Slide 2

The Maine Quality Forum

• Created as part of the Dirigo Health Agency
• Tasked with assessing the quality of healthcare in Maine and reporting information to the people of Maine
• Tasked with promoting best practice in Maine
• Maintained mission of providing actionable information about health care quality in easily accessible format

Slide 3

Addressing the Mandates

• Used Institute of Medicine definition (STEEEP) as guiding framework
• Right thing, the right way, at the right time
• Guiding Principles of Change
• Power of public reporting (move from Maine Medical Assessment Foundation model to public model)
• Value of within state comparisons
• The people of Maine as constituency rather than specific stakeholders
• Communication target not necessarily the change target
• Multi-stakeholder, public processes

Slide 4

Data Process

• Started with SAVA (using discharge data) during development of quality metrics
• Drawing upon National Quality Forum metrics worked with Advisory Council to select metrics to be submitted by hospitals
• Worked with Maine Health Data Organization (MHDO) re: rulemaking and micro-specification
• Participated in the Tri-partite group of Pathways to Excellence
• Developed initial web site with a key data component

Slide 5

Initial Website

• Used small area variation analysis on procedures of interest
• Presented data via bar charts developed in Excel
• Graphs presented hospitals significantly different from the expected
• Provided data tables for drill down
• Good start but difficult to understand
• Very difficult to update new data runs
• Maine Quality Forum (MQF) site for example: www.mainequalityforum.gov

Slide 6

Revision Process

• Advisory Council advised:
  • Simpler representation
  • Broader audience
  • More than one view of the data
  • Drill down from simplest to most complex (visual to raw data)
  • Needed to include new data (Chapter 270)
  • Dennis Shubert attended presentation re: new AHRQ State Snapshots

Slide 7

Next Steps

• Intrigued by dial graphics representation method
• Shared with Advisory Council
• Reached out to AHRQ (Dwight) who brokered relationship with Thomson Healthcare (formerly Medstat) and AcademyHealth
• Connected with Thomson Healthcare
• Provided us with code

Slide 8

Medstat

• MQF Determined a need for support
• Methods
• Web design
• Training
• Contracted with Medstat (Thomson Healthcare)
• Contracted with RADCorp
• Began process of applying methodology to Maine 's data
• Training MHDO Epidemiologist

Slide 9

Methodological Challenges Encountered

• Small “N”
• Limited by number of hospitals
• Small “n”
• Limited by number of measures
• Limited by number of cases within measure
• Regression Model
• Nursing Data
• Phase II SAVA-GIS design

Slide 10

Political Challenges

• Maine Hospital Association
• PTE process
• Northern New England Quality Improvement Organization
• Nursing Data
• Public Process
• Advisory Council
• Multi-stakeholder involvement
• Multiple views
• Other political considerations

Slide 11

Resolutions

• Change to speedometer
• Change methodology
• Regression model
• Data inclusion/exclusion
• Nursing Data Representation
• Descriptive Language
• New MQF data site: 207.103.203.51

Slide 12

Phase II

• GIS maps for variation analyses
• New Chapter 270 data