Comparing UDS Data
As February 15th approaches, the Quality, IT, HR, Finance, and Compliance teams at HRSA Health Centers are scrambling to pull everything together for the Uniform Data System (UDS) submission. The struggle is real. HRSA doesn’t always release the PIN updating the requirements on time. EMRs often don’t have specific reports or updated reports for the new requirements. And when they do, the workflows to make the reports work often require a huge change. With all of the work that goes into the submission of the UDS, we are often so tired we don’t take a step back to reflect on what it is telling us. What’s more, we often don’t connect the dots between our past performance, how we compare to others, and what we can do to monetize our performance.
Using publicly available data from HRSA, dp3solutions has compiled a national database of UDS data and built a custom BI dashboard for each Health Center in the country. We want to help our health centers take a step back and decide what to do next to improve patient care in their communities and their own bottom line.
In this post, we’ll take a look a deidentified health center’s dashboard in detail to understand what it is telling us, and what we should do about it. Let’s jump in.
Overview
This dashboard presents a single page view of the health center’s quality data from the UDS over three years, the total patients served in the most recent UDS, and two tables detailing how many patients would it take to meet goals for the UDS improvement. We used Microsoft PowerBI to build the report based on the HRSA data found at https://data.hrsa.gov/tools/data-reporting/program-data.
The column and line graph details the health center’s performance year over year and compared to the national percentiles.
The total patients graphic gives a total of the number of unique patients served by the health center in the most recent calendar year.
The table for Patients to Improve 15% or Reach 100% details the current percentage performance along with the number of patients needed to improve by 15% or reach 100% compliance. This helps detail the work necessary to meet the Clinical Quality Improver Award.
Finally, the table for Patients to Meet Next Quartile or 100% details the current Adjust Quartile Ranking for each measure, and the number of patients required to reach the next quartile ranking or 100% compliance. This table directs the attention to what it will take for a health center to meet the Health Center Quality Leader Award.
Next, let’s take a look at each item in detail.
Comparisons - Year to Year and Peer to Peer
Let’s zoom in on the UDS Comparison to National Benchmarks. Each of the 16 quality measures is grouped together with 2017, 2018, and 2019 percent performance represented by different shades of blue columns. For measures that do not have a bar, like the CAD Statin measure, there is missing data from HRSA or the measure changed from previous years so there is no available data.
In this example, you can see that while most measures are stable, the Dental Sealant measure took a sharp drop in 2019. This would be worth exploring with the health center to see if there was a reporting change, an EMR issue, or a previous misreporting to understand such a drastic drop. This is also a likely candidate for improving this year.
Also, of note, the Weight Assessment and Nutrition Counseling for Children measure improved in 2019. This would also warrant a conversation with the health center to determine what actions lead to this positive change. Was it a focused intervention, an update to a template, a coding change, or was it merely a reporting anomaly?
Remember, the bar graph here is percent compliant which is the numerator over the denominator, where the denominator is the number of qualifying patients less any exclusions. This graph is helpful to compare with other health centers in terms of performance, but may hide the actual work required to make a change.
That’s where the dashed lines for percentile comparison come in.
Using the HRSA data for all health centers, the dashed lines provide a peer-to-peer comparison for the quality measures. The red line represents the 25th percentile or the bottom 25% of health centers for each measure. This means 75% of health centers out performed this group, or in raw numbers about 1,100 health centers did better than this. The yellow line represents the 50th percentile, and the green line represents the 75th percentile. You can see that for Diabetes Control and Low Birth Weights the color orders are switched because the better performance is lower.
You can also see that for some measures the three lines are close together like Low Birth Weight, while other measures are more spread out, like Depression Screening and Follow Up. For the closer measures, this means every patient can make a big difference on which quartile you score in - which plays to the Health Center Quality Leader Award. Leader Award - but may make it difficult to score a big increase. For the spread-out measures, this means it will take more percentage points to make a difference, but it’s like that you may be able to make large gains on this measure and qualify for the Clinical Quality Improver Award.
Overall, this health center has several measures in between the 50th and 75th percentile (or HRSA’s 2nd Quartile Rank), with a few above and a few below. Let’s look at 3 measures specifically.
Measure Specifics - Up and Down
Depression Screening
This health center has been able to improve the Depression Screening measure each year from 2017 to 2018. Starting close to the 25th percentile mark in 2017, they have now move within a few patients of breaking into the next quartile. From an outsider perspective, because of the wide distribution of the percentiles, and the steady improvement of the health center, this feels like a create candidate for focused improvement. This may be a project for the EMR team to figure out how templates and reminders can help automate this measure.
Diabetes Control
This measure has stayed relatively flat over the past three years for this health center. And understandably so. This is a difficult measure to move. You can see that the better performance is lower for this measure, but that this health center is in the HRSA 2nd Quartile Rank, and appears to be within striking distance of the 1st Quartile Rank. Given the huge impact Diabetes has on our communities, as well as HRSA’s focused attention on this measure, this would be something that would require dedicated time and resources to help make a meaningful difference. You may not see the quick benefits for a measure like this.
Early Prenatal Care
The health center had been in the HRSA 1st Quartile Rank for two years and then slipped last year. This measure is largely about care coordination and access for prenatal patients. Given the health center’s previous success, it may be worth investigating what was different and how we can return to the previous success.
Achieving Clinical Quality Improver Award
While the column and line chart is good for comparison to other health centers, this table begins to make things actionable. This table looks at each quality measure, and provides the number of patients needed to have a 15% improvement or meet 100% compliance.
For example, Asthma is already at 97% compliance in the most recent year, and can only improve 3 percent. That 3 percent, however, represents 68 patients. This helps the message sink in, and we begin to get an idea of the work required to make these improvements.
This can be helpful for Quality Team to figure out where the low hanging fruit is, as well as the financial team to understand the scope of resources that will be required to make a meaningful improvement. The upside, is that this can also help identify which measures should be considered for improving to meet the Clinical Quality Improver Award.
Taking the Depression example we looked at earlier, a 15% improvement would take them from 71% to 86% compliant, but would be 4,499 patients. This again speaks to the need for automation and systems solutions to help take advantage of this opportunity.
Achieving Health Center Quality Leader Award
Similar to the previous table, this table helps identify the number of patients need to meet the goal. Instead of a 15% growth, this table looks at what it would take to get to the next Quartile Rank for HRSA. To move the CAD Statin measure out of the 4th Quartile to the 3rd Quartile, 258 patients need to have the correct medication. For Low Birth Weights, however, only 12 few patients would be needed to move this to the next goal.
Reviewing this data can help a team reviewing the overall performance to determine how many measures need to be improved to bring up the overall score and enable a health center to attain the Health Center Quality Leader Award.
What’s the Impact?
Finally, the Total Patients card shows how many overall unique patients this health center served in the last UDS. This health center served 52,771 unique patients across medical, dental, behavioral health, vision, enabling services, and substance abuse. This number helps give a perspective to the overall impact of improving these measures, and an estimate of what the Awards from HRSA will be worth. If this health center is able to improve at least 1 quality measure by 15% that will mean approximately $3,000 + $52,771 = $55,771 dollars. In addition, the Health Center Quality Leader Award would be another $55K, which is nothing to sneeze at.
Conclusion
Taking the time to reviewing the UDS data to set a game plan is well worth the investment to see where you’ve been and decide where you will go. If you’d like a copy of your dashboard contact us here and we’ll start a conversation.