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Guide to Inpatient Quality Indicators: Quality of Care in Hospitals – Volume, Mortality, and Utilization

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[ This page left intentionally blank ] AHRQ Quality Indicators Guide to Inpatient Quality Indicators: Quality of Care in Hospitals – Volume, Mortality, and Utilization Department of Health and Human Services Agency for Healthcare Research and Quality http://www.qualityindicators.ahrq.gov June 2002 AHRQ Pub. No. 02-RO204 Revision 3 (July 21, 2004) Citation AHRQ Quality Indicators—Guide to Inpatient Quality Indicators: Quality of Care in Hospitals—Volume, Mortality, and Utilization. Rockville, MD: Agency for Healthcare Research and Quality, 2002. Revision 3 (July 21, 2004). AHRQ Pub. No. 02-RO204. Preface In health care as in other arenas, that which cannot be measured is difficult to improve. Providers, consumers, policy makers, and others seeking to improve the quality of health care need accessible, reliable indicators of quality that they can use to flag potential problems or successes; follow trends over time; and identify disparities across regions, communities, and providers. As noted in a 2001 Institute of Medicine study, Envisioning the National Health Care Quality Report, it is important that such measures cover not just acute care but multiple dimensions of care: staying healthy, getting better, living with illness or disability, and coping with the end of life. The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are one Agency response to this need for multidimensional, accessible quality indicators. They include a family of measures that providers, policy makers, and researchers can use with inpatient data to identify apparent variations in the quality of inpatient or outpatient care. AHRQ‘s Evidence-Based Practice Center (EPC) at the University of California San Francisco (UCSF) and Stanford University adapted, expanded, and refined these indicators based on the original Healthcare Cost and Utilization Project (HCUP) Quality Indicators developed in the early 1990s. The AHRQ QIs are organized into three modules: Prevention Quality Indicators, Inpatient Quality Indicators, and Patient Safety Indicators. AHRQ has published the three modules as a series. The first module—Prevention Quality Indicators—was released in 2001 and is available at AHRQ‘s Quality Indicators Web site at http://www.qualityindicators.ahrq.gov/. This second module focuses on health care provided within the inpatient hospital setting. The Inpatient Quality Indicators include three distinct types of measures. Volume measures examine the volume of inpatient procedures for which a link has been demonstrated between the number of procedures performed and outcomes such as mortality. In-hospital mortality measures examine outcomes following procedures and for common medical conditions. Utilization examines procedures for which questions have been raised about overuse, underuse, and misuse. Full technical information on the first two modules can be found in Evidence Report for Refinement of the HCUP Quality Indicators, prepared by the UCSF-Stanford EPC. It can be accessed at AHRQ‘s Quality Indicator Web site (http://www.qualityindicators.ahrq.gov). The third module—Patient Safety Indicators (PSIs)—was released in May 2003. Information on the PSIs, including the technical information, software and other documentation is also available at AHRQ‘s Quality Indicators Web site. Improving the quality of inpatient hospital services is a critical part of efforts to provide high quality health care in the United States. This guide is intended to facilitate such efforts. As always, we would appreciate hearing from those who use our measures and tools so that we can identify how they are used, how they can be refined, and how we can measure and improve the quality of the tools themselves. You may contact us by sending an e-mail to [email protected]. Irene Fraser, Ph.D., Director Center for Organization and Delivery Studies The programs for the Inpatient Quality Indicators (IQIs) can be downloaded from http://www.qualityindicators.ahrq.gov/iqi_download.htm. Instructions on how to use the programs to calculate the IQI rates are contained in the companion text, Inpatient Quality Indicators: Software Documentation (both SAS and SPSS). Version 2.1 i Revision 3 (July 21, 2004) Acknowledgments This product is based on the work of many individuals who contributed to its development and testing. The following staff from the Evidence-based Practice Center (EPC) at UCSF-Stanford performed the evidence review, completed the empirical evaluation, and created the programming code and technical documentation for the AHRQ Quality Indicators: Core Project Team Mark McClellan, M.D., Ph.D., principal investigator Jeffrey Geppert, J.D. Kathryn M. McDonald, M.M., EPC coordinator Patrick Romano, M.D., M.P.H. Sheryl M. Davies, M.A. Kaveh G. Shojania, M.D. Other Contributors Amber Barnato, M.D. Paul Matz, M.D. Mark Schleinitz, M.D. Paul Collins, B.A. Courtney Maclean, B.A. Herb Szeto, M.D. Bradford Duncan M.D. Susana Martins, M.D. Carol Vorhaus, M.B.A Michael Gould, M.D., M.S. Kristine McCoy, M.P.H. Peter Weiss, M.D. Paul Heidenreich, M.D. Suzanne Olson, M.A. Meghan Wheat, B.A. Corinna Haberland, M.D. L. LaShawndra Pace, B.A. Consultants Douglas Staiger, Ph.D. The following staff from Social & Scientific Systems, Inc., developed this software product, documentation, and guide: Programmers Technical Writer Graphics Designer Leif Karell Patricia Burgess Laura Spofford Kathy McMillan Contributors from the Agency for Healthcare Research and Quality: Anne Elixhauser, Ph.D. H. Joanna Jiang, Ph.D. Denise Remus, Ph.D., R.N. Margaret Coopey, R.N., M.G.A, M.P.S. Support efforts, including refinement and enhancement of the AHRQ Quality Indicators and related products, are provided by the Support for Quality Indicators contract team. The following individuals from Stanford University, University of California (UC) and Battelle Memorial Institute constitute the Support for Quality Indicators core team: Sheryl M. Davies, M.A. Mark Gritz, Ph.D. Rajin Mangru, B.S. Bruce Ellis, M.S. Greg Hubert, B.S. Kathryn M. McDonald, M.M. Jeffrey Geppert, J.D. Elaine Keller, M.Ed. Patrick Romano, M.D., M.P.H The Agency for Healthcare Research and Quality Support for Quality Indicators team includes: Denise Remus, Ph.D., R.N., Project Officer Mary B. Haines, Contract Officer The contribution of the peer reviewers of the evidence report and the beta-testers of the software products is also knowledged, their input was invaluable. Version 2.1 ii Revision 3 (July 21, 2004) Table of Contents Preface .......................................................................................................................................................... i Acknowledgments ...................................................................................................................................... ii Introduction to the AHRQ Inpatient Quality Indicators ........................................................................... 1 What Are the Inpatient Quality Indicators? ............................................................................................... 2 How Can the IQIs be Used in Quality Assessment? ................................................................................ 5 What Does this Guide Contain? ............................................................................................................... 5 Support for Potential and Current Users of the AHRQ QIs .................................................................... 6 Origins and Background of the Quality Indicators .................................................................................. 7 Development of the HCUP Quality Indicators .......................................................................................... 7 Development of the AHRQ Quality Indicators .......................................................................................... 7 AHRQ Quality Indicator Modules .............................................................................................................. 8 Methods of Identifying, Selecting, and Evaluating the Quality Indicators ............................................ 9 Step 1: Obtain Background Information on QI Use ................................................................................. 9 Step 2: Search the Literature to Identify Potential QIs .......................................................................... 10 Step 3: Review the Literature to Evaluate the QIs According to Predetermined Criteria ...................... 10 Step 4: Perform a Comprehensive Evaluation of Risk Adjustment ....................................................... 11 Step 5: Evaluate the Indicators Using Empirical Analyses .................................................................... 12 Summary Evidence on the Inpatient Quality Indicators ....................................................................... 15 Strengths and Limitations in Using the IQIs ........................................................................................... 20 Questions for Future Work ...................................................................................................................... 20 Detailed Evidence for Inpatient Quality Indicators ................................................................................ 22 Esophageal Resection Volume (IQI 1) ................................................................................................... 23 Pancreatic Resection Volume (IQI 2) ....................................................................................................
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