3099 — Inpatient Quality Indicators: Comparison of Facility-Level Rates Across the VA
Borzecki AM (COE - Bedford), Chew PW
(COE- Bedford), Loveland SA
(COE - Bedford), Loya PM
(COE - Bedford), Hartmann CW
(COE - Bedford), Rosen AK
(COE - Bedford)
The Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are evidence-based measures that screen for potential inpatient quality problems using administrative data. They measure procedure volume (counts), utilization (rates), and in-hospital procedure and condition-specific mortality (rates). Despite extensive non-VA use for quality improvement, IQIs have received little VA attention. This study examined: 1)the feasibility of applying the IQIs to VA data and
2)variation in counts and rates across facilities and years.
We used FY03-06 VA inpatient files and AHRQ IQI software (v3.1) to examine facility-level IQI counts and ratios of observed (unadjusted) to expected rates (risk-adjusted using age, gender and APR-DRGs), as appropriate for 23 IQIs, across facilities and years.
Rarer volume IQIs varied across facilities (e.g., pancreatic resection: annual range 1-9, median 2), fluctuating slightly by facility over time; more common procedures such as coronary bypass (facility range 1-325, median 130) showed an annual decrease in total VA-performed procedures (5,806-5,328 in FY03 vs FY06). Observed facility mortality rates were highest for complex procedures such as pancreatic resection (FY03 mean 0.24+/-0.44) but decreased annually (FY06 mean 0.15+/-0.42). Overall annual observed to expected ratios (O/Es) were < 1.0 (i.e., rate < expected). However, 2 of 55 facilities had O/Es > 1.0 at least 2 of 4 years. For more common procedures, observed mortality rates decreased annually (e.g., coronary bypass: FY03 mean 3.98+/-2.69 to 2.62+/-2.17 in FY06); all facilities had O/Es < 1.0 across years. VA-wide mortality rates from conditions such as stroke were fairly stable over time with O/Es < 1.0. In any given year there were a few outlier facilities (O/Es > 1.0) but no consistent trend. Utilization indicators showed the most facility variation, e.g., incidental appendectomy (FY03 facility mean 1.08+/-1.87 per 100 laparotomies). Several facilities had O/Es > 1.0 across all years.
Facility-level mortality rates were lower than expected over time for all medical condition-related IQIs, and all but the most complex procedure-related IQIs. Rates of potentially inappropriate procedure use were more likely to exceed expected rates with certain facilities consistently higher over time.
Preliminary analyses suggest that, especially with respect to potentially inappropriate procedure use,
on-site facility examination may provide opportunities for provider training and cost-saving.