AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Quality Indicator Overview

  • What are the AHRQ Quality Indicators™ (QIs)?

    The AHRQ QIs are standardized, evidence-based health care quality measures that can be used with readily available hospital inpatient administrative data. There are 101 Quality Indicators organized into four main modules and two standalone modules that measure quality associated with the delivery of care that occurs in either a hospital inpatient setting:

    To use the AHRQ QI, organizations may download and use the free software distributed by AHRQ in either SAS or Windows format. The software output or QI results can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes in quality over time.

  • Where can I find a list of the AHRQ QIs?

    A list of the AHRQ Quality Indicators modules is provided below.

    Inpatient Quality Indicators (IQI) module, reflects quality of hospital care for adults and includes:

    • Inpatient mortality for medical conditions
    • Inpatient mortality for surgical procedures
    • 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 may be associated with lower mortality

    Pediatric Quality Indicators (PDI) module reflects quality of hospital care for children below the age of 18 and neonates and includes:

    • Potential complications and errors resulting from a hospital admission for children and adolescents (e.g., neonatal mortality, postoperative sepsis)
    • Potentially avoidable hospitalizations among children

    Prevention Quality Indicators (PQI) module reflects ambulatory care sensitive conditions that identify quality of care for "ambulatory care sensitive conditions." These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. Examples include:

    • Asthma
    • High blood pressure
    • Low birth weight

    Patient Safety Indicators (PSI) module reflects quality of hospital care for adults with a focus on potentially avoidable complications and errors that occur during a hospital inpatient stay. Examples include:

    • Pressure ulcers
    • Foreign object left in after surgery
  • Who develops the AHRQ QIs?

    The QI measures are developed by a team of technical experts in collaboration with AHRQ. The AHRQ QIs are updated and new measures are added, as a result of new research evidence or validation efforts, user feedback, guidance from the National Quality Forum and general advances in the science of quality measurement. This is an ongoing process.

  • Which AHRQ QIs have been endorsed by the National Quality Forum?

    More than half of the AHRQ QIs have been endorsed by the National Quality Forum (NQF). As of March 2015, NQF had endorsed 42 individual QIs and 3 composite QIs. A complete list of NQF-endorsed QIs is available at:
    http://www.qualityindicators.ahrq.gov/Downloads/Modules/V45/Module_NQF_Endorsement_V4.5.pdf

  • Who uses the AHRQ QIs and for what purpose(s)?

    The AHRQ QIs are used by a wide range of organizations for a variety of purposes. For example:

    • Researchers, quality improvement officers, hospital administrators and community health planners use AHRQ QIs to ask questions that provide initial feedback about clinical areas appropriate for further, more in-depth analysis and to assess hospital safety, quality, patient experience, cost and utilization.

    • Hospitals and hospital systems nationwide use the AHRQ QIs to assist quality improvement efforts in acute care hospital settings.

    • State hospital associations, state data associations, hospitals and hospital systems use the AHRQ QIs to help them understand how their hospital(s) compare on quality measures in relationship to other hospitals or to state and national averages.

    • State hospital associations use the AHRQ QIs to assess hospital quality and primary care access.

    • Insurers and business groups use the AHRQ QIs to compare hospital performance rates and assess relative safety, quality and affordability.

    • State agencies use the AHRQ QIs in their public reporting on hospital quality to assess quality of care and increase transparency regarding health care performance.

    • AHRQ has included the AHRQ QIs in the MONAHRQ® software (My Own Network powered by AHRQ), used by State agencies, hospitals and hospital associations, coalitions and others to assess and report on hospital quality.

    • The Center for Medicare & Medicaid Services (CMS) uses AHRQ QIs in the Hospital Compare website to help consumers, hospitals, health care practitioners, health policy leaders and others inform decisions and actions to achieve safer, higher quality and more affordable health care.

    • A number of federal health programs or reform efforts use AHRQ QI as an integral part of assessing, incentivizing and reporting on hospital quality improvement, including:
    • The AHRQ QI also are under consideration for inclusion in additional national programs such as the Physician Quality Reporting System (PQRS).

    Learn more about how the AHRQ QIs are used to improve the quality of health care.

  • What are the benefits of using AHRQ QIs? Are there any limitations?

    Benefits:
    Using free, publicly-available QI software from AHRQ, in either SAS or Windows format, users can calculate QI rates based on their hospital administrative data using a standard desktop computer. Each version of AHRQ QI is released with software in two different platforms: a SAS®† application and a Windows application. AHRQ WinQI runs on Windows operating systems and requires freely available software components: AHRQ-produced software, Microsoft .NET (for runtime environment and core software libraries), and Microsoft SQL Server Express (for data storage and manipulation).

    Limitations:
    In terms of limitations, the AHRQ QIs can be used with hospital administrative data. They are not available for other types of settings (e.g., long-term care, outpatient, ambulatory, hospice, individual practice, emergency department, or diagnostic centers) or measurement of populations or at the population level (e.g., mental health or substance abuse, emergency preparedness, patient falls, rehabilitation, readmission, surgery, heparin therapy, c. difficile, or nursing quality). However, AHRQ Quality Indicators are available for certain ambulatory care sensitive conditions indicators for adults (see PQI module) and children (see PDI module). To find Quality Indicators for other settings, check AHRQ’s National Quality Measures Clearinghouse or the National Quality Forum’s measure search tool. The Healthcare Cost and Utilization Project (HCUP) also produces helpful tools such as crosswalks and software.

    The QI software is intended to be used with data that cover entire patient populations (e.g., all discharges from a hospital in a year) or data that were sampled from a patient population using simple random sample. The SAS QI software does not support weighted QI estimates or standard errors for weighted estimates. Thus, analyses using data obtained from a complex sampling design will not produce accurate estimates for the population from which the data were sampled. For a more thorough description of weighted AHRQ QI analyses, see the technical documentation on the AHRQ QI website.

    Learn more about who uses the AHRQ QIs and for what purposes

  • How are the AHRQ QIs used to improve the quality of health care?

    One of the basic foundations for producing evidence on how to improve quality is quality measurement. AHRQ QIs are widely used for research, health care planning, quality improvement and reporting initiatives throughout the United States (US). The current AHRQ QIs taking advantage of data enhancements, improvements in coding practices and advanced statistical methodologies where possible have evolved into metrics used not only for quality improvement but also into metrics for public reporting and pay for performance. AHRQ QIs now serve multiple purposes; including research, needs assessment for planning at the local, state, and national levels, hospital and community quality improvement initiatives, performance assessment through private and public reporting, public reporting to reward favorable outcomes and encourage changes in hospital behavior, and information to be used by healthcare purchasers that link performance with payment.

    Learn more about the benefits and limitations of using the AHRQ QIs.

  • What information or materials can be obtained through the AHRQ Quality Indicators website?

    The AHRQ Quality Indicators (QIs) website supplies the QI software and supporting documentation for ONLY the AHRQ QIs: Prevention Quality Indicators, Patient Safety Indicators, Inpatient Quality Indicators, and Pediatric Quality Indicators. The website also includes information about how to access technical assistance and sign up for email updates, in addition to a range of historical documentation about past releases and explanatory materials, such as presentations and recordings of informational webinars.

    The AHRQ QI website does not provide:

    • Data sources
      • To obtain data you will likely have to go through your hospital or hospital association, State agency or, possibly, HCUP Reports on hospitals
      • If you have a published report based on the AHRQ Quality Indicators and you would like to determine how that report was generated, you will need to contact the author of that report
    • Reports on users of the software
    • Care guidelines or advice on how to improve rates or use the software output
    • Individual training
  • How are the AHRQ Quality Indicators revised and how do I learn more about the revisions that have been made?

    Each year new coding changes and other software updates are incorporated into the AHRQ Quality Indicators software and release the most updated version, usually by the end of spring. The rates for indicators are informally compared from year to year to identify 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. The Quality Indicators are reviewed carefully for validity and are submitted to the National Quality Forum (NQF) for review and endorsement. The Quality Indicator measures tend to be very complex and depend on detailed diagnosis and procedure coding. When new codes are added or revised, the priority is on specificity and sensitivity. Additionally, updates are typically made to the software to improve usability and enhance the functionality.

    There is extensive documentation on the specific Quality Indicators, the software and the methodology for creating the Quality Indicators. Some commonly asked questions are:

    • How do I learn about changes?
      • Consult the relevant Quality Indicators module page (PQI, IQI, PSI, PDI)
        • From here you can see the Log of Coding Updates and Revisions, which documents all changes to the measures and software for that particular module.
      • Consult the Quality Indicators software page
        • Review the release notes for SAS and WinQI
        • Review the results of comparison testing
    • Where can I see a list of all the ICD-9 codes?
      • A list of ICD-9 codes can be found here.
    • How do I learn about prevalence, costs, length of stay, etc.?
      • HCUPNet is a good resource to learn more about various health statistics.
    • Where can I find information about ICD-10?
      • Information about ICD-10 can be found here.

    Current documentation is available for download in PDF format for ease of compatibility. AHRQ does not provide the Word versions of the PDF documents.

  • How do I learn about quality measures other than the AHRQ QIs?

    To learn about quality measures other than the QIs, you can search AHRQ’s National Quality Measure Clearinghouse, HHS Measure Inventory or the National Quality Forum's measure search tool, where you will find measures from other topic areas that use a variety of data sources.

  • How can I find out about the AHRQ QIs used in Hospital Compare?

    Select AHRQ Quality Indicators are currently used by the Centers for Medicare and Medicaid Services (CMS) on its Hospital Compare website. If you have questions about the definitions of the AHRQ QI used, please consult the QI specifications (PQI, IQI, PSI, PDI) or, if needed, contact AHRQ QI support. However, if you have questions about the analyses or results used in your Hospital Compare Report please note the following, per Hospital Compare:

    There are a variety of informational materials posted on QualityNet that may help you gain a greater understanding of CMS’ calculation and reporting of Agency for Healthcare Research and Quality (AHRQ) measures based on Medicare claims and the use of these measures for the Hospital Inpatient Quality Reporting Program (formerly known as RHQDAPU). To access this information visit www.qualitynet.org, Hospitals-Inpatient > Claims-Based Measures > AHRQ Indicators. Information posted on QualityNet will be updated periodically, so please visit the site for the most up-to-date information.

    For questions or comments about the Centers for Medicare & Medicaid Services' (CMS) calculation or reporting of the AHRQ measures under the Hospital Inpatient Quality Reporting (IQR) Program based on Medicare claims, contact Mathematica Policy Research (CMS' contractor) at AHRQmeasuresforIQR@mathematica-mpr.com

Updated April 20, 2015