BACKGROUND/RATIONALE:
The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are a group of evidence-based measures that use administrative data to screen for potential quality problems in the inpatient and outpatient settings. They represent readily available and low cost measures that may be applied to VA data. Although numerous organizations outside the VA have effectively used the QIs for hospital quality improvement, monitoring trends over time, and public, national, and state reporting, these indicators have received little attention in the VA. Therefore, applying the QIs to VA data presents a unique opportunity to further VA's agenda in quality improvement and patient safety initiatives.

OBJECTIVE(S):
Specific study objectives are to: 1) develop collaborations with key stakeholders who will provide clinical and methodological input and guidance on identifying a set of high-priority QIs for use in VA; 2) apply and modify the AHRQ QI algorithms for use on VA data; 3) compare QI rates across VA facilities/VISNs; 4) investigate the validity of these QIs as indicators of quality; 5) Develop a facility-level quality report and informational guide that facilities can use to understand their QI rates.

METHODS:
This was an observational study using existing national databases from FY04 through FY07. We obtained input from key VA stakeholders, convened through a steering committee using a modification of the RAND Appropriateness Method to determine which QI measures were of highest priority for the VA and merited further study. We obtained information on VA care from the National Patient Care Database. We validated the QIs by examining their association with each other and related measures from the External Peer Review Program. QI rates were compared across facilities and to non-VA benchmarks. Additionally, we developed a report template containing VISN and facility-level reports of QI measures, and associated educational guide to facilitate interpretation of results by local managers and clinicians.


FINDINGS/RESULTS:
The QI algorithms were relatively easy to apply to VA data with minor modifications. At the VA, VISN and facility level, surgical procedure death rates have been fairly stable over time (FY04 through FY07), while medical condition death rates have been decreasing. There was relatively little inter-VISN or inter-facility variation with respect to procedural IQIs, but some variation in medical conditions. We were able to identify consistent outlier VISNs and facilities over time. The utilization indicators showed the most VISN and facility-level variation, with several consistent outliers across years. Using additional years of data did not substantially improve the ability to discriminate between VISNs or facilities with respect to procedure-related mortality. For the PQIs, several VISNs and facilities were consistently high or low outliers over time over. While in-hospital and 30-day condition or procedure specific mortality were mostly strongly correlated, procedure volume and procedure related mortality measures were not correlated. Several medical mortality IQIs were strongly correlated with each other. Correlations between related EPRP process measures and QIs were generally weak.

IMPACT:
The AHRQ QIs can be applied to VA data and used to compare VA VISNs and facilities. They can be useful to tracks rate trends over time, and to reveal variation between sites. By identifying potential quality events related to mortality and utilization and admissions, they may complement existing VA QI initiatives.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Borzecki AM, Christiansen CL, Chew P, Loveland S, Rosen AK. Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions. Medical care. 2010 Dec 1; 48(12):1117-21. [view]
2. Borzecki AM, Christiansen CL, Loveland S, Chew P, Rosen AK. Trends in the inpatient quality indicators: the Veterans Health Administration experience. Medical care. 2010 Aug 1; 48(8):694-702. [view]

Conference Presentations

1. Shimada SL, Rosen AK, Chew PW, Borzecki AM. Are There Racial/Ethnic Disparities in Mortality Rates and Surgical Procedure Use in the Veterans Health Administration? Paper presented at: AcademyHealth Annual Research Meeting; 2009 Jun 30; Chicago, IL. [view]
2. Borzecki AM, Loveland S, Chew PW, Loya PM, Rosen AK. Inpatient Quality Indicator Rates in Select Veteran Populations. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 30; Chicago, IL. [view]
3. Borzecki AM, Chew PW, Loveland S, Loya PM, Rosen AK. Inpatient Quality Indicators Rates in Special VA Populations. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD. [view]
4. Borzecki AM, Chew PW, Loveland SA, Loya PA, Hartmann CW, Rosen AK. Inpatient Quality Indicators: Comparison of Facility-Level Rates Across the VA. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]
5. Borzecki AM, Loya PM, Chew PW, Loveland S, Rosen AK. Translating the AHRQ Quality Indicators to the VA. Poster session presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ. [view]
6. Hanchate AD, Borzecki AM, Loveland S, Zhao S, Chew PW, Shwartz M, Ash AS, Rosen AK. Using Laboratory Results Data to Improve Risk Adjustment of In-hospital Mortality in the VA. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 13; Baltimore, MD. [view]
7. Rosen AK, Borzecki AM, Kaafarani H, Hanchate AD, Loveland S, Hartmann CW, Shwartz M, Rivard P, Shin M. Validating the Patient Safety Indicators (PSIs): Do They Reflect True Safety Events? Poster session presented at: VA HSR&D National Meeting; 2009 Feb 14; Baltimore, MD. [view]

DRA: Health Systems Science
DRE: none
Keywords: Quality assessment, Quality assurance, improvement
MeSH Terms: none