Five Years of AQI: What do we know about ourselves now?

Report
Five Years of the AQI:
What Do We Know About Ourselves Now?
Richard P. Dutton, M.D. M.B.A.
Executive Director
aqihq.org
Disclosure
•
I am the Executive Director of the Anesthesia Quality
Institute
•
The AQI pays my salary
•
I think the AQI is a good idea!
© 2014 ANESTHESIA QUALITY INSTITUTE
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Agenda
• Provide the history and purpose of AQI
• Give an update on AQI progress and future goals
• Educate professional anesthesiologists
© 2014 ANESTHESIA QUALITY INSTITUTE
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The AQI
Vision: To become the primary source for quality
improvement in the clinical practice of anesthesiology
Mission: To maintain AQI’s registries with case data as
the primary resource for anesthesiologists looking to
assess and improve patient care.
© 2014 ANESTHESIA QUALITY INSTITUTE
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AQI-Who We Are
• Richard P. Dutton, M.D., M.B.A.
o Executive Director
• Hubert Kordylewski, Ph.D.
o System Architect
• Lance Mueller, M.S.
o Director
• Adrian Liau, Ph.D.
o Senior Research Associate
• Rico Turman, B.S.
o Application Developer
• Jill Mlodoch, M.S.M.
o Registry Manager
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AQI-Who We Are
• Benjamin Westlake, B.S.
o Application Developer
• Debbie Novi, B.S.
o Quality Division Assistant
• Antonio Sepulveda, B.S.
o Application Developer
• Ashley Kieta, B.A.
o Communications & Public
Relations Associate
• Santana Sandoval, B.S.
o Application Developer
© 2014 ANESTHESIA QUALITY INSTITUTE
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AQI-Who We Are
• Miles Faciane
– Application Developer
• Annette Antos
– Quality and Regulatory Reporting Specialist
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AQI Registries
• NACOR
• AIRS
• PPAI
• Closed Claims Project
• National Pain Registry
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Putting on AIRS
• Re-certified as a
Patient Safety
Organization
• > 1,300 cases
• 40 articles
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www.aqiairs.org
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NACOR: The National Anesthesia
Clinical Outcomes Registry
•
•
•
•
•
•
Participation at the practice level
Every case, every day
All available data
Feedback via online reporting
Certified for regulatory reporting
The goal: Local Quality Improvement
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21 Million Cases
• Adding 2,500,000 cases
per quarter
o Registry 2.0 – no
abstraction or eyeballs
• Will capture 25% of all
the anesthesia cases in
the U.S. in 2014
o 34,000 Anesthesia
Providers
o 3,300 Facilities
• The largest registry of its
kind
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What NACOR collects
• Administrative data
20m cases
• Outcomes data
4m
• AIMS data
1m
• Hospital EHR data
none
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Census Registry Participation
Sign
Participation
and
Business
Associates
data use
agreements
Enter
practice,
provider, and
facility
information
© 2014 ANESTHESIA QUALITY INSTITUTE
Registry
participant
runs case
level data
report
Registry
participant
uploads data
to the
Registry
Registry
participant
views
reports
14
Census Registry Reports
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Outcomes Reporting
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Provider Level Report
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NACOR Growth
NACOR Cases
Facilities
25000000
2500
20000000
2000
15000000
NACOR Cases
10000000
1500
Facilities
1000
5000000
500
0
2010 2011 2012 2013 2014
0
2010
2011
Providers
2013
2014
Practices
25000
250
20000
200
15000
150
Providers
10000
Practices
100
5000
50
0
2010 2011
2012INSTITUTE
2013
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QUALITY
2012
0
2014
2010
2011
2012
2013
2014
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Provider Distributions
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Average Practice Size
60
MD/DO
CRNA
OTHER
50
40
30
20
10
0
Q1
Q2
Q3
Q4
Q1
© 2014 ANESTHESIA QUALITY INSTITUTE
2010
Q2
Q3
2011
Q4
Q1
Q2
2012
Q3
Q4
2012
Q1
Q2
Q3
2013
Q4
Q1
20
2014
Q2
Practices by Their Largest Facility
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Anesthesiologists by Facility Type
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Cases by Facility Type
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Cases by Facility Type
Freestanding Surgery Center
University Hospital
450000
700000
400000
600000
350000
500000
300000
400000
250000
University Hospital
200000
150000
200000
100000
100000
50000
0
0
2010
2011
2012
2013
2010
Large Community Hospital (over 500
beds)
900000
800000
700000
600000
500000
400000
300000
200000
100000
0
Freestanding Surgery
Center
300000
2000000
2011
2012
2013
Medium Community Hospital (100500 beds)
1500000
Large Community Hospital
(over 500 beds)
1000000
Medium Community
Hospital (100-500 beds)
500000
© 2014 ANESTHESIA QUALITY INSTITUTE
2010
2011
2012
2013
0
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2010
2011
2012
2013
Practice Income Source
90
80
70
Percentage
60
50
Contracted
Fee for Service
40
Other
30
20
10
0
2010
© 2014 ANESTHESIA QUALITY INSTITUTE
2011
2012
Year
2013
2014
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Patient Distribution by Age and Gender
250000
200000
150000
Female
Male
100000
50000
0
1
4
7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 103 106
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Patient Age Over Time
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Outpatient Surgery
80
70
60
Percent
50
40
30
20
10
0
Q1
Q2
Q3
Q4
2010
© 2014 ANESTHESIA QUALITY INSTITUTE
Q1
Q2
Q3
2011
Q4
Q1
Q2
Q3
2012
Q4
Q1
Q2
Q3
2013
Q4
Q1
Q2
2014
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Monitored Anesthesia Care
25
20
Percent
15
10
5
0
Q1
Q2
Q3
Q4
2010
© 2014 ANESTHESIA QUALITY INSTITUTE
Q1
Q2
Q3
2011
Q4
Q1
Q2
Q3
2012
Q4
Q1
Q2
Q3
2013
Q4
Q1
Q2
2014
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Top 6 Cases by Patient Age
90,000
80,000
70,000
60,000
50,000
# of Cases
40,000
30,000
20,000
10,000
0
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90
Upper gastrointestinal endoscopy biopsy
Cholecystectomy and common duct exploration
Colonoscopy and biopsy
Forceps vacuum and breech delivery
Lens and cataract procedures
Other therapeutic procedures on muscles and tendons
© 2014 ANESTHESIA QUALITY INSTITUTE
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Cases by Facility Type
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Procedures by Time
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Cases by Facility by Time
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Practice Benchmarking
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Outcomes
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Outcomes
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Outcomes
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Outcomes
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Outcomes
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Major Outcomes
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Major Outcomes
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Overall Outcomes
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Practice Benchmarking
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Practice Benchmarking
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Changing National Practice
© 2014 ANESTHESIA QUALITY INSTITUTE
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Outcomes in NACOR
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Patient Satisfaction
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AQI Educational Resources
•
•
•
•
•
•
Nuts and bolts of quality management
Outcomes of interest
Data capture templates
Anesthesia QM references and links
List of acronyms
Links to information technology vendors
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MOCA--PPAI
•
•
•
•
•
•
Addresses the Part IV requirements
ABA approved modules available from ASA
13 modules now, more in the coming year
“Customizable” QM project modules coming soon
Clinical data from real-world practice
AQI holds and aggregates the data
© 2014 ANESTHESIA QUALITY INSTITUTE
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The Participant User File (PUF)
• The PUF file is a collection of all cases in NACOR
• The file contains de-identified patient demographic,
billing, procedural, outcomes, clinical, and provider
information, all in a single common format.
• Requires PUF request form to be completed and
approved by the AQI
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PUF-more
• PUF is accompanied by a User Guide and a Data Dictionary
• The PUF is available in multiple download formats. PUF will
require statistical software to open the file and do analytics.
• New version of PUF made available on a quarterly basis – includes
a Readme.txt for specific information about this version of the file
• File is available for download on an FTP site.
Credentials/instructions will be provided when PUF request is
approved.
• We are creating a listserv community of approved PUF researchers.
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Data Dictionary
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PUF User Guide
© 2014 ANESTHESIA QUALITY INSTITUTE
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Sample of PUF Data
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AQI and MPOG
• The Multicenter Perioperative Outcomes Group
• Same data, different purposes:
o AQI – Local quality improvement
o MPOG – Research
• Joint participation encouraged
o Shared formats, data elements
• Regular communication to ensure that requests for data
wind up in the right place
o The right data for the question
o Avoidance of duplicative efforts
© 2014 ANESTHESIA QUALITY INSTITUTE
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AQI and SCOR
• The SAMBA Clinical Outcomes Registry is becoming the
AQI’s recommended ambulatory data module
• Multiple data collection methods
o Stand-alone SCOR software
o Abstraction from EHR
• Ambulatory specific benchmark reporting through
SAMBA, to their members
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AQI and STS/SCA Registry
• The Society for Thoracic Surgeons / Society for
Cardiovascular Anesthesia Registry
• Granular case data collected by nurse abstractors, as
part of the STS registry
• SCA has defined the data elements, and will assist STS
in data analysis
• Analysis will benefit from STS risk adjustment model
• Do this if you can!
© 2014 ANESTHESIA QUALITY INSTITUTE
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Maternal Quality Improvement Project
•
•
•
•
•
•
MQIP: outcomes in childbirth
A joint venture of ASA and ACOG
AQI is the ‘Technical Vendor’
EHR built to collect structured data
Direct transmission to Registry for 90% of desired fields
Progress
o Steering Committee
o Advisory Committee
o Data elements defined (first draft)
o Epic build happening at University of Rochester
© 2014 ANESTHESIA QUALITY INSTITUTE
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The NGO / WFSA Quality Project
• Began as a request to aggregate data from overseas
trips by US anesthesiologists
• Request from WFSA Quality Committee to make it a
template for local (international) use
• Agreement on data elements and format
• Templates up on AQI website
• Data collection mechanisms established
o Paper > Scantron
o Tablet > direct to cloud
• Stay tuned!
© 2014 ANESTHESIA QUALITY INSTITUTE
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The Anesthesia Leadership Registry
•
•
•
•
A database of individuals
Jobs and titles outside the OR
Contact information
Linked to ASA Membership Data; ASA Practice Registry
• Uses:
o National understanding of our “footprint”
o Networking for existing leaders
o Mentoring for new leaders
© 2014 ANESTHESIA QUALITY INSTITUTE
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The Qualified Clinical Data Registry
• NACOR is a certified QCDR
• CMS Pay for Performance reporting for anesthesia
practices and eligible providers
• Avoid penalties, qualify for incentives!
• 19 measures available in 2014; more in 2015
• Practice must be participating in NACOR
• Reporting to CMS is free for ASA members; nominal cost
for non-members
• Information available on the AQI website
© 2014 ANESTHESIA QUALITY INSTITUTE
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Contact Us
www.aqihq.org
or
[email protected]
© 2014 ANESTHESIA QUALITY INSTITUTE
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