On the top of the slide are the logos for the Department of Health & Human Services and the AHRQ logo. The Department of Health & Human Services logo is an artistic image of an eagle with the outlined profile of faces. The AHRQ logo reads, “AHRQ – Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, www.ahrq.gov.”

Slide 2

AHRQ Quality Indicators (QIs)

This presentation uses a template with a blue background and a header with the AHRQ and Department of Health & Human Services logos on the left. The header and body of the slide are separated by a light blue horizontal line that traverses 80 percent of the slide from the left.

• Use existing hospital discharge data, based on readily available data elements
• Incorporate severity adjustment methods (APR-DRGs, comorbidity groupings and hierarchical modeling)
• Five modules: Inpatient, Patient Safety, Prevention, Pediatric, and Neonatal

Slide 3

Preventable Hospitalization Costs: A County-Level Mapping Tool

The PHC tool is a new QI software application designed to help organizations to:

• Better understand geographical patterns of potentially preventable hospital admission rates for selected health problems.
• Allocate resources more effectively by calculating potential cost savings if admission rates are reduced.

Slide 4

Main Functions of the PHC Tool

• Creation of maps that show the rates of hospital admission for selected health problems on a county-by-county basis.
• Calculation of potential cost savings that may occur if the number of hospital admissions for selected health problems in each county is reduced.
• Ability to place additional information about local populations onto maps to indicate the number of persons who are at greatest risk for those health problems in each county.

Slide 5

It processes all Prevention QIs...

• PQI 1 Diabetes Short-term Complications Admission Rate
• PQI 2 Perforated Appendix Admission Rate
• PQI 3 Diabetes Long-term Complications Admission Rate
• PQI 5 Chronic Obstructive Pulmonary Disease Admission Rate
• PQI 7 Hypertension Admission Rate
• PQI 8 Congestive Heart Failure Admission Rate
• PQI 9 Low Birth Weight Rate
• PQI 10 Dehydration Admission Rate
• PQI 11 Bacterial Pneumonia Admission Rate
• PQI 12 Urinary Tract Infection Admission Rate
• PQI 13 Angina without Procedure Admission Rate
• PQI 14 Uncontrolled Diabetes Admission Rate
• PQI 15 Adult Asthma Admission Rate
• PQI 16 Lower-extremity Amputation Rate among Diabetic Patients

There is no longer a PQI 4 and PQI 6.

Slide 6

and all area-level Pediatric QIs

• PDI 14 Asthma Admission Rate
• PDI 15 Diabetes Short-term Complications Admission Rate
• PDI 16 Gastroenteritis Admission Rate
• PDI 17 Perforated Appendix Admission Rate
• PDI 18 Urinary Tract Infection Admission Rate

Slide 7

Applying the QIs

• To calculate area rates it was necessary to have access to the state and county data.
• The software produces observed and risk-adjusted rates for all PQIs and PDIs.
• Output converted to rates
  -Rates expressed either per 100 population and per 10,000 population

Slide 8

This slide shows a map of uncontrolled diabetes admission (2001, PQI14) in Maryland. The map is broken down by county and is color-coded to show different categories of rates per 10,000 people. The map also uses an indicator shaped like a person to show the number of people age 18 and over in a given area. The size of the person indicates the number of people in an area. The smallest person indicator represents 897 people. The medium-size indicator represents 19,391 people. The largest person indicator represents 79,054 people.

Data Source: Healthcare Cost and Utilization Project & Maryland Health Services Cost and Review Commission.

Slide 9

Map Interpretation - Example

This slide shows a map of congestive heart failure admission rate (PQI 8), 2002 in the state of Michigan. The map is broken down by county and is color-code to show different categories of rates for 100,000 population. This slide shows how to interpret this kind of map. The name of the indicator and the date year in is located at the top of the map. Next to the state map will be a map key, indicating the data quintiles and what colors are used to represent each quintile. Sometimes on the maps, symbols in the shape of a person are used to indicate the number of people in an area. The larger the person symbol, the more people are reside in that county.

Slide 10

Data Interpretation

This slide shows a screen shot of a printout of all AHRQ PQIs by county for the state of Michigan. The print out shows how you can compare each county's rate to the overall state rate and where the upper and lower confidence intervals for each county are located.

Slide 11

Cost Data Interpretation

This slide shows a screen shot of an Excel spreadsheet. At the top of the spreadsheet is the QI Name. In this case, it is “Chronic Obstructive Pulmonary Disease (PQI 5). Below it is the county number, county name, mean cost for the specific QI, total number of cases, and total cost. The columns to the left list the potential cost savings if the number of admissions were reduced by 10%, 20%, 30%, 40%, and 50%.

Slide 12

Where to Download

Download the PHC mapping tool (SAS and Windows versions) and all technical documentation at: http://www.qualityindicators.ahrq.gov/mappingtool.htm

Slide 13

Technical Support

If you have technical questions of any kind while using the PHC tool, contact the QI team at: Support@qualityindicators.ahrq.gov or 1-888-512-6090

Slide 14

Questions?

This slide shows a map of the United States that is color-coded by unknown categories.

Slide 15

Contact information

MaryBeth Farquhar, RN, MSN, CAGS
Senior Advisor, Quality Indicators Initiative
MaryBeth.Farquhar@ahrq.hhs.gov
301-427-1317