Using AHRQ QI Composites

1
Using AHRQ QI Composites

• AHRQ Annual Conference 2008

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What is a composite?

• Composite measures are combinations of two or
  more components measures
• Component measures may be outcome (mortality,
  morbidity, proxy), process, structure, patient
  experience, cost or conjunctive (and/or)
  combinations of each other

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Purpose of a composite

• Advantages of a composite
• Improved statistical precision through increasing
  the effective sample size
• Simultaneous consideration of more than one
  component measure
• Optimal when more then one component is important
• Do not know in advance which component is most
  important

4
Purpose of a composite

• Two mechanisms of performance improvement to
  achieve the goal of the composite (e.g. reduce
  post-operative mortality, adverse events, etc.)
• Reward effort
• Quality improvement, pay-for-performance
• Recognize ability
• Comparative reporting, selective contracting

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AHRQ QI Composites

• Four composite measures
• Mortality for selected procedures
• Mortality for selected conditions
• Patient safety for selected indicators
• Pediatric patient safety for selected indicators
• Developed with the composite workgroup
• Reports available on AHRQ QI website

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AHRQ QI Composites

• Common methodology
• The scale is a reliability-adjusted
  observed-to-expected ratio
• The aggregation approach is a weighted average of
  these ratios
• The weights are user defined, but generally the
  proportion of numerator events
• Overall or for specific populations

7
National Quality Forum

• Composite Measure Evaluation Framework
• NQF Member comments due September 11, 2008 by
  600 PM ET
• Importance, scientific acceptability, usability,
  feasibility
• Components NQF-endorsed or assessed to have met
  the individual measure criteria

8
Public Reporting and PPV
Hospital Patients Rate Events
A 1,000 0.050 50.0
B 1,000 0.025 25.0
Total 2,000 75.0

Hospital Patients Rate Events
A 900 0.050 45.0
B 1,100 0.025 27.5
Total 2,000 72.5
9
Public Reporting and PPV
Hospital Patients Rate PPV Events
A 1,000 0.050 0.500 25.0
B 1,000 0.025 0.500 12.5
Total 2,000 37.5

Hospital Patients Rate PPV Events
A 900 0.050 0.500 22.5
B 1,100 0.025 0.500 13.8
Total 2,000 36.3
10
Public Reporting and PPV
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Public Reporting and PPV
Hospital Patients Rate E(PPV) Events
A 1,000 0.050 0.500 25.0
B 1,000 0.025 0.500 12.5
Total 2,000 37.5

Hospital Patients Rate E(PPV) Events
A 900 0.050 0.500 22.5
B 1,100 0.025 0.500 13.8
Total 2,000 36.3
With variance
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Public Reporting and PPV

• How good is good enough?
• Goal of improving quality as measured by overall
  population outcomes
• Demand elasticity
• change in Q for change in signal
• Provider rate and variance
• Relationship between PPV and PPV variance