AHRQ Quality Indicator Tools for Data Analytics

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AHRQ Quality Indicators (AHRQ QIs) are standardized, evidence-based measures of healthcare quality that can be used with readily available hospital inpatient administrative data found in a typical hospital discharge abstract to measure and track clinical performance and outcomes. AHRQ QIs provide healthcare decision makers, such as program managers, researchers, and others at the Federal, State, and local levels, with tools to assess their data, highlight potential quality concerns, identify areas for further study and investigation, and track changes over time. AHRQ QIs are available via free software distributed by AHRQ. The QIs are reported at two levels: Hospital and Area. 

At the hospital level, the QIs are used to support internal quality improvement, monitoring, and assessment of adverse events related to patient safety. These indicators reflect inpatient quality of care, such as potentially avoidable complications and iatrogenic events; inpatient mortality for certain procedures and medical conditions; and overuse, underuse, or misuse of inpatient procedures. 

At the geographic area level, the QIs are used to identify access to outpatient care, which includes appropriate postdischarge followup care. These indicators provide insight into the health of the community and the community-based healthcare system through the use of hospital data. These indicators identify hospital admissions that evidence suggests might have been avoided through access to high- quality outpatient or preventive care. 

Area-level QIs can be used as a "screening tool" to help flag potential healthcare access problems or concerns about population health. They can also help public health agencies, State data organizations, healthcare systems, and others interested in improving healthcare quality in their communities to identify and investigate communities that may need interventions. 

These hospital and area-level indicators support development of trend and benchmark information for comparing a given hospital’s current performance or an area’s incidence rate with previous years (trending) and with national benchmarks.

Quality Indicator Modules

The AHRQ QIs include the following modules: Maternal Health Indicators (MHIs) Beta, Prevention Quality Indicators in Emergency Department Settings (PQEs), Prevention Quality Indicators in Inpatient Settings (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs).

Maternal Health Indicators (MHIs), currently in beta testing, are area-level measures that aim to broadly address healthcare quality in the domain of maternal health and identify opportunities to reduce complications during the peripartum period. MHIs identify severe maternal morbidity (SMM) and mortality that could be prevented by high-quality healthcare. The measures are identified through delivery discharge claims data and can be used for population health analysis, surveillance, quality assurance, and research purposes. The MHI measures are meant to be used at the area level and are not intended as accountability measures.

Prevention Quality Indicators in Emergency Department Settings (PQEs) are measures of visits to the emergency department (ED) (treat-and-release ED visits and inpatient admissions through the ED) that may be associated with a lack of access to quality care in other settings. They may reflect availability of community health resources (e.g., medical care, dental care) or disease burden or both. It should be noted that the PQEs do NOT reflect the quality of care provided in the ED. 

PQEs are part of the set of population-based area-level QIs that includes the inpatient Prevention Quality Indicators (PQIs) and inpatient Pediatric Quality Indicators (PDIs). Like these area-level QIs, they include measures that identify conditions for which access to quality ambulatory care can reduce the likelihood of hospital care. 

Prevention Quality Indicators (PQIs) are population-based indicators that capture all cases of potentially preventable complications that occur in a given population either during a hospitalization or in a subsequent hospitalization. PQIs can be used to identify admissions that might have been avoided through access to high-quality outpatient care.

The PQIs flag potential healthcare quality problem areas that need further investigation. In addition, they provide a quick check on primary care access or outpatient services in a community and help organizations identify unmet needs in their communities.

Inpatient Quality Indicators in Inpatient Settings (IQIs) help hospitals assess quality of care inside the hospital and identify areas that might need further study. The IQIs provide a perspective on quality of care inside hospitals, including inpatient mortality for surgical procedures and medical conditions and utilization of procedures for which there are questions of overuse, underuse, and misuse.

Patient Safety Indicators (PSIs) help hospitals assess the incidence of adverse events and in-hospital complications and identify issues that might need further study. PSIs provide information on potentially avoidable safety events that represent opportunities for improvement in care delivery. More specifically, they focus on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.

Pediatric Quality Indicators (PDIs) help detect issues in pediatric hospital care that may need further study. They can also be used to evaluate preventive care for children in outpatient settings by identifying potential quality and patient safety issues specific to the pediatric inpatient population. PDIs focus on potentially preventable complications and iatrogenic events for pediatric patients treated in hospitals and on preventable hospitalizations among pediatric patients, considering the special characteristics of the pediatric population.

Quality Indicator Products

AHRQ QI Software: AHRQ’s free software can be used to calculate AHRQ QI rates and to help generate accurate and actionable results. Use of this software ensures a standard, trusted approach to quality measurement and means more resources are available to support patient care improvements.

QI Toolkit: The Toolkit for Using the AHRQ Quality Indicators (QI Toolkit) is a free and easy-to-use resource for hospitals planning to use the AHRQ QIs to track and improve inpatient quality and patient safety. The QI Toolkit also may serve as a general guide to applying improvement methods in a hospital setting. Hospitals can select the most appropriate tools for their current quality improvement priorities and capabilities, and each tool can be adapted to an individual hospital’s needs.

The tools are organized by the six quality improvement process steps:

• Assessing Readiness To Change.
• Applying QIs to Your Hospital’s Data.
• Identifying Priorities for Quality Improvement.
• Implementing Evidence-Based Strategies To Improve Clinical Care.
• Monitoring Progress and Sustainability of Improvements.
• Analyzing Return on Investment.

ROI Tool: The Return on Investment Estimation (ROI) tool (PDF, 464 KB) is for examining anticipated financial outcome data, thus supporting hospital and health system leadership in making more informed decisions when prioritizing resources for quality improvement initiatives. This tool provides a step-by-step method for calculating ROI for a new set of actions implemented to improve performance on one or more AHRQ QIs. Potential users of this tool include individuals who will contribute to ROI calculations, which may include hospital or health system financial, quality, or analytic staff, as well as statisticians, data analysts, and programmers.

Pediatric Toolkit: The Pediatric QI Toolkit is a standalone pediatric version of the QI Toolkit that meets the needs of hospitals that serve children. It includes a concise set of tools to facilitate efforts to improve clinical quality and can be used to improve performance on PDIs and other measures of inpatient pediatric quality. It contains the same six steps as the QI Toolkit, including materials that improvement teams can use to identify and catalog quality and patient safety concerns, educate clinical leaders and staff, and home in on priorities. It also includes indicator-specific best practices for improving performance on the PDIs. While the QI Toolkit, ROI Tool, and Pediatric Toolkit have not been updated since December 2017, they remain relevant for quality improvement initiatives.

AHRQ QI Publications

• AHRQ QI Quality Improvement Case Studies.
• AHRQ QI Publications by Year (PDF, 258 KB).

More Information

• AHRQ QI Technical Assistance: QISupport@ahrq.hhs.gov or (301) 427-1949. 
• AHRQ QIs Frequently Asked Questions.