Specific Questions about AHRQ QIs

What version of the 3M APR-DRG software should be used with the Inpatient Quality Indicator (IQI) module?

In IQI Version 3.0, the AHRQ QI software was updated to use 3M APR-DRG version 20.  Prior versions of the AHRQ IQI module used APR-DRG version 15.  The correct risk adjusted rates cannot be obtained if the software is run with the incorrect version of APR-DRG.

The Inpatient Quality Indicators software documentation states the 3M APR-DRG software is separate and that the indicators need version 20 of 3M's APR-DRG software. How can I obtain this software?

A limited license 3M APR-DRG grouper software is available for download along with the SAS and Windows versions of the AHRQ Inpatient Quality Indicators.  Please carefully read the license agreement before downloading this software.

The APR-DRG software can be licensed from 3M Health Information Systems (3M HIS). 3M HIS makes APR-DRG software available for use with the AHRQ Quality Indicators at a discounted price. 3M HIS can be contacted by calling 1-800-367-2447. When calling, indicate that you are interested in the AHRQ APR-DRG Version 20 product. The APR-DRG Definitions Manual can also be licensed without licensing the APR-DRG software

3M is not affiliated in any way with AHRQ.

Where can I find the technical specifications for the Quality Indicators?

The technical specifications for the indicator definitions have been moved from each module's User Guide into a separate Technical Specifications document.  Detailed specifications, including specific ICD-9-CM codes, DRGs, and/or patient age or sex are included in the documents. The Technical Specifications for each QI module (PQI, IQI, and PSI) may be downloaded from the QI Web site at http://www.qualityindicators.ahrq.gov/downloads.htm.

The technical specifications for the QI software (applications in either SAS® or SPSS® syntax) can be found in each QI module’s software documentation. Detailed specifications, including input file formats, software files, and data processing instructions are provided. Each QI module’s software documentation can be downloaded from the QI Web site at http://www.qualityindicators.ahrq.gov/downloads.htm. Click on the desired module and scroll down to the downloads section at the bottom of the page. Documentation is available in both Word® and PDF formats.

What is the difference between the Healthcare Cost and Utilization Project (HCUP) QIs and the AHRQ QIs?

The AHRQ QIs (Inpatient Quality Indicators (IQIs), Prevention Quality Indicators (PQIs), and Patient Safety Indicators (PSIs)) are a refinement and further development of the HCUP QIs and are intended to replace them. The HCUP QIs will no longer be updated or supported. Additional information about the Healthcare Cost and Utilization QIs can be found on the HCUP Archive page of the Quality Indicators Web site.

What is the difference between the Prevention Quality Indicators (PQIs), the Inpatient Quality Indicators (IQIs), the Patient Safety Indicators (PSIs) and the Pediatric Quality Indicators (PDIs)?

The PQIs, IQIs and PSIs relate to different aspects of the quality of care that occurred in either the outpatient or inpatient setting, although all three modules rely solely on hospital inpatient administrative data.  The PQIs, IQIs and PSIs focus on adult populations while the PDIs focus on pediatric populations.

Prevention Quality Indicators (PQIs). These indicators consist of "ambulatory care sensitive conditions," hospital admissions that evidence suggests could have been avoided through high-quality outpatient care or that reflect conditions that could be less severe, if treated early and appropriately.

Inpatient Quality Indicators (IQIs). These indicators reflect quality of care inside hospitals and include inpatient mortality; utilization of procedures for which there are questions of overuse, underuse, or misuse; and volume of procedures for which there is evidence that a higher volume of procedures is associated with lower mortality.

Patient Safety Indicators (PSIs). These indicators also reflect quality of care inside hospitals, but focus on potentially preventable surgical complications and other iatrogenic events.

Pediatric Quality Indicators (PDIs).  These indicators span the different categories of quality of care found in the PQIs, IQIs and PSIs, but are limited to the pediatric population.

Do the AHRQ QIs (IQIs, PQIs, PSIs, and PDIs) assess quality of care for patients who receive care on an outpatient basis or in the emergency room, but are not admitted to the hospital?

No, the AHRQ QIs rely solely on inpatient hospital administrative data and do not assess quality of care for patients who are not admitted to a hospital. This is a known limitation of these indicators. Future versions of the AHRQ QIs may be developed that rely on additional data sources that will include patients receiving care in an outpatient basis or in an emergency room to generate a more comprehensive set of quality indicators to address other settings of care.

Is a version of the software available using International Classification of Diseases, Tenth Revision (ICD-10) codes instead of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes?

No, the hospital discharge records or administrative data in the United States use ICD-9-CM thus ICD-10 is not available in the data.  In addition, the clinical modification of ICD-10 is still under development and has not been finalized.

Can the indicators be grouped together for analysis?

Yes, theoretically the indicators can be grouped together, however, the AHRQ QIs software does not arithmetically combine indicators together nor does it provide summary measures across all of the indicators. Simple arithmetic combinations of indicator values may obscure valuable information conveyed in the values of individual indicators. We encourage users to examine individual indicators, together with other potentially related indicators, in the context of their specific needs. For example, some users may be interested in examining a set of indicators by clinical domain (e.g., cardiovascular care, diabetes care), comparing volume and outcome measures, or analyzing indicators by service area (e.g., pediatric, surgical, medical). Considering the result of each individual indicator in the context of related indicators can increase understanding of quality of care as measured by the AHRQ QI.

AHRQ is conducting workgroups to determine the best methods for creating composite measures of the QIs.  More information will be distributed on the QI mailing list and newsletters as these workgroups are conducted.  For a discussion on the some of the considerations in creating aggregate measures, see the September 2005 PowerPoint Presentation  from the AHRQ QI Users Meeting.

Can the Prevention Quality Indicators (PQIs) be used at a hospital level?

The Prevention Quality Indicators (PQIs) are designed to highlight rates of hospitalizations that may have been preventable with timely access to quality outpatient care. The denominators for the PQIs are population based and, therefore, the rates are not directly applicable to individual hospitals. These indicators may be of interest to integrated health plans that provide both outpatient and inpatient care to the same population or to hospital systems that serve a defined population. However, such use would require modification of the PQIs software to construct the relevant population files for the population that is "at risk" for subsequent hospitalization.  The AHRQ Support team is unable to assist users with such revisions as the PQIs are designed for use at an area level; use at the hospital level is not an option of the current software.

Are national or state benchmark levels for the AHRQ QIs available for comparison purposes?

HCUPNet now has the Prevention Quality Indicators (PQIs) at the national level. The HCUPNet Web site     (http://www.hcup.ahrq.gov/HCUPNet.asp) provides national trend statistics and some breakdowns. The addition of Inpatient Quality Indicators (IQI) and Patient Safety Indicators (PSIs) is anticipated in the future. The recently published National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) also includes similar national level statistics for selected PQIs and the PSIs. The reports may be accessed at http://www.qualitytools.ahrq.gov. No state-level information is being released at this time.

In addition to the sources above, the User Guides for each indicator set (PQI, IQI, and PSI) contain information on national rates for the current definitions of each indicator. The User Guide for each QI module may be downloaded from the QI Web site at http://www.qualityindicators.ahrq.gov/downloads.htm. Click on the desired module and scroll down to the downloads section at the bottom of the page. Documentation is available in both Word® and PDF formats.

Publications may provide another source for comparative data.  Visit the Presentations page (http://www.qualityindicators.ahrq.gov/published.htm) on the QI Web site for more details.