Transcript 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.
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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
Basic Principles
• The more you know, the better you do
• Quality management data
= research data
= business data
• Every patient encounter is a data point
NACOR: the National Anesthesia
Clinical Outcomes Registry
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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
NACOR – September, 2013
Practices under contract:
Facilities:
Providers:
Cases:
Outcomes:
300
2,100
21,000
13,000,000
2,000,000
Outcomes
• Mortality:
0.04%
• Major:
0.52%
• Minor:
10.21%
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Anesthesia Measures
• Approved for public reporting:
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Antibiotic timing
Central line bundle
PACU normothermia
Smoking cessation
PONV prophylaxis
PACU and ICU hand-offs
Aspirin for stent patients
Registry participation
Brown M&Ms
Where do we need to be?
The Perfect Quality Measure
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A real outcome
Demonstrates variability
Easy to collect
Easy to risk adjust
Easy to report
Acceptable to the public (government)
Acceptable to the profession
Mortality
Easy to define
Easy to count
Should be a good
way to define
effectiveness …
…right?
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)
Public Reporting
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
Do We Contribute to Mortality?
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Stress and inflammation
Fluid management
Ventilator strategy
Post-op analgesia
Antibiotics
DVT prophylaxis
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
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
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
Serious Administrative Events
• Unplanned
admission
• Unplanned ICU
• Late case
cancellation
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Late start
Intra-op delay
Slow emergence
Delayed departure
from PACU
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Helping
Anesthesia
Professionals
Improve Patient
Care
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Helping
Anesthesia
Professionals
Improve Patient
Care
PONV
• Countable, although definitions vary
• Common, assessable at the provider level
• Improvable
– Empiric evidence
– Scientific literature
• But does it matter?
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– No durable harm, but …
– Important to patient satisfaction
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
How do we get there?
At the Personal Level
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Find something meaningful to measure!
Insist on seeing the data
Follow trends over time
Share your data upwards
Look for peer group benchmarks
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
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
Contact Us!
www.aqihq.org
or
[email protected]