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From Process to Outcome Measures : How Can AQI Facilitate?

From Process to Outcome Measures : How Can AQI Facilitate?. Richard P. Dutton, MD MBA Executive Director. DATA!. Where are we now?. The Challenge. The government wants to know that Ma and Pa are getting the healthcare they deserve … and that our taxes pay for. The AQI.

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From Process to Outcome Measures : How Can AQI Facilitate?

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  1. From Process to Outcome Measures: How Can AQI Facilitate? Richard P. Dutton, MD MBA Executive Director

  2. DATA!

  3. Where are we now?

  4. The Challenge The government wants to know that Ma and Pa are getting the healthcare they deserve … and that our taxes pay for.

  5. The AQI • A non-profit 501(c)3 corporation • Vision: To become the primary source for quality improvement in the clinical practice of anesthesiology • Mission: To establish and maintain the National Anesthesia Clinical Outcomes Registry

  6. Basic Principles • The more you know, the better you do • Quality management data = research data = business data • Every patient encounter is a data point

  7. NACOR: the National Anesthesia Clinical Outcomes Registry • Participation at the practice level • Every case, every day • All available data • Feedback via online reporting • Regulatory compliance • PQRS • OPPE, FPPE • The goal: Local Quality Improvement

  8. NACOR– September, 2013 Practices under contract: 300 Facilities: 2,100 Providers: 21,000 Cases: 13,000,000 Outcomes: 2,000,000

  9. Outcomes • Mortality: 0.04% • Major: 0.52% • Minor: 10.21%

  10. Anesthesia Measures • Approved for public reporting: • Antibiotic timing • Central line bundle • PACU normothermia • Smoking cessation • PONV prophylaxis • PACU and ICU hand-offs • Aspirin for stent patients • Registry participation

  11. Brown M&Ms

  12. Where do we need to be?

  13. The Perfect Quality Measure • A real outcome • Demonstrates variability • Easy to collect • Easy to risk adjust • Easy to report • Acceptable to the public (government) • Acceptable to the profession

  14. Mortality Easy to define Easy to count Should be a good way to define effectiveness … …right?

  15. Anesthesia Mortality Estimates Mortality in elective outpatient surgery: 7.8/million in ASCs (92/million in offices) (Vila et al. Arch Surg 2003) Mortality within 30 days of admission: 4/hundred at the Shock Trauma Center (Dutton et al. J Trauma 2010)

  16. Public Reporting

  17. Too Rare to be Effective? The average anesthesia provider might see 1 perioperative death per year … … but … Up to 4% of patients will die within 30 days of major surgery

  18. Do We Contribute to Mortality? • Stress and inflammation • Fluid management • Ventilator strategy • Post-op analgesia • Antibiotics • DVT prophylaxis

  19. Shared Accountability • Team-based measures of real outcomes • “Owned” in equal parts by surgery, anesthesia and nursing • Collected, reported and benchmarked at the facility level • Used by all for accreditation and regulation

  20. The Rate of Successful Anesthesia Denominator: All patients scheduled for surgery at 0600 on a given day Numerator: The number of those patients who complete the scheduled surgery without a serious adverse event

  21. Serious Adverse Events • Mortality • Organ system failure • Respiratory • Cardiac • Renal • Neurologic injury • Cognitive • Peripheral • Wrong surgery • Cardiac or respiratory arrest • Anaphylaxis • Malignant hyperthermia • Difficult airway • Medication error

  22. Serious Administrative Events • Unplanned admission • Unplanned ICU • Late case cancellation • Late start • Intra-op delay • Slow emergence • Delayed departure from PACU

  23. Helping Anesthesia Professionals Improve Patient Care

  24. Helping Anesthesia Professionals Improve Patient Care

  25. PONV • Countable, although definitions vary • Common, assessable at the provider level • Improvable • Empiric evidence • Scientific literature • But does it matter? • No durable harm, but … • Important to patient satisfaction

  26. Patient Satisfaction? • Considered an important outcome measure • Required for facilities • CAHPS • S-CAHPS • CAHPS HOSD/ASC • Will be required for physicians • Limited data in anesthesiology

  27. How do we get there?

  28. At the Personal Level • Find something meaningful to measure! • Insist on seeing the data • Follow trends over time • Share your data upwards • Look for peer group benchmarks

  29. At the Practice Level • Measure those things that matter to your patients and facilities • Seek common definitions • Work with vendors • Work with registries • Share the data upwards • Seek external benchmarks

  30. At the National Level • Learn – by looking – what anesthesiologists consider important • Encourage common definitions • AQI website: www.aqihq.org • Defcon • Aggregate data, learn what works • Advocate for the profession

  31. Contact Us! www.aqihq.org or r.dutton@asahq.org

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