AHRQ Quality Indicators Software Changes Overview
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The webinar will be recorded and will be available on
the AHRQ QI website.
•
All participant lines are in listen-only mode
throughout the presentation.
•
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.
2
T
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P
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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, Pantheon
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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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Removal of E Codes
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POA Changes
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Code updates
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Removed Prediction
Module
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Update to APR-DRG grouper
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Individual measure updates
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User feedback
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Expert review
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Listing in presentation not exhaustive
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Facilitates ICD-10 compatibility
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Inconsistent reporting of E-codes
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Affected measures:
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PDI 01, 03, 13
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PSI 05, 08, 15, 16, 21, 25, 26
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E-codes minor aspect of indicator specification
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E-codes retained for “Self-inflicted injury”
(exclusion for PSI 08)
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Use standard coding
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Y = Present on Admission
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W = Clinically undetermined
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POA exempt diagnoses assume POA = Y
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N = Not present on admission
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Anything else is considered not present
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POA = 1 is not present on admission
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APR-DRGs used in IQI Risk Adjustment
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Update to v32
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Limited license download available
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Coding changes for FY2015
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v32 may be applied to older datasets
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No changes due to ICD-9 Update
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MS-DRG and MDC
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Five new MS-DRG
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Updated corresponding MDC
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Minor revisions to measures (error, omission)
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Reminder: coding must be to required detail
level
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County populations: 2014 Census Estimate
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Reference population: Combined 2012 SIDs
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Risk adjustment coefficients use new reference
population
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Population changed, methodology did not except
treatment of POA
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Data is more current
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Measures may be run with or without POA
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Affects entire dataset
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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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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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PSI Composite weights updated
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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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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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IQI Composite weights updated
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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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PQI 10: Dehydration Admission Rate
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Restricted kidney failure POA exclusion to Stage V or
End Stage
►
Increase in observed rate
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PDI Composite weights updated
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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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Additional documentation referenced in this presentation:
•
Rate Comparison, version 4.5 to 5.0
http://www.qualityindicators.ahrq.gov/Downloads/Software/V50/AHR
Q_QI_Rate_Comparison_V45_V50.pdf
•
Coding Updates and Revisions
►
PQI
http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/ChangeL
og_PQI_v50.pdf
►
IQI
http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V50/ChangeL
og_IQI_v50.pdf
►
PSI
http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/ChangeL
og_PSI_v50.pdf
►
PDI
http://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V50/ChangeL
og_PDI_v50.pdf
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:
AHRQ QI Technical Assistance Team
QIsupport@ahrq.hhs.gov
D
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http://www.qualityindicators.ahrq.gov/Modules/Default.aspx
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This overview discusses the changes to the AHRQ Quality Indicators Software v5.0, covering topics such as coding updates, methodology changes, and key measure details. Removal of E-codes, POA changes, APR-DRG updates, and expert reviews are highlighted.
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Presentation Transcript
AHRQ Quality Indicators Software Overview of Changes to v5.0 August 20, 2015
Webinar Instructions The webinar will be recorded and will be available on the AHRQ QI website. All participant lines are in listen-only mode throughout the presentation. 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. 2
Todays 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, Pantheon 3
Agenda 1. Overview of Changes 2. Coding updates 3. Methodology changes 4. Details of changes to key measures 5. Questions and closing 4
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 5
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) 6
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 7
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 8
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 9
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 10
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 11
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 12
Strata Identifiers Indicator IQI 2A IQI 2B IQI 2C IQI 4A IQI 4B IQI 4C IQI 4D IQI 11A IQI 11B IQI 11C IQI 11D SAS IQ2A IQ2B IQ2C IQ4A IQ4B IQ4C IQ4D IQ11A IQ11B IQ11C IQ11D WinQI IQI 201 IQI 202 IQI 203 IQI 401 IQI 402 IQI 403 IQI 404 IQI 111 IQI 112 IQI 113 IQI 114 Indicator IQI 17A IQI 17B IQI 17C SAS IQ17A IQ17B IQ17C WinQI IQI 171 IQI 172 IQI 173 PSI 4A PSI 4B PSI 4C PSI 4D PSI 4E PS4A PS4B PS4C PS4D PS4E PSI 42 PSI 43 PSI 44 PSI 45 PSI 46 13
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 14
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 15
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 16
Key Measure Changes: PQI PQI 10: Dehydration Admission Rate Restricted kidney failure POA exclusion to Stage V or End Stage Increase in observed rate 17
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 18
Questions and Answers Additional documentation referenced in this presentation: Rate Comparison, version 4.5 to 5.0 http://www.qualityindicators.ahrq.gov/Downloads/Software/V50/AHR Q_QI_Rate_Comparison_V45_V50.pdf Coding Updates and Revisions PQI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/ChangeL og_PQI_v50.pdf IQI http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V50/ChangeL og_IQI_v50.pdf PSI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/ChangeL og_PSI_v50.pdf PDI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V50/ChangeL og_PDI_v50.pdf 19
Thank You General Questions and Comments: AHRQ QI Technical Assistance Team QIsupport@ahrq.hhs.gov Documentation: http://www.qualityindicators.ahrq.gov/Modules/Default.aspx 20
