

• Reminder: coding must be to required detail level

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Coding Update: Populations

• County populations: 2014 Census Estimate

• Reference population: Combined 2012 SIDs

• Risk adjustment coefficients use new reference population► Population changed, methodology did not except

treatment of POA

• Data is more current

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Methodology Changes: POA

• Measures may be run with or without POA► Affects entire dataset

• Affects numerators for PSI, IQI, PDI

• Prediction module removed► HCUP databases now have POA data available► CMS requires POA data resulting in widespread use► POA prediction module estimates were not always

comparable to real data► POA data is highly affected by coding variation

• Reference population selected for strong POA states

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Methodology: Stratification

• Strata are now exclusive► Version 4.5 allowed one discharge in multiple► Risk adjustment and stratified rates affected

• Priority assigned in order of mortality rate

• Exclusion determined separately for each stratum

• Affected measures:► IQI 02, 04, 09, 11, 17► PSI 04

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Strata Identifiers

Indicator SAS WinQI

IQI 2A IQ2A IQI 201

IQI 2B IQ2B IQI 202

IQI 2C IQ2C IQI 203

IQI 4A IQ4A IQI 401

IQI 4B IQ4B IQI 402

IQI 4C IQ4C IQI 403

IQI 4D IQ4D IQI 404

IQI 11A IQ11A IQI 111

IQI 11B IQ11B IQI 112

IQI 11C IQ11C IQI 113

IQI 11D IQ11D IQI 114

Indicator SAS WinQI

IQI 17A IQ17A IQI 171

IQI 17B IQ17B IQI 172

IQI 17C IQ17C IQI 173

PSI 4A PS4A PSI 42

PSI 4B PS4B PSI 43

PSI 4C PS4C PSI 44

PSI 4D PS4D PSI 45

PSI 4E PS4E PSI 46

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Key Measure Changes: PSI

• PSI Composite weights updated

• PSI 09/27: Perioperative/Postoperative Hemorrhage or Hematoma► Platelet disorders added to numerator exclusion► Observed rate reduced

• PSI 10: Postoperative Physiologic and Metabolic Derangement Rate► Diabetic complication codes removed from exclusions► Resulting indicator now limited post-operative acute renal failure► Chronic kidney failure exclusion restricted to Stage V or End

Stage► Observed rate increased

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Key Measure Changes: PSI

• PSI 11: Postoperative Respiratory Failure Rate► Removed exclusions for senility without psychosis► Revised exclusion list for facial procedures

o Removed gingivoplasty; added exclusions for facial bone and laryngo-tracheal operations

► Expanded conditions included in exclusions for lung cancer and esophageal surgery

► Slight decrease in observed rate, increase in expected

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Key Measure Changes: IQI

• IQI Composite weights updated

• IQI 20: Pneumonia Mortality Rate► Added Avian Influenza, H1N1, and Novel Influenza

Virus to denominator specification► Slight decrease in observed rate

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Key Measure Changes: PQI

• PQI 10: Dehydration Admission Rate► Restricted kidney failure POA exclusion to Stage V or

End Stage► Increase in observed rate

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Key Measure Changes: PDI

• PDI Composite weights updated

• PDI 09: Postoperative Respiratory Failure► Mirrors PSI 11 changes► Removed exclusions for gingivoplasty and senility

without psychosis► Added denominator exclusions for facial bone and

laryngo-tracheal operations► Expanded conditions included in exclusions for lung

cancer and esophageal surgery► Slight decrease in observed rate

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Questions and Answers

Additional documentation referenced in this presentation:

• Rate Comparison, version 4.5 to 5.0http://www.qualityindicators.ahrq.gov/Downloads/Software/V50/AHRQ_QI_Rate_Comparison_V45_V50.pdf

• Coding Updates and Revisions► PQI

http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/ChangeLog_PQI_v50.pdf

► IQIhttp://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V50/ChangeLog_IQI_v50.pdf

► PSIhttp://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/ChangeLog_PSI_v50.pdf

► PDIhttp://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V50/ChangeLog_PDI_v50.pdf

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Thank You

General Questions and Comments:

AHRQ QI Technical Assistance Team QIsupport@ahrq.hhs.gov

Documentation:

http://www.qualityindicators.ahrq.gov/Modules/Default.aspx