Patrick S. Romano, MD MPH
Professor of Medicine and Pediatrics
UC Davis School of Medicine
AcademyHealth 2006 Child Health Services Research Meeting
June 24, 2006

Funded by AHRQ
Support for Quality Indicators II (Contract No. 290-04-0020)
 Mamatha Pancholi, AHRQ Project Officer
 Marybeth Farquhar, AHRQ QI Senior Advisor
 Mark Gritz and Jeffrey Geppert, Project Directors, Battelle Health and Life Sciences
Data used for analyses:
Nationwide Inpatient Sample (NIS), 1995-2003. Healthcare Cost and
Utilization Project (HCUP), Agency for Healthcare Research and
Quality
State Inpatient Databases (SID), 1997-2003 (38 states). Healthcare
Cost and Utilization Project (HCUP), Agency for Healthcare
Research and Quality

Acknowledgments
We gratefully acknowledge the data organizations in participating states that contributed data to HCUP and that we used in this study: the Arizona Department of Health Services; California
Office of Statewide Health Planning & Development; Colorado Health & Hospital Association;
Connecticut - Chime, Inc.; Florida Agency for Health Care Administration; Georgia: An
Association of Hospitals & Health Systems; Hawaii Health Information Corporation; Illinois
Health Care Cost Containment Council; Iowa Hospital Association; Kansas Hospital
Association; Kentucky Department for Public Health; Maine Health Data Organization;
Maryland Health Services Cost Review; Massachusetts Division of Health Care Finance and
Policy; Michigan Health & Hospital Association; Minnesota Hospital Association; Missouri
Hospital Industry Data Institute; Nebraska Hospital Association; Nevada Department of Human
Resources; New Jersey Department of Health & Senior Services; New York State Department of Health; North Carolina Department of Health and Human Services; Ohio Hospital
Association; Oregon Association of Hospitals & Health Systems; Pennsylvania Health Care
Cost Containment Council; Rhode Island Department of Health; South Carolina State Budget &
Control Board; South Dakota Association of Healthcare Organizations; Tennessee Hospital
Association; Texas Health Care Information Council; Utah Department of Health; Vermont
Association of Hospitals and Health Systems; Virginia Health Information; Washington State
Department of Health; West Virginia Health Care Authority; Wisconsin Department of Health &
Family Services.

Overview of insights (?)
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Why use the PedQIs?
–
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Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Validate or test key hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

Overview of insights (?)
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Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Validate or test key hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

We don’t have to do this, but …
 Not: invent or choose indicators that make us look good
 Not: hide or redefine indicators that make us look bad

 National Quality Forum (NQF)
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Hospital care
Adult cardiac surgery
Nursing-sensitive indicators
Safe practices
Shell in place for ambulatory indicators
 JCAHO
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JCAHO/CMS adult core measures
National patient safety goals
 AHRQ
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Patient safety indicators (PSIs)
Inpatient quality indicators (IQIs)
 Others
(e.g., pediatric ORYX, NICU mortality)
Also: financials, patient satisfaction

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Norton Healthcare Surgery Report Card brief description
% surgeries w/ postoperative bleeding
% abdominal surgeries w/ postop wound dehiscence
% w/ pneumothorax resulting from medical care
% surgeries w/ postop physiologic derangement
% surgeries w/ postop respiratory failure
% surgeries w/ postop PE or
DVT
% surgeries w/ postop sepsis
% craniotomy patients who die (AHRQ risk-adjusted) desired AUD low low low low low low low low
0.15
0.00
0.09
0.05
0.6
1.1
5.2
6.5
NH
0.23
0.20
0.08
0.09
1.6
1.5
3.1
6.8
Red or green if outside 99% C.I. based on U.S.
SW SUB
0.30
0.22
0.05
0.05
0.6
0.8
1.8
6.6
KCH
0.19
0.24
0.07
0.03
0.9
0.8
0
September 14, 2005 posting
KY
0.22
0.16
0.07
0.09
0.8
0.9
1.9
7.4
U.S.
0.22
0.20
0.08
0.11
0.4
0.9
1.2
7.4

“Why we did it”
 Accountability as a public asset
– Clinical care is, in fact, our “widget”
– We talk about our financials with bond raters, the press, etc.; why not our clinical performance?
 Proactively influence the the public reporting arena
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Clinical over purely financial
Transparent over proprietary
Evidence based over arbitrary
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Get the organization moving in a direction that is inherently inevitable
Improve our care; “We’ll manage what we measure and report”

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Unused data never become valid.
Even a lousy indicator can drive improvement.

Overview of insights (?)
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Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Validate or test key hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

National trends in PSI rates, 2000-2003 KID
Extremely rare events (<0.01%)
0.005%
0.005%
0.004%
0.004%
0.003%
0.003%
0.002%
0.002%
0.001%
0.001%
Foreign body left in during procedure
Transfusion reactions (ABO/Rh)
0.000%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

National trends in PSI rates, 2000-2003 KID
Rare events (0.01-0.1%)
0.10%
0.09%
0.08%
0.07%
0.06%
0.05%
Accidental puncture and laceration
Postop abdominopelvic wound dehiscence
Iatrogenic PTX - neonate
0.04%
0.03%
0.02%
0.01%
Iatrogenic PTX - nonneonatal
0.00%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

National trends in PSI rates, 2000-2003 KID
Low-frequency events (0.1-0.5%)
0.4%
0.4%
0.3%
0.3%
0.2%
0.2%
Decubitus ulcer
Selected infections due to medical care
Postop hemorrhage/hematoma
0.1%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

National trends in PSI rates, 2000-2003 KID
Medium-frequency events (0.5-5.0%)
5.0%
4.5%
4.0%
3.5%
3.0%
2.5%
Pediatric heart surgery mortality
Postop sepsis
2.0%
1.5%
Postop respiratory failure
1.0%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

National trends in PSI rates, 2000-2003 KID
High-frequency events (>5.0%)
40%
38%
36%
34%
32%
30%
28%
26%
24%
Perforated appendix
22%
20%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

National trends in PSI rates, 2000-2003 KID
Potentially avoidable hospital conditions
0.20%
0.18%
0.16%
0.14%
0.12%
0.10%
0.08%
0.06%
0.04%
0.02%
Gastroenteritis/dehydration
UTI
Asthma
Diabetic short-term complications
0.00%
2000 2003
Kids’ Inpatient Database 2000 and 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Unadjusted Rates.

0.900
0.800
0.700
0.600
0.500
0.400
0.300
0.200
0.100
0.000
Asthma Diabetes Gastroenteritis
Kids’ Inpatient Database 2003. AHRQ Healthcare Cost and Utilization Project.
AHRQ PDI Version 3.0b Risk-adjusted Rates.
UTI
Northeast
Midwest
South
West

Overview of insights (?)
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
Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Validate or test key hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

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Ran the AHRQ PSIs on NACHRI’s Case Mix database, containing 3 million discharges from approximately 70 children’s hospitals.
Developed the NACHRI Pediatric PSI Collaborative, a self-selected group of 20 hospitals interested in pursuing this analysis further
Published a manuscript entitled “Relevance of the AHRQ PSIs for
Children’s Hospitals” in the January 2005 journal Pediatrics.
Developed and released a Patient Safety Indicator Toolkit (available through NACHRI’s website) with sample press release, op ed, Q&A, and background documents for hospitals to educate their communities and the media on the relevance and utility of PSIs for pediatrics.
Developed an online, secure chart review tool that allowed Collaborative participants to review the preventability of patients flagged as having any of 11 selected PSI events.
Fostered a relationship with AHRQ and Stanford/UC Davis to update each other on NACHRI’s findings and the PedQI development work.

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Collaborative Participants
 AL / Children’s Hospital of Alabama / Dr. Crayton Farguson *
 CA / Lucile Packard CH at Stanford / Dr. Paul Sharek *
CA / UC-Davis / Dr. James Marcin **
DC / Children’s National Medical Center / Dr. Tony Slonim
*
CA / Mattel Children’s at UCLA / Ms. Mary Kimball
**
FL / All Children’s / Dr. Jack Hutto *
KY / Kosair Children’s Hospital / Dr. Ben Yandell *
LA / Children’s Hospital New Orleans / Ms. Cindy Nuesslein *
MD / Johns Hopkins Children’s Center / Dr. Marlene Miller*
MA / Children’s Hospital Boston / Drs. Daniel Nigrin and Don Goldmann
MI / C.S. Mott Children’s Hospital – U Mich / Dr. Aileen Sedman
*
MO / Children’s Mercy Kansas City / Dr. Cathy Carroll *
OH / The Children’s Medical Center Dayton / Dr. Thomas Murphy *
OH / Cincinnati Children’s Medical Center / Drs. Uma Kotagal, Joseph Luria
*
OH / Children’s Hospital Columbus / Dr. Thomas Hansen
*
OH / Children’s Hospital MC of Akron / Dr. Michael Bird
PA / Children’s Hospital of Philadelphia / Drs. James Stevens, Joel Portnoy
TX / Texas Children’s Hospital / Dr. Joan Shook *
TX / Children’s Medical Center of Dallas / Dr. Fiona Levy, Ms. Kathy Lauwers
*
WI / Children’s Hospital of Wisconsin / Dr. Matthew Scanlon
*

“…while 40% to 50% may seem low for positive predictive value, in terms of real patients, this means that 4 or 5 out of 10 children had a preventable event for this indicator. This is worth looking at and the things we are finding in some instances, will allow for immediate changes that may impact outcomes for future patients.”
[Collaborative physician reviewer]

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During removal of non functioning port cath the end of the catheter was noted to be "irregular and not smoooth cut". It appeared the tip had been embolized for an unknown duration…
During replacement of pacemaker lead, a fragment of the lead broke off, embolized and ended up lodged (puncture) in the anterolateral papillary muscle.
No notation in original operative note or nursing record that sponge/needle counts were done and correct.
Count was reported as correct. Sponge discovered on xray due to complaints of abdominal pain by patient.
Child with bone tumor who had mandible removed with subsequent bone graft and much packing in wound. This was supposedly removed before extubation, but at the time of extubation a remaining pack blocked her airway causing reintubation with pack removal.

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…occurred during the insertion of a PICC line. The record indicates on the first attempt a artery paralleling the basilar vien was cannulated.
Urethral injury after a transurethral ablation of posterior urethral valves as well as bleeding post circumcision… both required suturing to repair.
14 year old feamle with spinal bifida and urinary and fecal incontinence who underwent appendicovesicostomy, continent cecostomy, bladder neck sling for urinary incontinence and enteroenterostomy. … a small perforation was made in the vagina and was repaired.
6 week old with pyloric stenosis who underwent laparoscopic pyloromyotomy. A small gastric mucosal perforation occurred at the end and required opening the abdomen to repair.
Colon was perforated during liver transplant.
Pt underwent transrectal drainage of abscess on 7/29 with foley used to drain bladder. Pt developed hematuria and required surgery exploration when bladder puncture was discovered from surgery.
Laparoscopic procedure using harmonic scalpel. Bleeding noted. converted to open procedure. Aorta repaired.
Laparascopic appendectomy. Small opening made in cecum. Repaired at the time of surgery.
After d/c from spinal fusion, patient presented to clinic with drainage from operative site.
Seroma noted. Admitted and returned to OR. … lacerated baclofen pump catheter.
Rib removed to use for laryngeal reconstruction--pleura was punctured.

Overview of insights (?)

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

Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Test interesting hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

Effect of work hours reform in NY teaching hospitals on smoothed PSI rates
Poulose BK, et al., Ann Surg 2005;241:847-860

Effect of work hours reform in NY teaching hospitals on smoothed PSI rates
Poulose BK, et al., Ann Surg 2005;241:847-860

Overview of insights (?)
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Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Validate or test key hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

 Is the outcome indicator associated with explicit processes of care (e.g., appropriate use of medications)?
 Is the outcome indicator associated with implicit process of care (e.g., global ratings of quality)?
 Is the outcome indicator associated with nurse staffing or skill mix, physician skill mix, or other aspects of hospital structure?
 Is the outcome indicator associated with other meaningful outcomes of care?

Estimating the impact of preventing each PSI event on mortality, LOS, charges
NIS 2000 analysis by Zhan & Miller, JAMA 2003;290:1868-74
Indicator
Postoperative septicemia
Postoperative thromboembolism
Postoperative respiratory failure
Postoperative physiologic or metabolic derangement
Decubitus ulcer
Selected infections due to medical care
Postoperative hip fracture
Accidental puncture or laceration
Iatrogenic pneumothorax
Postoperative hemorrhage/hematoma
Δ Mort (%) Δ LOS (d) Δ Charge ($)
21.9
6.6
21.8
19.8
10.9
5.4
9.1
8.9
$57,700
21,700
53,500
54,800
7.2
4.3
4.5
2.2
7.0
3.0
4.0
9.6
5.2
1.3
4.4
3.9
10,800
38,700
13,400
8,300
17,300
21,400

Estimating the impact of preventing each PSI event on mortality, LOS, charges
Zhan & Miller, JAMA 2003; key findings replicated by Rosen et al., 2005
Indicator
Birth trauma
Obstetric trauma –cesarean
Obstetric trauma - vaginal w/out instrumentation
Obstetric trauma - vaginal w instrumentation
Postoperative abdominopelvic wound dehiscence
Transfusion reaction*
Complications of anesthesia*
Foreign body left during procedure†
Δ Mort (%) Δ LOS (d) Δ Charge ($)
-0.1 (NS) -0.1 (NS)
-0.0 (NS)
0.0 (NS)
0.4
0.05
300 (NS)
2,700
-100 (NS)
0.0 (NS)
9.6
0.07
9.4
220
40,300
-1.0 (NS)
0.2 (NS)
2.1
3.4 (NS)
0.2 (NS)
2.1
18,900 (NS)
1,600
13,300
* All differences also NS for transfusion reaction and complications of anesthesia in VA/PTF.
† Mortality difference NS for foreign body in VA/PTF.

Some PSI rates are significantly higher in
African-Americans or Hispanics than in whites
Coffee RM, et al., Med Care 2005;43:I-48 to I-57

Some PSI rates are significantly lower in
African-Americans or Hispanics than in whites
Coffee RM, et al., Med Care 2005;43:I-48 to I-57

Overview of insights (?)
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
Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Test interesting hypotheses (research)
Is it a coding/documentation issue?
Is it a quality issue?
Questions and answers

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There is a basic tension between using administrative data for reimbursement and for defining quality indicators
– Submitting bills quickly versus coding from a complete record
– Maximizing the coding of complications and comorbidities versus only coding diagnoses “out of the norm.”
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–
–
Variation in QI rates might be due to variation in:
– Data availability (e.g., number of diagnosis codes, admission type, external cause of injury codes)
Documentation completeness and accuracy
ICD-9-CM and DRG coding
Performance (e.g., processes of care, staffing)

ICD-9-CM Coding
Adherence to best practices in coding and compliance with coding guidelines will ensure fair reimbursement and accurate measurement of quality indicators
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Use the highest possible level of specificity
– Avoid overuse of NEC and NOS designation
Follow guidelines re coding of secondary diagnoses
– Only codes that impact treatment or complications
Follow guidelines re coding of procedures
– Only significant procedures to be reported

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

 For reporting purposes the definition for "other diagnoses" is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or extended length of hospital stay; or increased nursing care and/or monitoring.
 UHDDS…defines Other Diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay.
Diagnoses that relate to an earlier episode which have no bearing on the current hospital stay are to be excluded.”

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“Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the physician indicates their clinical significance.”
“If the findings are outside the normal range and the physician has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the physician whether the abnormal finding should be added.”
“All conditions that occur following surgery…are not complications… there must be more than a routinely expected condition or occurrence… there must be a cause-and-effect relationship between the care provided and the condition…”

Participating Hospitals
State of Texas (THCIC PUDF)*
1999
Num
1999
Den
831 305519
1999
Obs
2.72
1999
RiskAdj
2.72
1999
Exp
2.72
1999
LoCI
2.44
1999
HiCI
3.00
1999
CI
Hosp A
Hosp B
6
3
3255
1324
1.84
2.27
1.82
2.27
2.75
2.72
Hosp C
Hosp D
55
1
1815
1427
Participating Hospitals
State of Texas (THCIC PUDF)*
2000
Num
2000
Den
831 326095
30.30
0.70
2000
Obs
2.55
30.28
0.66
2000
RiskAdj
2.55
2.72
2.89
2000
Exp
2.55
-0.91
-2.00
4.55
( 0.00, 4.55 )
6.54
( 0.00, 6.54 )
26.63
-3.47
2000
LoCI
2.28
33.94
( 26.63, 33.94 )
4.79
( 0.00, 4.79 )
2000
HiCI
2.82
2000
CI
Hosp A
Hosp B
Hosp C
3
2
45
3303
1604
1752
0.91
1.25
25.68
Hosp D
Participating Hospitals
State of Texas (THCIC PUDF)*
2001
Num
2
763
1484
2001
Den
333101
2001
Obs
1.35
2.29
0.90
1.27
25.66
2.58
2.51
2.55
1.36
2001
RiskAdj
2.29
2001
Exp
2.54
2.29
-1.81
-2.61
21.94
3.61
5.14
29.38
( 0.00, 3.61 )
( 0.00, 5.14 )
( 21.94, 29.38 )
-2.68
2001
LoCI
2.02
2001
HiCI
5.39
( 0.00, 5.39 )
2.56
2001
CI
Hosp A
Hosp B
Hosp C
Hosp D
8
4
53
1
3099
1553
1915
1618
2.58
2.58
27.68
0.62
2.58
2.58
27.66
0.59
2.29
2.29
2.29
2.40
-0.21
-1.37
24.11
-3.29
5.37
( 0.00, 5.37 )
6.53
( 0.00, 6.53 )
31.22
( 24.11, 31.22 )
4.46
( 0.00, 4.46 )
Stat
Sig o o
o
Stat
Sig o o
o
Stat
Sig o o
o

Birth Trauma―Injury to Neonate
Numerator:
Discharges with ICD-9-CM codes for birth trauma in any diagnosis field per 1,000 liveborn births.
Birth Trauma
ICD-9-CM diagnosis codes:
7670 Subdural and cerebral hemorrhage (due to trauma or to intrapartum anoxia or hypoxia)
7673 Injuries to skeleton (excludes clavicle)
7674 Injury to spine and spinal cord
7677 Other cranial and peripheral nerve injuries
7678 Other specified birth trauma
7679 Birth trauma, unspecified
Code Index under “Molding, head” lists 767.3
ICD-9-CM Coding Manual Definition
767.3 Other Injuries To Skeleton Due To Birth Trauma
Fracture of: long bones, skull
767.4 Injury To Spine And Spinal Cord Due To Birth Trauma
{Dislocation} {Fracture} {Laceration} {Rupture} of spine or spinal cord due to birth trauma

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“The UHDDS requires all significant procedures to be reported… A significant procedure is defined as one that meets any of the following conditions:
Is surgical in nature
Carries an anesthetic risk
Carries a procedural risk
Requires specialized training.”
What about central venous catheters?

“Selected infections due to medical care”
“Postoperative hemorrhage or hematoma”
999.3
Other infection
Infection following infusion, injection, transfusion, or vaccination
Sepsis following infusion, injection, transfusion, or vaccination
Septicemia following infusion, injection, transfusion, or vaccination
Excludes: the listed conditions when specified as: due to implanted device (996.60-996.69) postoperative NOS (998.51-998.59)
998.1
Hemorrhage or hematoma or seroma complicating a procedure
Excludes: hemorrhage, hematoma or seroma: complicating cesarean section or puerperal perineal wound (674.3) due to implanted device or graft (996.70-996.79)
998.11 Hemorrhage complicating a procedure
998.12 Hematoma complicating a procedure

Coding Resources
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American Health Information Management Association (AHIMA)
– www.ahima.org
American Hospital Association
– www.hospitalconnect.com/ahacentraloffice/ahaco/index.jsp
National Center for Health Statistics
– www.cdc.gov/nchs/icd9.htm
Centers for Medicare and Medicaid Services
– www.cms.gov
AHIMA Resources and Practice Briefs
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– www.ahima.org/infocenter/practice_tools.asp
Developing a Coding Compliance Policy Document
Developing a Physician Query Process
Ongoing Coding Reviews: Ways to Ensure Quality
HIM’s Role in Monitoring Patient Safety
Internet Resources for Coding and Reimbursement Practices

Overview of insights (?)
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
Why use the PedQIs?
–
–
Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
–
–
Evaluate impact of interventions
Test interesting hypotheses (research)
Is it a coding issue?
Is it a quality issue?
Questions and answers

Relevance of AHRQ PSIs for Children’s Hospitals
Sedman A, et al. Pediatrics 2005;115(1):135-145
PSI
Complications of anesthesia
Death in low-mortality DRG
Decubitus ulcer
Failure to rescue
Foreign body left in
Postop hemorrhage or hematoma
Iatrogenic pneumothorax
Selected infection 2 ° to med care
Postop DVT/PE
Postop wound dehiscence
Accidental puncture or laceration
No. reviewed
(total events)
Preventable
(PPV %)
74 (503) 11 (15%)
121 (1282) 16 (13%)
130 (2300) 71 (55%)
187 (5271)
49 (235)
15 (8%)
25 (51%)
114 (1571) 40 (35%)
114 (1113) 51 (45%)
152 (7291) 63 (41%)
126 (1956) 36 (29%)
41 (232) 19 (46%)
133 (4020) 86 (65%)
Nonpreventable Unclear
37
89
47
148
14
51
42
45
61
16
19
29
6
26
11
10
23
21
25
16
10
39

Linking the PedQIs to quality
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New collaboration with NACHRI to conduct chart reviews for PedQIs, focused on confirming the event, describing how it occurred, confirming correct risk stratification, and assessing preventability.
Build collaborative network with other partners, in which
UC/Stanford/Battelle will provide:
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Standardized, pretested abstraction tools
Abstraction guidelines and resources
Training programs for chart reviewers
Online tools for data collection, management, and cleaning
Summarized data reports for partners with suggestions for improvement (based on data from entire network)
– Optional chart over-reading to establish reliability/validity

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Tier indicators based on validity or potential usefulness for CQI and public reporting; flag indicators that don’t make the grade
Inform NQF review process
Modify indicator definitions if possible to improve sensitivity/specificity
Identify omitted risk factors to improve riskadjustment
Identify key loci of preventability (opportunities for improvement): what should providers with high rates look for in evaluating their care?
What can hospitals learn from the leaders?

Overview of insights (?)
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Why use the PedQIs?
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Establish accountability
Surveillance/track performance over time and across hospitals/units/services
– Trigger case finding, root cause analyses, identification of clusters
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Evaluate impact of interventions
Test interesting hypotheses (research)
Is it a coding issue?
Is it a quality issue?
Questions and discussion

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