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

NEWS from 2003

December 23 2003 – AHRQ Quality Indicators Incorporated into National Reports on Healthcare Quality and Disparities

Yesterday, December 22, 2003, HHS Secretary Tommy G. Thompson released the first national comprehensive efforts to measure the quality of health care in America and the differences in access to health care services for priority populations. The reports, the National Healthcare Quality Report and the National Healthcare Disparities Report, provide baseline views of the quality of health care and differences in use of health care services by priority populations including women; children; the elderly; racial and ethnic minority groups; low income groups; residents of rural areas; and individuals with special health care needs, specifically children with special needs, people with disabilities, people in need of long-term care, and people requiring end-of-life care, These reports use several AHRQ Quality Indicators selected from the Prevention Quality Indicators and Patient Safety Indicators modules based on data included in the Healthcare Cost and Utilization Project (HCUP).

"We need to make sure that we are building a healthier America by improving the quality of health care and ensuring that all our citizens benefit from the advantages that our health care system offers," Secretary Thompson said. "Assessing health care quality highlights our successes in reaching that goal, but more importantly, it shows us where we have more work to do and how we can make sure that all Americans benefit from scientific advances and technological innovations."

The reports point to an important priority for HHS to ensure that all Americans have the safest, highest-quality health care services possible available to them when needed. They were prepared by HHS' Agency for Healthcare Research and Quality (AHRQ) as directed by Congress.

"The data in these reports provide an important message for the nation -- we are making progress in enhancing health care quality and access, but we can do more, and we need to do more," said Carolyn M. Clancy, AHRQ's director. "The first editions of these reports, and those that follow, are an important key to meeting that challenge."

The reports are available on a new Web site, http://www.qualitytools.ahrq.gov. Launched yesterday, the site serves as a Web-based clearinghouse to make it easier for health care providers, health plans, policymakers, purchasers, patients and consumers to take effective steps to improve quality. Print copies of the reports also can be obtained by calling 1-800-358-9295 or by e-mailing ahrqpubs@ahrq.gov.

Additional information about the AHRQ Quality Indicators can be found on the Quality Indicators Web site, http://www.qualityindicators.ahrq.gov.

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September 16 2003 – Release of AHRQ Inpatient Quality Indicators Version 2.1 Revision 2

AHRQ is pleased to announce an update of the Inpatient Quality Indicators (IQIs), Version 2.1, Revision 2.  All updated IQI documentation and software are now available for download on the AHRQ Quality Indicators Web site (iqi_download).

This version incorporates changes to ICD-9-CM codes and DRGs effective October 1, 2001 (Fiscal Year 2002) and October 1, 2002 (Fiscal Year 2003).  With this software update, the IQI definitions now incorporate ICD-9 CM codes valid from October 1, 1994 through September 30, 2003.

In addition to the ICD-9 coding update, a few additional minor changes have been implemented for the purpose of improving the performance of these indicators. All changes to the indicators and the ICD-9 CM coding updates are detailed in two documents also available on the Web site. The documents accompanying the IQI software have been updated including new versions of the Guide to the Inpatient Quality Indicators, the IQI SAS Software Documentation, and IQI SPSS Software Documentation.  These new documents incorporate several stylistic changes, are available in Microsoft® Word® and PDF format, and include the updated IQI indicator definitions. The new software manuals also outline the treatment of missing data by the software.

AHRQ is committed to continued refinement and enhancement of the QIs based on feedback from users, knowledge gained through direct use, and new scientific evidence.  For example, the Support for Quality Indicators (SQI) contract team is reviewing the literature related to each IQI to both update the knowledge base underlying the indicators but also to identify any evidence that may suggest potential refinement of any indicator.  Significant information can be also obtained through user feedback and engaging in applied research and quality improvement efforts.  As an example of collaboration with users, AHRQ is currently working with the Healthcare Association of New York State (HANYS) and member hospitals on a project to evaluate the Acute Myocardial Infarction (AMI) indicator.

We welcome your feedback on indicator definitions, the QI software, and related documentation.  We also welcome hearing from you about your use of the indicators or "case studies" to assist AHRQ in identifying projects that translate research into practice.

Feedback, questions and comments regarding the AHRQ Quality Indicators may be submitted to QIsupport@ahrq.hhs.gov.

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August 20 2003 – Interpretative guide to Inpatient Quality Indicators Now Available

The Dallas-Fort Worth Hospital Council Data Initiative has kindly provided access to their guide designed to assist users in interpreting results from the Inpatient Quality Indicators. The Interpretative Guide is available on the AHRQ Quality Indicators Web site on the Quality Indicators Presentation page (http://www.qualityindicators.ahrq.gov/Resources.aspx#presentations.aspx).

The purpose of this Interpretative Guide is to assist hospitals and other users of the AHRQ Inpatient Quality Indicators (IQI) understand and interpret the results derived from the application of the IQI software to their own data. The Interpretative Guide is copyrighted and permission to reproduce or alter this material must be obtained from the Dallas-Fort Worth Hospital Council Data Initiative. Contact information is provided on the Quality Indicators Publications Page on the AHRQ Quality Indicators Web site.

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July 23 2003 – HCUP 2001 NIS Data Now Available

HCUP Nationwide Inpatient Sample (NIS) data from 2001 are now available. The NIS is a unique and powerful database of hospital inpatient stays.  Researchers and policymakers use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.

For more information about the NIS and how to order the data go to http://www.ahrq.gov/data/hcup/hcupnis.htm

Selected data from the 2001 NIS also are available on HCUPnet at http://www.ahrq.gov/hcupnet

Earlier data from the NIS was used to develop the AHRQ quality indicators.

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July 7 2003 – National rates for PQIs Now Available

National rates for the Prevention Quality Indicators (PQIs), based on the Nationwide Inpatient Sample data set, are now available on HCUPnet. In addition to overall national estimates for 1994, 1997 and 2000, HCUPnet also provides a breakdown of rates by age, socio-economic status (SES), patient residence and region for year 2000 data.

HCUPnet can be found at http://www.ahrq.gov/hcupnet . To access the PQIs on HCUPnet, first start HCUPnet, then click on the last tab "National Quality Indicators."

In the future, selected national rates for the Inpatient Quality Indicators and the Patient Safety Indicators will also be available on HCUPnet.

HCUPnet is a publicly available, free, web based application that provides access to the Nationwide Inpatient Sample for simple queries. HCUPnet is maintained and supported by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Inquiries specifically regarding HCUPnet should be addressed to hcup@ahrq.gov. Inquiries regarding the AHRQ QIs may be addressed to QIsupport@ahrq.hhs.gov.

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June 9 2003 – Research paper on Patient Safety in US Hospitals Now Available

An electronic reprint of the research paper "A National Profile of Patient Safety in US Hospitals Based on Administrative Data" by Romano, Geppert, Davies, Miller, Elixhauser and McDonald is temporarily available for download from the AHRQ QI Web site. To access the electronic reprint visit the Research Section of the AHRQ QI Web site.

This article was originally published by Health Affairs in its March/April 2003 issue and the electronic reprint is provided courtesy of Health Affairs. This electronic reprint is subject to copyright restrictions.

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May 30 2003 – Software to Calculate Confidence Intervals for PSIs Is Available by Request

The Agency for Healthcare Research and Quality (AHRQ) announces the availability of optional supplemental software that can be used to calculate statistical confidence intervals for the Patient Safety Indicators (PSIs). The optional software syntax is available in both SAS and SPSS format.  To use this optional syntax, users must replace one of the modules in the SAS or SPSS PSIs software.

Users interested in obtaining this optional syntax can request the replacement module by sending an E-mail to QIsupport@ahrq.hhs.gov. Please include "PSI Confidence Interval Syntax Request" in the subject line of the E-mail and indicate in the body of the E-mail which syntax (SAS or SPSS) you are requesting.

Although the AHRQ QI program modules are free, both SAS and SPSS are commercially licensed software packages that must be purchased. Neither SAS Institute Inc. nor SPSS Inc. has any affiliation with development of the AHRQ QIs

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May 30 2003 – Updated PSI SAS Software and Guide Now Available

Minor changes have been integrated into the Patient Safety Indicators SAS software and the Guide to Patient Safety Indicators document has been revised. These changes include: a correction to the Failure to Rescue indicator; updating of the empirical analyses results presented in the Guide; and, formatting changes to the software and the guide. The revised SAS software and Guide to Patient Safety Indicators are now available for download, free of charge, from the AHRQ QI Web site.

A log of changes, detailing each change in the SAS software and documentation, is also available for download. This log is in addition to the document previously available describing the changes in indicator definitions made between the release of the technical report and the release of the SAS and SPSS software.

The Patient Safety Indicators are the third module of the AHRQ Quality Indicators (QIs), which are measures of health care quality based on readily available hospital inpatient administrative data. The Patient Safety Indicators (PSIs) are a new tool to help health system leaders identify potentially preventable complications and iatrogenic events occurring during hospitalization. The PSIs were developed by AHRQ and investigators from the Evidence-based Practice Center at Stanford and the University of California after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

To use the AHRQ QI Patient Safety Indicators SAS or SPSS software program modules, users must have access to either the SAS or SPSS statistical software packages, respectively, and must apply the program modules to databases that contain information on hospital discharges.

Although the AHRQ QI program modules are free, both SAS and SPSS are commercially licensed software packages that must be purchased. Neither SAS Institute Inc. nor SPSS Inc. has any affiliation with development of the AHRQ QIs.

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May 30 2003 – PSI SPSS Software Released

The Agency for Healthcare Research and Quality (AHRQ) announces the availability of the AHRQ Patient Safety Indicators software in SPSS format. The SPSS software is now available for download, free of charge, from the AHRQ QI Web site.

In addition to the software, a document describing the changes in indicator definitions made between the release of the technical report and the release of the SAS and SPSS software is available for download. A separate log of changes made to the SAS software and Guide to the Patient Safety Indicators may also be downloaded.

The Patient Safety Indicators are the third module of the AHRQ Quality Indicators (QIs), which are measures of health care quality based on readily available hospital inpatient administrative data. The Patient Safety Indicators (PSIs) are a new tool to help health system leaders identify potentially preventable complications and iatrogenic events occurring during hospitalization. The PSIs were developed by AHRQ and investigators from the Evidence-based Practice Center at Stanford and the University of California after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

To use the AHRQ QI Patient Safety Indicators SPSS or SAS program modules, users must have access to either the SPSS or SAS statistical software packages, respectively, and must apply the program modules to databases that contain information on hospital discharges.

Although the AHRQ QI program modules are free, both SAS and SPSS are commercially licensed software packages that must be purchased. Neither SAS Institute Inc. nor SPSS Inc. has any affiliation with development of the AHRQ QIs.

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March 14 2003 – Patient Safety Indicators SAS Modules Are Available

The Agency for Healthcare Research and Quality (AHRQ) announces the availability of the Patient Safety Indicators software in SAS format. The Patient Safety Indicators are the third module of the AHRQ Quality Indicators (QIs), which are measures of health care quality based on readily available hospital inpatient administrative data. The Patient Safety Indicators (PSIs) are a new tool to help health system leaders identify potentially preventable complications and iatrogenic events occurring during hospitalization. The PSIs were developed by AHRQ and investigators from the Evidence-based Practice Center at Stanford and the University of California after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.

The SAS version of the PSIs software is now available, free of charge, for download. The PSIs are a set of indicators providing information on potential in-hospital complications and patient safety concerns following surgeries, procedures, and childbirth. The software can be used to help hospitals screen for adverse events that patients experience as a result of exposure to the health care system; these events are likely amenable to prevention by changes at the system or provider level. The Patient Safety Indicators software programs can be applied to any hospital inpatient administrative data.

To use the AHRQ QI Patient Safety Indicators SAS program modules, users must have access to the SAS statistical software package and must apply the program modules to databases that contain information on hospital discharges.

A SPSS version of the PSIs software modules will be released in April 2003. The availability of the SPSS version of the PSIs software will be announced through the AHRQ QI LISTSERV®.

The Guide to Patient Safety Indicators can be downloaded. This guide provides detailed information on the PSIs including concise descriptions, detailed operational definitions, and synthesis of empirical evidence.

Although the AHRQ QI program modules are free, both SAS and SPSS are commercially licensed software packages that must be purchased. Neither SAS Institute Inc. nor SPSS Inc. has any affiliation with development of the AHRQ QIs.

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January 14 2003 – Prevention Quality Indicators Version 2.1, Rev. 2 Now Available

Version 2.1, revision 2 (January 10, 2003) of the AHRQ Prevention Quality Indicators software is now available on the AHRQ QI Web site in SAS and SPSS format.

The Prevention Quality Indicators (QIs) are a set of measures that can be used with hospital inpatient discharge data to identify "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.

This most recent update includes several major changes to the PQI software, including:

  • Option to calculate rates at either MSA or county level for urban areas.
  • Instructions to calculate rates by the patient county of residence (if available in the input data).
  • Updated risk adjustment files, based on year 2000 national data.
  • Easier to understand printed output.
  • Increase in the number of default diagnosis and procedure fields.
  • Changes facilitating the use of either SAS or SPSS programs on the same dataset.

This version is valid for use with data from October 1, 1994 to September 30, 2002. The software download includes population reference files from the years 1997 through 2001. If you want to calculate the PQIs using discharge data prior to 1997, please contact technical support to obtain earlier population reference files.

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