Methods Applying AHRQ Quality Indicators to Healthcare ... - HCUP

Determining Benchmarks for State Performance for the Quality IndicatorsBased on a recommendation from the Institute of Medicine’s report on Future Directions for theNational Healthcare Quality and Disparities Reports, benchmarks based on a straight averageof the top 10 percent of reporting States were determined. For a benchmark to be calculated,rates for at least 30 States needed to be available. Top performing States are not identified.Comparison of Inpatient and Emergency Department Use for Selected PQIs and PDIsBeginning in the 2009 NHQR, the HCUP Nationwide Emergency Department Sample (NEDS)and NIS data were used to examine national and regional differences in inpatient andemergency department use for selected PQIs and PDIs. Details for this analysis are provided inAppendix E.Readmissions for Select Chronic ConditionsHCUP data was used to examine differences in hospital readmissions for congestive heartdisease, asthma, asthma with chronic obstructive pulmonary disease, pneumonia, and acutemyocardial infarction across States, income quartile, age, gender, and race/ethnicity. Details forthis analysis are provided in Appendix F.CAVEATSSome caution should be used in interpreting the AHRQ QI statistics presented in the NHQR andNHDR. These caveats relate to the how the QIs were applied, ICD-9-CM coding changes, inter-State differences in data collection, and other more general issues.Rehabilitation Hospitals: These hospitals are excluded from the 2000-2008 NIS but includedin the 1994 and 1997 NIS because of the change in the NIS sampling strategy (beginning in the1998 NIS). Patients treated in rehabilitation hospitals tend to have lower mortality rates andlonger lengths of stay than patients in other community hospitals, and the completeness ofreporting for rehabilitation hospitals is very uneven across the States. The elimination ofrehabilitation hospitals in 2000-2008 may affect trends in the QIs; however, based on previousanalyses, the effect is likely small since only 3 percent of community hospitals are involved.ICD-9-CM Coding Changes: A number of the AHRQ QIs are based on diagnoses andprocedures for which ICD-9-CM coding has generally become more specific over the period ofthis study. If coding changes cause earlier estimates to not be comparable to the laterestimates, then the earlier estimates are not reported. For this reason, the PQI for chronicobstructive pulmonary disease (PQI 5), the overall PQI composite (PQI 90), and chronic PQIcomposite (PQI 92) are not reported prior to 2005. In addition, birth trauma (PSI 17) is notreported prior to 2004, and QIs for postoperative hemorrhage (PSI 9 and PDI 8) are notreported before 1997.Data Collection Differences Among States: Organizations providing statewide data generallycollect the data using the Uniform Billing format (UB-92 or UB-04) and, for earlier years, theUniform Hospital Discharge Data Set (UHDDS) format. However, not every statewide dataorganization collects all data elements nor codes them the same way. For the NHQR andNHDR, uneven availability of a few data elements underlie some estimates, as noted next.Methods for HCUP Data in 2011 NHQR and NHDR 6December 9, 2011