HCUP Quality Indicators Archive 

Note: The Healthcare Cost and Utilization Project (HCUP) Quality Indicators (QIs) have been replaced by the Agency for Healthcare Research and Quality (AHRQ) QIs. The information below and the related downloadable files, which describe the HCUP QIs and their definitions, are for archival purposes only.

What are the HCUP QIs?

The Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) were developed by AHRQ in the early 1990s in response to States' requests for a quality assessment tool that could be used with hospital administrative data. The HCUP QIs comprised a set of 33 clinical performance measures that could be used to inform hospitals' self-assessments of inpatient quality of care as well as State and community assessments of access to primary care.

Because many organizations lacked the resources to build a quality and access assessment program from the ground up, HCUP QIs provided a low-cost approach to meeting short-term information needs that support and stimulate continuous quality improvement efforts. Developed as a quick and easy-to-use screening tool, HCUP QIs were intended as a starting point in identifying clinical areas appropriate for further, more in-depth study and analysis. HCUP QIs spanned three dimensions of care:

1. The first dimension—potentially avoidable adverse hospital outcomes—examined nine inpatient mortality rates among low-risk patients receiving common elective procedures, such as hip replacements, and seven complication rates during hospitalizations, such as urinary tract infection following major surgery.
2. The second dimension—potentially inappropriate utilization of hospital procedures—addressed nine utilization rates for which there are concerns of overuse or underuse, such as cesarean section deliveries.
3. The third dimension—potentially avoidable hospital admissions—indirectly assessed access to and appropriateness of primary care by identifying eight conditions prompting hospitalizations, such as immunization-preventable pneumonia and influenza among the elderly, that are thought to be avoidable with adequate primary care in the community.

How did the HCUP QIs differ from the new AHRQ QIs?

The HCUP QIs had several limitations, the new AHRQ Quality Indicators specifically address these limitations:

• The original HCUP QIs did not include any severity or risk adjustment.
• All denominators in the original HCUP QIs were based on hospital discharges, rather than area populations. Population-based denominators are more appropriate for certain indicators such as potentially avoidable hospital admissions and certain utilization measures.
• The original HCUP QIs were limited to predominantly surgical measures and did not well represent some conditions, such as chronic medical conditions and pediatric illnesses.
• Some low frequency measures showed a great deal of variation, or instability, from year to year.

Original HCUP QI Software and Guide Download

Some of the files below are in PDF format, help with PDF files is available.

• SAS® HCUP QI Software, zipped — 191 KB
• SPSS® HCUP QI Software, zipped — 64 KB
• Definitions of HCUP Quality Indicators, version 1.3
  • WordPerfect® format — 1.02 MB
  • PDF format — 513 KB | (PDF help)
• Guide to HCUP QI Software, version 1.3
  • WordPerfect® format — 548 KB
  • PDF format — 109 KB | (PDF help)

References

1. Ball, Judy, Anne Elixhauser, Meg Johantgen, D. Robert Harris, Marsha Goldfarb. Outcome, Utilization, and Access Measures for Quality Improvement. HCUP Quality Indicators: Methods Version 1.1 (HCUP Research Note Series, AHCPR Pub. No. 98-0035). Rockville, MD: Agency for Health Care Policy and Research; 1998.
2. Johantgen, Meg, Anne Elixhauser, Judy Ball, Marsha Goldfarb, D. Robert Harris. Quality indicators using hospital discharge data: State and national applications. The Joint Commission Journal on Quality Improvement 1998, February; 24(2): 88-105.
3. Jiang HJ, et al. Adapting the HCUP QIs for Hospital Use: The Experience in New York State. Joint Commission Journal on Quality and Improvement 2001;27(4): 200-15.

Original HCUP QIs

1. Potentially avoidable adverse hospital outcomes (16 indicators)
   • Inpatient mortality rates
     • Hysterectomy
     • Laminectomy/spinal fusion
     • Cholecystectomy
     • Transurethral prostatectomy
     • Hip replacement
     • Knee replacement
   • Complication rates
     • Pulmonary compromise after major surgery
     • Acute myocardial infarction after major surgery
     • Gastrointestinal hemorrhage or ulceration after major surgery
     • Venous thrombosis or pulmonary embolism after major surgery/invasive vascular procedure
     • Mechanical complications due to device, implant, or graft (excluding organ transplant)
     • Urinary tract infection after major surgery
     • Pneumonia after major surgery/invasive vascular procedure
     • Obstetrical complications
     • Adverse effects and iatrogenic complications
     • Wound infection
2. Potentially inappropriate utilization of hospital procedures (9 indicators)
   • Cesarean section delivery
   • Successful vaginal birth after cesarean section (VBAC)
   • Incidental appendectomy among elderly
   • Hysterectomy
   • Laminectomy and/or spinal fusion
   • Transurethral prostatectomy
   • Radical prostatectomy
   • Laparoscopic cholecystectomy
   • Coronary artery bypass graft (CABG)
3. Potentially avoidable hospital admissions (8 indicators)
   • Low birthweight
   • Very low birthweight
   • Pediatric asthma
   • Immunization-preventable pneumonia and influenza among the elderly
   • Cerebrovascular disease among nonelderly adults
   • Diabetes short-term complications
   • Diabetes long-term complications
   • Perforated appendix