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Investing in Children’s Health Care Quality Improvement: Returns in Lives, Health, and Dollars—An Illustration

Investing in Children’s Health Care Quality Improvement: Returns in Lives, Health, and Dollars—An Illustration. Denise Dougherty, Ph.D., Presented by Anne Elixhauser, Ph.D. June 24, 2006 CHSR, Seattle, WA. Overview.

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Investing in Children’s Health Care Quality Improvement: Returns in Lives, Health, and Dollars—An Illustration

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  1. Investing in Children’s Health Care Quality Improvement: Returns in Lives, Health, and Dollars—An Illustration Denise Dougherty, Ph.D., Presented by Anne Elixhauser, Ph.D. June 24, 2006 CHSR, Seattle, WA

  2. Overview • What would be the impact of investing in improvements in health care quality for children? • Two examples of preliminary studies: • Child lives saved • Morbidity avoided • Dollars to Medicaid

  3. No Needless Deaths—Investigators • Denise Dougherty, Ph.D., AHRQ • Lisa Simpson, MB, BCh, MPH, FAAP, University of South Florida • Melissa Romaire, MPH, CMS (work done at AHRQ) • Charles Homer, MD, NICHQ*-Cambridge, MA • Lisa C. White, MPH, NICHQ*-Seattle * National Initiative for Children’s Healthcare Quality

  4. Rationale and Methods • Rationale: draw attention to children’s healthcare quality • IHI 100,000 Lives Campaign on No Needless Deaths • Woolf et al. report on deaths due to disparities got a lot of attention • IOM’s To Err is Human figure of 98,000+ deaths due to medical errors received attention. • Identified leading causes of death in children 0-17 • Among leading causes, identified those with evidence that improved health care quality could reduce child deaths • Estimated # of deaths nationally that could be prevented with improved healthcare quality • Extrapolated life years gained using YPLL* method * Years of Potential Life Lost

  5. Results—Needless Deaths Prevented Through QI

  6. Other Evidence of Poor Quality of Care for Children Source: AHRQ, National Healthcare Quality Report and National Healthcare Disparities Report, 2005

  7. Improving Neonatal Outcomes of Medicaid-Covered Infants—Investigators • Denise Dougherty, Ph.D., AHRQ • Bernard Friedman, Ph.D., AHRQ • Vipul Mankad, MD, U MD (done while at CMS) • With assistance of: • Jeannette Rogowski, Ph.D. • Nikki Highsmith, MPA • Neonatal Outcomes Improvement Group

  8. Rationale and Methods • Rationale: CMS Medicaid trying to stimulate quality improvement and reduce costs • Methods: • Identified 4 illustrative perinatal areas with evidence of the potential for improvement • Detailed 2002 HCUP cost data on neonatal special care units from 7 States • Calculated differences between pre- and post-QI admissions or LOS • Extrapolated to national estimates using national totals of deliveries and incidence of conditions

  9. Results • Average cost difference between a Medicaid NICU stay and a Medicaid regular nursery stay was $18,607 • Average difference in LOS was 11-16 days Source: AHRQ, Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), 7 States, 2002 data, extrapolated to national estimates

  10. Preliminary Results Notes: 1) Gross mean costs of QI initiatives not included. 2) Medicaid programs may not be able to recoup all costs.

  11. Other compelling reasons to improve perinatal care • Neonatal deaths prevented: • 338 deaths prevented with smoking cessation • Prevention of extremely low birth weight and very low birth weight can potentially prevent: • Intensive care admissions and ICU days during the first year of life • Low IQ • Poor math and gross motor skills • Other poor neurodevelopmental outcomes (cerebral palsy, vision impairments) References available on request.

  12. Conclusions • Conclusions: • Needless deaths and substantial morbidity can be prevented • Substantial child life years gained • Medicaid expenditures can potentially be reduced

  13. Caveats and Needed Research • Caveats: • Figures are preliminary and illustrative due to incompleteness of data sources • Cost of QI interventions not included • State Medicaid programs unlikely to recoup all savings • Research needed: • Effectiveness of QI for other leading causes of child deaths and morbidity • National data on children’s health care quality and costs • Research on effectiveness of interventions (to develop quality measures)

  14. Informal Reactions from Previous Reviewers • Needless deaths pre-review • Enthusiasm during presentations • For potential publication: • Numbers are small relative to other conditions and due to QI focus • Child life years gained not understood • Neonatal care improvements • Some States eager to discuss • CMS to hold stakeholder meeting • Some States say they don’t have these problems – analysis doesn’t apply to them

  15. Questions • Is this enough to act on? • If not, why not? • What research strategies should be used to create more data and frame the issues?

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