New AHRQ tool to help hospitals better display quality data
All you need to take advantage of the Agency for Healthcare Research and Quality’s (AHRQ) latest tool is hospital administrative or claims data. Called MONAHRQ (My Own Network, Powered by AHRQ), the free tool is a software program built to allow organizations to analyze data and/or create their own websites.
The AHRQ released MONAHRQ in early June with the hope that many organizations, including individual hospitals, hospital associations, and regional health initiatives, would take advantage of the ability to analyze and display data at no cost, says Anne Elixhauser, PhD, senior research scientist at the AHRQ, who is responsible for the tool.
“I remember several years ago I was at a conference and I heard a CEO of a hospital talking about how he wanted his hospital to get out in front on the quality reporting frontier,” says Elixhauser. “He wanted his hospital to have a website that explicitly described all the quality information he had available … and it took them a year and about $300,000 to put a website together.”
That cost is something Elixhauser and her team have heard echoed by other hospitals and state associations. To alleviate this burden, the AHRQ looked at its cadre of existing tools and put together a few of them, including the AHRQ quality indicators, a Windows-based version of the AHRQ quality measures, and HCUPnet (which contains information from the Healthcare Cost and Utilization Project), into one package.
The idea is that someone with hospital claims data can enter raw data into the MONAHRQ system and not have to do much more work to analyze the data, generate HTML pages with reports, create a website, and grant users access to the reports and websites in a logical way, says Elixhauser.
After more than two years of work, the first version of the tool offers four paths for users, two at the hospital level and two at the county level. The following are the hospital-level paths included in the tool:
- Quality measures based on the AHRQ quality indicators, which include 57 measures such as inpatient mortality and adverse events following certain procedures
- Basic utilization statistics, such as numbers of discharges, lengths of stay, costs for specific conditions, procedures, or diagnosis-related groups (DRG)
The following are the county-level paths included in the tool:
- Potentially avoidable hospitalizations. These are hospitalizations in which good outpatient care could have potentially averted the need for patients to have been hospitalized. This is reported at the county level because it’s not really a reflection on the quality of care provided at one specific hospital, says Elixhauser. “We’re simply using the hospital data as a window into the community,” she says.
- Hospitalization rates for specific conditions, procedures, and DRGs by county, which allows for a broader comparison by area, such as rates of breast cancer or myocardial infarction.
Comparative ability provides real value in tool
Although individual hospitals have the option of submitting their own data to the tool and creating a website to display their quality information either internally or to the public, the value in the tool is its ability to compare multiple hospitals’ data, says Elixhauser.
“The real power of MONAHRQ is in its comparative ability … and that requires data from multiple hospitals, like all the hospitals in a state,” she says. “What I expect is that organizations that have data from multiple hospitals will be the ones that have the biggest impact.”
That’s how the tool will likely be used in Minnesota, says Mark Sonneborn, vice president of information services at the Minnesota Hospital Association (MHA). The MHA already collects claims data from all emergency and inpatient departments in the state and contributes that information to the AHRQ through HCUP. One of the difficulties has been that it’s had to run those data through the AHRQ software and then manipulate the information to display it.
“MONAHRQ is going to solve that problem,” says Sonneborn. “We’re going to be able to run this data and display it immediately and have our members be able to look at some of this data, which will be a big benefit for us.”
Karla Weng, MPH, CPHQ, program manager at Stratis Health in Bloomington, MN, a nonprofit organization that works with hospitals to improve quality and is also the Minnesota Medicare Quality Improvement Organization, echoed that sentiment.
“My assumption is that rather than individual hospitals using the tool, critical access hospital networks or other groups that support multiple hospitals may be the ones that utilize the tool,” Weng says.
Sonneborn says he is not convinced the Web pages that the tool creates will provide value for members of the general public. Instead, they are likely more beneficial for hospital staff who are familiar with the indicators.
MHA’s plan is to roll the tool out to members only as a means of allowing them to check up on how they’re doing on the AHRQ quality indicators. This will allow hospitals to benchmark how they stack up against the national average for some indicators, as well as against other hospitals in the state and against themselves in a previous time period, says Sonneborn.
MHA was involved in beta-testing MONAHRQ in winter 2009, says Sonneborn. During that time, a group of hospital and state data associations tested the tool. One of the issues the beta testers worked on was determining whether different methods for data storage affected the tool.
“There are different ways that data is stored in different states, and that was something that AHRQ wanted to see if it made a difference,” says Sonneborn. “In our part of the beta test, we were the problem; it didn’t work right away, they didn’t know why, but we got all that figured out. That’s what a beta test is for—finding the bugs and problems people might have.”
Although Sonneborn notes that the data display of MONAHRQ is not quite ready for public viewing, future versions may accomplish this better, which will likely drive patient engagement. In Minnesota, there’s a state mandate to publicly display these types of quality data, so other efforts are under way to engage patients.
“There are other efforts to make this data public and make our providers accountable for the patient safety they provide,” says Sonneborn. “Most of all, MONAHRQ makes it easy for us to deliver the information to our members.”
Another question raised is the ease of use for facilities that do not have the resources to hire staff members trained in software data analysis.
“My initial take is that even though the tool appears to greatly simplify the process, there is still some analytic and data expertise needed to utilize the tool, which may be a challenge to some facilities,” says Weng.
Ultimately, the hope is that MONAHRQ will give hospitals one more way to make being transparent easier.
“The basic goal here is to provide information that is pretty readily available if you have the ability to get to it,” Elixhauser says. “Right now, virtually every state in the country collects data from all the hospitals in their state. A lot of those states already do public reporting, a lot of them don’t. What we’ve done here is provide a tool that would remove some technical and financial barriers not to do it.”
Editor’s note: Visit http://monahrq.ahrq.gov for more information about MONAHRQ and to download the tool.