Slide Presentation from the AHRQ 2008 Annual Conference
On September 10, 2008, AHRQ Speakers, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (556 KB).
Slide 1
Using Agency for Healthcare Research Quality (AHRQ) Quality Indicator (QI) Composites
- AHRQ Annual Conference 2008.
Slide 2
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.
Slide 3
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.
Slide 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.
Slide 5
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 Web site.
Slide 6
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.
Slide 7
National Quality Forum (NQF)
- Composite Measure Evaluation Framework.
- NQF Member comments due September 11, 2008, by 6:00 PM ET.
- Importance, scientific acceptability, usability, feasibility.
- Components NQF-endorsed or assessed to have met the individual measure criteria.
Slide 8
Public Reporting and PPV
- Table shows:
- Hospital—Patients—Rate—Events.
- A—1,000—0.050—50.0
- B—1,000—0.025—25.0
- Total—2,000—(blank)—75.0
Slide 9
Public Reporting and PPV
- Table shows:
- Hospital—Patients—Rate—PPV—Events.
- A—1,000—0.050—0.500—25.0—25.0
- B—1,000—0.025—0.500—12.5—12.5
- Total—2,000—(blank)—(blank)—37.5
Slide 10
Public Reporting and Positive Predictive Value (PPV)
- Bar graph shows "Variance in PPV" (percentages here are approximate based on where the tops of bars appear to be).
- 0.20: 4%
- 0.30: 13%
- 0.40: 20%
- 0.50: 26%
- 0.60: 20%
- 0.70: 13%
- 0.80: 3%
Slide 11
Public Reporting and PPV
- Tables show:
- 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—(blank)—(blank)—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—(blank)—(blank)—36.3
- With variance
Slide 12
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.
Current as of January 2009
Internet Citation:
Using AHRQ Composites. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/091008slides/AHRQQI.htm