The Agency for Healthcare Research and Quality (AHRQ) conducts many research tasks, of which the Quality Indicators (QIs) are only one. Information about AHRQ's other projects can be found through their main website: www.ahrq.gov. AHRQ develops Quality Indicators to provide health care decision makers with tools to assess their data. The AHRQ Quality Indicators website supplies the Quality Indicators software and supporting documentation for ONLY the quality indicators: Prevention Quality Indicators, Patient Safety Indicators, Inpatient Quality Indicators, and Pediatric Quality Indicators. The AHRQ Quality Indicators do not provide:
Currently, the AHRQ Quality Indicators are only for use with administrative data in acute care hospitals, and are not available for other types of settings (e.g., long-term care, outpatient, ambulatory, hospice, individual practice, emergency department, or diagnostic centers) or populations (e.g., mental health or substance abuse, emergency preparedness, patient falls, rehabilitation, readmission, surgery, heparin therapy, c. difficile, or nursing quality). Other agencies may have quality indicators for other settings, so you are encouraged to check the National Quality Measures Clearinghouse or National Quality Forum website. The Healthcare Cost and Utilization Project (HCUP) also produces tools helpful to crosswalks and software. However, AHRQ Quality Indicators for certain ambulatory care sensitive conditions indicators for adults (see PQI module) and children (see PDI module) are available.▲
Documentation (SAS® or WinQI) is available regarding interpretation. AHRQ Quality Indicators user support does not provide support with interpretation of individual cases or advice on how to apply codes to a specific case.
Is benchmark information available?
Date Published: February 28, 2011
Date Updated: June 1, 2012
Yes. There are three sources of benchmark information available. The first source is the Reference Population rate used in the calculation of the risk-adjusted rate using indirect standardization. There are two (equivalent) ways a hospital might use the Reference Population rate: compare the hospital's observed rate to the hospital's expected rate (the observed-to-expected ratio) or compare the hospital's risk-adjusted rate to the Reference Population Rate. The second source is the comparative data (available on the AHRQ Quality Indicators website) based on the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). A hospital may use the NIS to compare the hospital's risk-adjusted rate to the risk-adjusted rate from a nationally representative sample of hospitals. Additionally, QI summary statistics are available via HCUPnet at http://hcupnet.ahrq.gov/.
Each year we incorporate the new coding changes and other software updates into the AHRQ Quality Indicators software and release the most updated version, usually by the end of Spring. We informally compare rates for indicators from year to year and look for unexpected percentage changes, and update the indicators to conform to yearly changes in ICD-9-CM diagnosis codes and procedure codes, so a formal test using confidence intervals would be of limited use, given the time delay in having data with the current coding structure. Our indicators are reviewed carefully for validity and many have been endorsed by the National Quality Forum (NQF); they tend to be very complex and depend on detailed diagnosis and procedure coding. When new codes are added or revised, our priority is on specificity and sensitivity. Additionally, updates are typically made to the software to improve usability and enhance the functionality.
We provide extensive documentation on the specific Quality Indicators, the software, and the methodology for creating the Quality Indicators. Some commonly asked questions are:
Our current documentation is available for download in PDF format for ease of compatibility. We do not provide the Word versions of the PDF documents.▲
The AHRQ Quality Indicators are focused on quality and are less focused on prevalence and incidences of all cases. For example, we are not interested in all strokes but only the most acute strokes where evidence suggests that some of the variability among hospitals might be reduced through improved processes of care.
These rates would likely be too narrow and based on too few cases to be of value. The indicators were developed and validated with clinical consultants, expert panels, and considerable research as to their validity, reliability, and usefulness in identifying classes of events that may be problems and that are actionable. Also, many are endorsed by the NQF.
There is a significant interest in additional stratifications of the data (e.g., hemorrhagic vs. ischemic stroke. Users of the Windows® software (WINQI) may use the custom stratification feature of the provider level reports to review risk-adjusted rates by these types of clinical classifications. One concern is reliability as you drill down into more specific strata because of the low frequency of many of the indicators.▲
The AHRQ QI support line is available to answer your questions about the QI definitions and receive your feedback on those definitions; however, the QI support line does not provide consultation on appropriate use of the codes. If you have questions about individual cases or general coding guidelines please follow either of these approaches:
The QI will be updated for ICD-10-CM/PCS on a timeline that is consistent with the Centers for Medicare and Medicaid Services (CMS) implementation. There is currently a report, entitled “ICD-9-CM to ICD-10-CM/PCS Conversion of AHRQ Quality Indicators” available on the QI website, which details some of the considerations that are part of the conversion.
To learn about quality measures other than the QI you can search the National Quality Measure Clearinghouse or National Quality Forum , where you will find measures from other topic areas that use a variety of data sources.