Fluent Essays

Write a 175- to 265-word response to the following: What are some key identifiers used in health care to determine quality? Explain each one. Which identifier do you believe is most valuable? Why? AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 http://www.qualityindicators.ahrq.gov Contract No. HHSA290201800003G July 2021 http://www.qualityindicators.ahrq.gov/ AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Version 2021 Page i July 2021 Table of Contents 1.0 Overview .......................................................................................................................................... 1 2.0 What Are the Composites? ............................................................................................................ 1 3.0 How Are the Composites Created?............................................................................................... 3 4.0 Steps for Creating the Composite ................................................................................................. 3 5.0 How Have the Composites Changed? .......................................................................................... 3 6.0 What Are the Current Uses of the Composites? ......................................................................... 3 7.0 Additional Resources ...................................................................................................................... 4 Index of Tables Table 1. AHRQ PQI Composite Measures, v2021 ........................................................................................ 2 AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Version 2021 Page 1 July 2021 1.0 Overview The goal in developing the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators™ (QI) composite measures was to provide a measure that could be used to monitor performance over time or across regions and populations using a method that applied at the national, regional, state or provider/area level. Potential benefits of composite measures are to: summarize quality across multiple indicators, improve the ability to detect differences, identify important domains and drivers of quality, prioritize action for quality improvement, make current decisions about future (unknown) health care needs and avoid cognitive “shortcuts”. Despite these potential advantages there are concerns with composite measures, such as: masking important differences and relations among components, not being actionable, not being representative of parts of the health care system that contribute most to quality or detracting from the impact and credibility of reports. In weighing the benefits and concerns of composite measures there are also a number of potential uses to consider, such as: consumer use for selecting a hospital or health plan, provider use for identifying domains and drivers of quality, purchaser use for selection of hospitals or health plans to improve employee health and policymaker use for setting policy priorities to improve the health of a population. This document provides a technical overview for AHRQ QI users. 2.0 What Are the Composites? The Prevention Quality Indicators (PQI) are measures of potentially avoidable hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs), which, though they rely on hospital discharge data, are intended to reflect issues of access to, and quality of, ambulatory care in a given geographic area. The PQI composites are intended to improve the statistical precision of the individual PQI, allowing for greater discrimination in performance among areas and improved ability to identify potentially determining factors in performance. An overall composite captures the general concept of potentially avoidable hospitalization connecting the individual PQI measures, which are all rates at the area level. Separate composite measures were created for acute and chronic conditions to investigate different factors influencing hospitalization rates for each condition. See Table 1 for the measures that comprise each of the four PQI composites. The PQI composites provide the following advantages: • Provide assessment of quality and disparity • Provide baselines to track progress • Identify information gaps • Emphasize interdependence of quality and disparities • Promote awareness and change AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Version 2021 Page 2 July 2021 Table 1. AHRQ PQI Composite Measures, v2021 PQI 90 PREVENTION QUALITY OVERALL COMPOSITE PQI 01 Diabetes Short-Term Complications Admission Rate PQI 03 Diabetes Long-Term Complications Admission Rate PQI 05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate PQI 07 Hypertension Admission Rate PQI 08 Heart Failure Admission Rate PQI 11 Community Acquired Pneumonia Admission Rate PQI 12 Urinary Tract Infection Admission Rate PQI 14 Uncontrolled Diabetes Admission Rate PQI 15 Asthma in Younger Adults Admission Rate PQI 16 Lower-Extremity Amputation among Patients with Diabetes Rate PQI 91 PREVENTION QUALITY ACUTE COMPOSITE PQI 11 Bacterial Pneumonia Admission Rate PQI 12 Urinary Tract Infection Admission Rate PQI 92 PREVENTION QUALITY CHRONIC COMPOSITE PQI 01 Diabetes Short-Term Complications Admission Rate PQI 03 Diabetes Long-Term Complications Admission Rate PQI 05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate PQI 07 Hypertension Admission Rate PQI 08 Heart Failure Admission Rate PQI 14 Uncontrolled Diabetes Admission Rate PQI 15 Asthma in Younger Adults Admission Rate PQI 16 Lower-Extremity Amputation among Patients with Diabetes Rate PQI 93 PREVENTION QUALITY DIABETES COMPOSITE PQI 01 Diabetes Short-Term Complications Admission Rate PQI 03 Diabetes Long-Term Complications Admission Rate PQI 14 Uncontrolled Diabetes Admission Rate PQI 16 Lower-Extremity Amputation among Patients with Diabetes Rate AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Version 2021 Page 3 July 2021 3.0 How Are the Composites Created? The composites were created through a workgroup1 that included discussion of conceptual issues related to the composite (e.g., single composite vs. separate composites) and analyses using 2003 State Inpatient Databases (SID) from the AHRQ Healthcare Cost and Utilization Project (HCUP). The PQI composites are calculated by summing the number of discharges that meet the inclusion and exclusion rules for the numerator in any of a composite’s component measures (i.e., a hospitalization for any of the component PQIs), because the components have a common denominator. Beginning in Version 4.3, PQI 05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate and PQI 15 Asthma in Younger Adults Admission Rate have complementary denominators (age greater than or equal to 40; age less than 40) so the rationale still applies. Descriptive statistics for the PQIs were calculated as hospitalizations per 100,000 persons for the entire dataset and by county. Correlations and factor loadings for the county level rates (adjusted for age and gender) were examined. The relation between the composite and other area measures potentially related to access to care (e.g., hospital beds per population and primary care physician density) were examined. 4.0 Steps for Creating the Composite The composites are constructed by summing the hospitalizations across the component conditions and dividing by the population. Rates can optionally be adjusted for age, sex and socio-economic status when comparing across regions or demographic groups. 5.0 How Have the Composites Changed? The specifications of the PQI composite measures have changed in two ways since the initial release. First, PQI 10 Dehydration Admission Rate and PQI 13 Angina Without Procedure Admission Rate measures were retired in Version 2019 and removed from the composites containing them.2 Second, a fourth PQI composite measure, PQI 93 Prevention Quality Diabetes Composite, was added. There have also been changes to the specifications of component PQIs that constitute the composites, which can be found on the AHRQ QI website in the Log of Coding Updates and Revisions (https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/v2021/ChangeLog_PQI_v2021.pdf). 6.0 What Are the Current Uses of the Composites? The PQI composites are intended to be used to provide national estimates that can be tracked over time and to provide State and county level estimates that can be compared with the national estimate and to each other. The following two questions were examined in the initial creation of the composite: 1 Agency for Healthcare Research and Quality (2006). Prevention Quality Indicators (PQI) Composite Measure Workgroup Final Report. The report is available at https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/PQI_Composite_Development.pdf 2 PQI 10 was removed from PQI composites 90 and 91. PQI 13 was removed from PQI composites 90 and 92. https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/v2021/ChangeLog_PQI_v2021.pdf https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/PQI_Composite_Development.pdf AHRQ Quality IndicatorsTM Quality Indicator User Guide: Prevention Quality Indicators (PQI) Composite Measures, v2021 Version 2021 Page 4 July 2021 1. Does disease prevalence impact variability? As anticipated, areas with higher rates of diabetes and hypertension show higher hospitalizations, particularly in the chronic composite. However, for asthma the contrary relation is true suggesting other confounding factors. 2. Is variability driven by poverty status? Areas with low levels of poverty also show lower hospitalization rates for each of the PQI composites, which is independent of access to care. 7.0 Additional Resources See the AHRQ QI website for additional PQI resources and downloads http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx Agency for Healthcare Research and Quality (2006). Prevention Quality Indicators (PQI) Composite Measure Workgroup Final Report. The report is available at https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/PQI_Composite_Development.pdf http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/PQI_Composite_Development.pdf Prepared for: 1.0 Overview 2.0 What Are the Composites? 3.0 How Are the Composites Created? 4.0 Steps for Creating the Composite 5.0 How Have the Composites Changed? 6.0 What Are the Current Uses of the Composites? 7.0 Additional Resources An official website of the Department of Health and Human Services Careers | Contact Us | Español | FAQs | Email Updates Search AHRQ Topics Programs Research Data Tools Funding & Grants News About Home Talking Quality Select Measures To Report Domains of Health Care Quality SHARE: Talking Quality Plan Your Reporting Project Translate Data Into Information Explain and Motivate Use Distribute Your Quality Report Promote Your Quality Report Assess Your Reporting Project Resources About TalkingQuality Select Measures To Report Domains of Health Care Quality Types of Quality Measures Data Sources Key Questions About Measures Measures in Different Settings Quality Measurement Resources Six Domains of Health Care Quality A handful of analytic frameworks for quality assessment have guided measure development initiatives in the public and private sectors. One of the most influential is the framework put forth by the Institute of Medicine (IOM), which includes the following six aims for the health care system. Safe: Avoiding harm to patients from the care that is intended to help them. Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively). Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. Existing measures address some domains more extensively than others. The vast majority of measures address effectiveness and safety, a smaller number examine timeliness and patient-centeredness, and very few assess the efficiency or equity of care. Frameworks like the IOM domains also make it easier for consumers to grasp the meaning and relevance of quality measures. Studies have shown that providing consumers with a framework for understanding quality helps them value a broader range of quality indicators. For example, when consumers are given a brief, understandable explanation of safe, effective, and patient-centered care, they view all three categories as important. Further, when measures are grouped into user-friendly versions of those three IOM domains, consumers can see the meaning of the measures more clearly and understand how they relate to their own concerns about their care. To learn more about grouping measures into categories, go to Organizing Measures To Reduce Information Overload. To learn more about selecting and reporting measures within categories that consumers understand, refer to: Hibbard J. Engaging Consumers in Quality Issues: While the road to engaging consumers is steep, it is fairly well marked. Washington, DC: National Institute for Health Care Management Foundation; October 2005. Available at http://www.nihcm.org/pdf/ExpertV9.pdf . Hibbard JH, Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347- 351. Pillittere D, Bigley MB, Hibbard J, et al. Exploring Consumer Perspectives on Good Physician Care: A Summary of Focus Group Results. New York: The Commonwealth Fund; January 2003. Available at https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2003_jan_exploring_consumer_perspectives_on_good_physician_care__a_summary_of_focus_group_results_pillittere_consumerperspectives_578_pdf.pdf Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001. Institute of Medicine (IOM). Performance Measurement: Accelerating Improvement. Washington, D.C: National Academy Press; 2005. Hibbard JH, Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351. Also in Select Measures to Report The Six Domains of Health Care Quality Types of Measures You Can Report Understanding Data Sources Selecting the Right Measures for Your Report Measures of Quality for Different Health Care Settings Quality Measurement Resources [1] [2] [3] [1] [2] [3] Page last reviewed November 2018 Page originally created February 2015 Connect With Us Sign up for Email Updates To sign up for updates or to access your subscriber preferences, please enter your email address below. Sign Up Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857 Telephone: (301) 427-1364 Careers Contact Us Español FAQs Accessibility Disclaimers EEO Electronic Policies FOIA HHS Digital Strategy HHS Nondiscrimination Notice Inspector General Plain Writing Act Privacy Policy Viewers & Players U.S. Department of Health & Human Services The White House USA.gov Internet Citation: Six Domains of Health Care Quality. Content last reviewed November 2018. 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