AQI Quality is Pain Free!

1. AQI Quality is Pain Free! 27 July, 2011

2. The public perceives widespread problems with quality y

3. Disclosure I am the Business Analyst of the Anesthesia Quality Institute, a public charity devoted to creating a national registry. The AQI pays my salary. I am strongly biased on this topic.

4. Disclosure, continued • If I fail to convince enough people to contribute data: • the AQI will fail • I will be fired • my dog will starve

5. Objectives • Review the purposes of the AQI and it’s various projects • What, How, Who • Provide an overview of the benefits of joining AQI • Discuss future directions and solicit questions

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

7. Guiding Principles • Storage capacity and bandwidth are infinite • 1 Terabyte of storage 5 years ago cost $600 • Today <$75 • Anesthesia events are rare • Lots of data will be needed • Open formatting will decrease competition and encourage participation • Anesthesiologists are impatient by nature

8. The Who of AQI Can you match the title with the picture? • The Man with the Plan • IT Guru • The Organizer • Jack of all Trades • Data Detective • Code Jockey

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

10. Why Have Quality Management? To improve patient outcomes To improve business efficiency To meet regulatory requirements

11. Basic QM Philosophy • The more you know, the better you do • Quality management data = research data + business data • Every patient encounter is a data point

12. What to Collect? Quality Improvement data Hospital EHR / EMR data AIMS data Administrative / Billing data

13. Who Contributes? Everyone! “Of the Profession … For the Profession” All practices have data, all have a need for data Administrative data is not perfect … but is still useful

14. Practice Recruitment Process Legal agreements Practice Demographic Survey Technical assessment Data transmission

15. AQI – Registry 2.0 • Select all cases (no bias) • Collect all available data • De-identify data • Caveat: context must be preserved • Build a system of “pipes” for data flow • Verify the data: electronic/human auditing • Invest in analysis and reporting

16. NSQIP AQI • 2 - year history • Open to all • All cases • Passive data capture • Undefined elements • Complex analysis • Free * • Up and running • 20 year history • Limited participants • Selected cases • Focused abstraction • Defined elements • Easy analysis • Expensive • Up and running

17. Where are we now? • 516 interested practices • 106 Participants • As of July 25, 2011: • 81 groups providing data • 707 facilities • 4430 providers • 1,255,931 cases

18. NACOR Metrics • Reports of Outcomes • The number of all cases in NACOR with a serious adverse event reported is 1110. This represents 0.45 % of all cases performed by reporting practices. • The number of deaths reports to date in NACOR (excluding ASA 6 organ donors) is 129.

19. Practice Reports

20. Practice Reports

21. AQI Talking Points • AQI is only collecting billing data • Billing data is important but over 80% of the cases come from practices reporting at least 1 quality measure. • I can’t contribute because I don’t have an AIMS system. • Every practice can contribute. Every practice has billing/admin data. Many practices w/o AIMS have quality data they contribute.

22. AQI Talking Points cont… • It’s too expensive and takes too much time. • AQI membership is $500/physician. Waived if physician is an ASA member. • Once initial setup is complete, contributing data takes < 10 minutes/month for all your cases. • AQI is giving my data to the government. • We can’t – that would be illegal.

23. AQI Talking Points cont… • What about HIPPA? • The legal agreements address HIPAA compliance. Also, practices can choose not to send fields they are not comfortable sending. • What’s in it for the practices? • Practices receive benchmarked reports to use for improving patient outcomes, practice efficiency, and regulatory reporting

24. AQI products – Anesthesia Incident Reporting System (AIRS) • Browser-based incident reporting system • Allows for confidential or anonymous reporting • Reports can be emailed to local quality coordinators • Reported events will be used as learning tools – in conjunction with NACOR data • Based on input from the AIRS committee • Large Academic Centers and International Members (NZ/AU) • Live – Collecting Cases! • Grand opening part of AQI activities at ASA Annual Meeting

25. AQI Products – NPRNational PAIN Registry • Developing a new registry for Pain procedures • Created a browser-based application for use in tracking patient visit for Pain Treatments • Live – Beta Testing • Tracks patient visits over time • Developed at the request of leading members of ASRA

26. Next Steps for Practices • Take good care of patients • Measure outcomes • Use standard definitions • Measure at 24 hours • Include a category for “uneventful” • Use the data • Tell us how you did it

27. Next Steps for the AQI • Continued data gathering: 100 practices • Steadily improved reporting: • Formatting and navigation • Depth of reporting • Outcome benchmarks • Provider level • Focused analytic projects • OPPE and FPPE • Practice dashboards

28. Upcoming AQI Webinars • Part2: Quality Management in Your Practice • Presenter: Dr. Richard Dutton, AQI Executive Director • Date: Late August • Part3: Practical Application of QM in Your Practice • Presenter: Dr. Christina Doyle • Date: TBD - Late September

29. “Knowledge is Power” “Let’s Dance” -- Kevin Bacon, Footloose, 1984 -- Sir Francis Bacon, 1597