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

NEWS from 2006

October 13 2006 – AHRQ QI Composite Measure and Risk Adjustment/Hierarchical Modeling Draft Reports Public Comment Period

The Agency for Healthcare Research and Quality (AHRQ) has re-posted for public comment the AHRQ QI Composite Measure draft reports for the Inpatient Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). In addition, the draft report on Risk Adjustment and Hierarchical Modeling has been posted for public comment. The draft reports are available for public comment until COB on Friday, December 8th, 2006. Comments should be provided via email or as an email attachment and sent to Project_Officer@qualityindicators.ahrq.gov.

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September 29 2006 – Release of the Pediatric Quality Indicator Risk Adjustment Module (Windows)

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Pediatric Quality Indicator (PedQI) risk adjustment module in Windows (Version 3.0b). The SAS module was released in May, 2006. There will be no SPSS® version of the PedQI module. The PedQI documentation and software are available for download or viewing on the AHRQ Quality Indicators website (pdi_download).

For additional SAS and Windows software and documentation changes included in this release (Version 3.0b) and for all changes made since the original release of the Pediatric Quality Indicators in February, 2006, please consult the PedQI Change Log, available on the website.

The Pediatric Quality Indicator module is the result of phase I of the pediatric indicator development. The module consists of 13 provider level indicators and 5 area level indicators from the current AHRQ QI modules that were evaluated and reviewed for applicability to the pediatric population. The development process and results are detailed in the report "Measures of Pediatric Health Care Quality Based on Hospital Administrative Data" available on the website (pdi_measures_v30b.doc).

PedQI Version 3.0b is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2006 (FY 2006) or from October 1, 1994 through September 30, 2006. The PedQI Technical Specification includes the coding details and inclusion and exclusion criteria.

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September 19 2006 – AHRQ QI Composite Measure Reports Public Comment Period

The Agency for Healthcare Research and Quality (AHRQ) has posted for public comment the AHRQ QI Composite Measure draft reports for the Inpatient Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). The draft reports are available for public comment until COB on Tuesday, September 26th, 2006. Comments should be provided via email or as an email attachment and sent to Project_Officer@qualityindicators.ahrq.gov.

The IQI Composite Measure draft report can be found at AHRQ_IQI_Composite_Draft.pdf and the PSI Composite Measure draft report can be found at AHRQ_PSI_Composite_Draft.pdf.

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September 13 2006 – Upcoming Release of the Pediatric Quality Indicator Risk Adjustment Module (Windows); the AHRQ QI Composite Measure Public Comment Period; AHRQ QI Validation Pilot Reminder

This announcement is intended to notify users of the AHRQ Quality Indicators about upcoming activities in the AHRQ QI program.

  1. Release of the Pediatric Quality Indicator Risk Adjustment Module (Windows)
    The Agency for Healthcare Research and Quality (AHRQ) is planning to release the AHRQ Pediatric Quality Indicator (PedQI) risk adjustment module for the Windows version of the software at the end of September. The SAS module was released in May, 2006. There will not be a SPSS version of the PedQI module. The PedQI documentation and software will be available for download or viewing on the AHRQ Quality Indicators website (pdi_download).

    The Pediatric Quality Indicator module is the result of Phase I of the pediatric indicator development. The module consists of 13 provider level indicators and 5 area level indicators adapted from the current AHRQ QI modules that were evaluated and reviewed for applicability to the pediatric population. The evelopment process and results are detailed in the report "Measures of Pediatric Health Care Quality Based on Hospital Administrative Data" available on the website(pdi_measures_v30.doc).

  2. The AHRQ QI Composite Measure Public Comment Period
    The efforts of the AHRQ Quality Indicators Workgroup on Composite Measures for the Inpatient Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs) are nearing completion, and reports detailing the methodology for constructing the composites will soon be made available for public comment. An announcement with specific instructions for downloading the report and submitting comments will be distributed via this listserv® sometime in the next few weeks. Parties potentially interested in submitting comments should be aware that the turnaround time for reviewing the reports and submitting comments will be relatively brief (approximately one week). For more information on the AHRQ QI Workgroup on Composite Measures, see (May25 Release).
  3. AHRQ QI Validation Pilot Reminder
    A reminder that organizations interested in participating in the AHRQ QI Validation Pilot must submit their indication of interest form by COB tomorrow, Thursday, September 14. For more information on the AHRQ QI Validation Pilot project, see (Aug21 Release).
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August 21 2006 – Pilot Validation Project for the AHRQ Patient Safety Indicators

The Agency for Healthcare Research and Quality (AHRQ) is interested in determining the feasibility and practicality of a pilot project that would assist in the validation of selected AHRQ Quality Indicators in the coming year. The Agency is considering partnering with 5-7 organizations to volunteer for participation in a validation pilot for the AHRQ Patient Safety Indicators (AHRQ PSI). The aims of the validation pilot are to gather evidence on the scientific acceptability of the AHRQ PSI in an effort to consolidate the evidence base of the AHRQ PSIs, to improve guidance on the interpretation and uses of the AHRQ PSI data, and to evaluate potential refinements to the AHRQ PSI specifications. Partner organizations may include individual hospitals, hospital systems, hospital associations, state governments, or other organizations engaged in quality improvement, public reporting and/or health data activities with access to administrative and medical record data on acute inpatient hospital stays. For more information, see ahrqqi_cvp.doc.

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July 17 2006 – The AHRQ Quality Indicators Risk Adjustment Workgroup

The AHRQ Quality Indicators (AHRQ QI) Risk Adjustment Workgroup will begin this month to evaluate risk-adjustment and hierarchical modeling methodologies for the AHRQ QI. Nominations for the Workgroup were submitted to the AHRQ QI Support Team in response to a notice that appeared on May 16, 2006 in the Federal Register (Volume 71, Number 94, pp. 28345-6). Many well-qualified individuals were nominated. All the nominations received were evaluated by a selection committee and were based on several key factors:

  • Knowledge of recent risk-adjustment and hierarchical modeling approaches published in the literature;
  • Peer-reviewed publications relevant to the development and use of risk-adjustment, hierarchical modeling, performance measures, and reporting;
  • Expertise in statistical methods relevant to the evaluation of alternative approaches to risk-adjustment and hierarchical modeling;
  • Experience with development of measures based on administrative data and its uses;
  • Expertise in hospital quality improvement and patient safety; and
  • Familiarity with the AHRQ Quality Indicators and their application.

Members of the AHRQ Quality Indicators Risk Adjustment Workgroup are:

Confirmed Members
  • Dan R. Berlowitz, Bedford Veterans Affairs Medical Center
  • Cheryl L. Damberg, Pacific Business Group on Health
  • R. Adams Dudley, Institute for Health Policy Studies, UCSF
  • Marc Nathan Elliott, RAND
  • Byron J. Gajewski, University of Kansas Medical Center
  • Andrew L. Kosseff, Medical Director of System Clinical Improvement, SSM Health Care
  • John Muldoon, National Association of Children’s Hospitals and Related Institutions
  • Sharon-Lise Teresa Normand, Department of Health Care Policy Harvard Medical School
  • Richard J. Snow, Doctors Hospital, OhioHealth
Liaison Members
  • Simon P. Cohn, National Committee on Vital and Health Statistics (Kaiser Permanente)
  • Donald A. Goldmann, Institute for Healthcare Improvement
  • Andrew D. Hackbarth, Institute for Healthcare Improvement
  • Lein Han, Centers for Medicare & Medicaid Services
  • Amy Rosen, Bedford Veterans Affairs Medical Center
  • Stephen Schmaltz, Joint Commission on Accreditation of Healthcare Organizations
Technical Advisors
  • Rich Averill, 3M
  • Robert Baskin, AHRQ
  • Norbert Goldfield, 3M
  • Bob Houchens, Medstat
  • Eugene A. Kroch, Institute for Healthcare Improvement Technical Advisor (Carescience)
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June 22 2006 – National Initiatives on Quality Measurement
The National Quality Forum: Call for Steering Committee and Technical Panel Nominations

The National Quality Forum (NQF) has issued a call for nominations for the project entitled "National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2006". This is a project that is sponsored by AHRQ and the project in which the Quality Indicators (QIs) will be evaluated for potential endorsement by the NQF. There will be one Steering committee and 5 Technical Advisory Panels (one panel each for each module submitted — Pediatrics, Patient Safety, and Inpatient; one TAP for composite measures; and one TAP for evaluation of reporting/implementation). All nominations MUST be submitted by 6:00 pm EDT, Tuesday, July 18, 2006.

For more information, please see the attached Call For Nominations and Nominations Form.

Emergency Department Performance Measures: Potential Measures of Operational Quality

Nineteen members of the emergency medicine community, including members from the Emergency Department (ED) Benchmarking Alliance, ED Practice Management Association, American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Nurses Association, Volunteer Hospital Association, Institute of Healthcare Improvement, National ED Inventory Project, RWJ Urgent Matters, Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality, met in Atlanta in February to discuss and develop performance measures for the ED. The purpose of the meeting was to begin the process of standardizing the terminology and implementation of ED performance measures that will serve as markers of operational quality. The resulting Consensus Statement is being circulated for comment and discussion. If you have any questions or comments, please contact Pamela Owens, Ph.D. at Pamela.Owens@ahrq.hhs.gov.

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May 31 2006 – Release of the Pediatric Quality Indicator Risk Adjustment Module (SAS Only)

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Pediatric Quality Indicator (PedQI) risk adjustment module in SAS (Version 3.0b). The PedQI documentation and software are available for download or viewing on the AHRQ Quality Indicators website (pdi_download).

The Pediatric Quality Indicator module is the result of phase I of the pediatric indicator development. The module consists of 13 provider level indicators and 5 area level indicators from the current AHRQ QI modules that were evaluated and reviewed for applicability to the pediatric population. The development process and results are detailed in the report "Measures of Pediatric Health Care Quality Based on Hospital Administrative Data" available on the website (pdi_measures_v30.pdf).

PedQI Version 3.0b is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2006 (FY 2006) or from October 1, 1994 through September 30, 2006. The PedQI Technical Specification includes the coding details and inclusion and exclusion criteria.

The Windows version of the PedQI risk adjustment module will be made available as soon as possible. There is no SPSS version of the PedQI module.

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May 25 2006 – The AHRQ Quality Indicators Composite Measure Workgroup

The AHRQ Quality Indicators Composite Measure Workgroup will begin this month to develop composite measures for the Inpatient Quality Indicators (IQI) and the Patient Safety Indicators (PSI). Nominations for the AHRQ QI Composite Measure Workgroup were submitted to the AHRQ QI Support Team in response to a notice in the Federal Register (April 4, 2006). Many well-qualified individuals were nominated. Nominations were evaluated by a selection committee on several key factors:

  • Peer-reviewed publications relevant to the development of composite measures;
  • Expertise in statistical methods relevant to the development of composite measures;
  • Knowledge of recent composite methodologies published in the literature;
  • Experience with development of measures based on administrative data and its uses;
  • Expertise in hospital quality improvement and patient safety;
  • Familiarity with the AHRQ Quality Indicators and their application;
  • Experience with application of performance measures for public reporting;

Members of the AHRQ Quality Indicators Composite Measure Workgroup for the Inpatient Quality Indicators and the Patient Safety Indicators are:

Confirmed Members
  • John Birkmeyer, University of Michigan
  • Bruce Boissonnault, Niagara Health Quality Coalition
  • John Bott, Employer Health Care Alliance Cooperative
  • Dale Bratzler, Oklahoma Foundation for Medical Quality
  • Sharon Cheng, MedPAC
  • Elizabeth Clough, Wisconsin Collaborative for Healthcare Quality
  • Nancy Dunton, University of Kansas Medical Center, School of Nursing
  • John Hoerner, Hospital Industry Data Institute
  • David Hopkins, Pacific Business Group on Health
  • Gregg Meyer, Massachusetts General Physicians Organization
  • Elizabeth Mort, Massachusetts General
  • Janet Muri, National Perinatal Information Center
  • Vi Naylor, Georgia Hospital Association
  • Eric Peterson, Duke University Medical Center
  • Martha Radford, New York University Hospitals Center
  • Gulzar Shah, National Association of Health Data Organizations
  • Paul Turner, Vermont Program for Quality in Health Care
Liaison Members
  • Justine Carr, National Committee on Vital and Health Statistics
  • Robert Hungate, National Committee on Vital and Health Statistics
  • Sheila Roman, Centers for Medicare & Medicaid Services
  • Amy Rosen, Bedford Veterans Affairs Medical Center
  • Stephen Schmaltz, Joint Commission on Accreditation of Healthcare Organizations
  • Jane Sisk, National Center for Health Statistics
  • Ernie Moy, Agency for Healthcare Research and Quality
Technical Advisors
  • John Adams, RAND
  • Bob Houchens, Medstat
  • Bill Rogers, Rogers Associate
  • Chunliu Zhan, Agency for Healthcare Research and Quality
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May 16 2006 – Federal Register Notice for Risk Adjustment Approaches to Administrative Data

AHRQ has published a notice in the Federal Register seeking nominations for the AHRQ Quality Indicators Workgroup on Risk Adjustment Approaches to Administrative Data. See the full text of the annoucement in text or in PDF format.

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May 12 2006 – AHRQ Webcast: Pay-for-Performance: Practical Guidance for Decision-Making and the Latest Evidence

You may be interesting in tuning-in for this AHRQ webcast next Tuesday. If so, please use the registration website below to join us.

Free AHRQ-Sponsored Web Conference for Purchasers & Providers

When: Tuesday, May 16, 2006, 2:00-3:30 p.m. EST
Registration: http://www.academyhealth.org/ahrq/p4pwebconference/

This AHRQ Web Conference will highlight key design-related decisions associated with quality-based payment schemes:

  • Which providers should you target first - hospitals or physicians?
  • Is it better to use a 'carrot' or a 'stick' approach?
  • Should purchasers give incentives to providers by using bonuses, withholds, or a combination?
  • How can a quality-based payment scheme enhance existing public report card initiatives?

For each of these decisions and others, a panel of health services researchers and purchasers will share evidence, guidance, and practical experiences. In addition, participants will hear the latest findings on pay-for-performance.

The Web conference will feature Pay for Performance: A Decision Guide for Purchasers, a new AHRQ-supported tool, and the latest research findings on quality-based purchasing published in a recent special supplement of the Medical Care Research and Review (MCRR).

To request copies of these publications, call AHRQ's Publications Clearinghouse at 1-800-358-9295 or e-mail AHRQPubs@ahrq.hhs.gov.

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May 1 2006 – Update to the 3M APR-DRG Limited License Grouper and Update to the AHRQ QI Version 3.0 Documentation

The Agency for Healthcare Research and Quality (AHRQ) has posted an update to the 3M APR-DRG Limited License Grouper (in SAS and Windows) and updates to the AHRQ QI Version 3.0 documentation released in February, 2006. The software and documentation are now available for download from the AHRQ QI web site (www.qualityindicators.ahrq.gov). Relevant links to software and documentation are provided below.

  1. Update to 3M APR-DRG Limited License Grouper
    The updated 3M APR-DRG Limited License Grouper incorporates three changes to the grouper software: the revised version 1) includes updated code mappings for FY2006 ICD-9-CM diagnosis and procedure codes; 2) corrects a problem with the code mapping for ICD-9-CM diagnosis codes added after FY2003 that resulted in some principal diagnosis codes being identified as invalid (GRC=11); and 3) adds three APR-DRG codes (163, 220 and 260) used in the risk-adjustment for IQI #12 (CABG Mortality) and IQI #24 (Incidental Appendectomy). SAS and SPSS syntax users who assigned the APR-DRG codes without using the Limited License Grouper are not affected by this update; otherwise users should re-calculate the IQI expected and risk-adjusted rates.
  2. Update to the AHRQ QI Version 3.0 Documentation
    Users should consult the current PQI, PedQI and PSI change logs for a list of updates to the documentation for each module since the release of Version 3.0 in February, 2006. In some cases the SAS, SPSS or Windows software has been updated to reflect these changes. All updated AHRQ QI software and documentation are now available for download or viewing on the AHRQ Quality Indicators website. For the Prevention Quality Indicators, see pqi_download. For the Pediatric Quality Indicators, see pdi_download. For the Patient Safety Indicators, see psi_download.
  3. Release of the Pediatric Quality Indicator Risk Adjustment Module
    The SAS PedQI risk adjustment module is scheduled for release in May, 2006. The posting of the module will be announcement from this listserv and on the AHRQ QI website.

    For questions, please contact QIsupport@ahrq.hhs.gov

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April 19 2006 – Federal Register Notice for Workgroup on Inpatient and Patient Safety Composite Measures

The Agency for Healthcare Research and Quality (AHRQ) has published a notice in the Federal Register (Tuesday, April 4th, 2006; Vol. 71, No. 64 Pp. 16786-7) seeking nominations for members of the AHRQ QI Workgroup on Composite Measures for the Inpatient Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). The text of the notice, including Workgroup selection criteria and activities, may be found at fr04ap06N.pdf..

DATES: Please submit nominations on or before May 4, 2006. Self-nominations are welcome. Third-party nominations must indicate that the individual has been contacted and is willing to serve on one of the workgroups. Notification of selected candidates will be contacted by AHRQ no later than May 15, 2006.

ADDRESSES: Nominations can be sent in the form of a letter or e-mail, preferably as an electronic file with an e-mail attachment and should specifically address the submission criteria as noted below. Electronic submissions are strongly encouraged. Responses should be submitted to:

AHRQ Quality Indicators Initiative
Agency for Healthcare Research and Quality
Center for Delivery, Organization and Markets
540 Gaither Road, Room 5121
Rockville, MD 20850
E-mail: projectofficer@qualityindicators.ahrq.gov

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February 20 2006 – Release of the AHRQ QI Version 3.0 and the Pediatric Quality Indicator Module

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Quality Indicator Version 3.0 for the Inpatient Quality Indicators (IQI) and Patient Safety Indicators (PSI), and the new Pediatric Quality Indicator (PedQI) module. The software and documentation are now available for download from the AHRQ QI web site www.qualityindicators.ahrq.gov).

The February 2006 edition of the AHRQ QI newsletter summarizes the major changes implemented in Version 3.0. The newsletter can be found at 2006-February-AHRQ-QI-Newsletter.htm. Relevant links to software and documentation are provided below.

  1. Inpatient Quality Indicators FY2006 Coding Update (Version 3.0)
    AHRQ is pleased to announce an FY2006 coding update of the AHRQ Inpatient Quality Indicators (IQIs), Version 3.0. All updated IQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (iqi_download).

    IQI Version 3.0 is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2006 (FY 2006) or from October 1, 1994 through September 30, 2006. After a complete review of the ICD-9-CM codes and DRGs that were effective October 1, 2005 (FY 2006) it was determined that limited changes were required to the IQI definitions. In addition, the two pediatric IQIs were moved to the new Pediatric Indicator Module and the inclusion criteria modified when necessary to include only adults. All changes included in Version 3.0 are detailed in two documents, the IQI Change Log and IQI Indicator Changes, available on the website. The IQI Technical Specification includes the coding details and inclusion and exclusion criteria.

    The risk-adjustment for the IQI Version 3.0 was updated to use 3M APR DRG Version 20.0. In addition, the software now includes a limited-license 3M APR DRG grouper to assign the APR DRG and severity-of-illness or risk-of-mortality subclass to individual cases in the user's input data only for those APR?DRGs used in the IQI risk-adjustment. Users who do not wish to agree to the license terms for the limited license grouper may select to download a version of the software without it.

    IQI Version 3.0 is available in SAS, Windows and SPSS. The SPSS version is only intended for users transitioning to the SAS or Windows applications, was updated only with coding and specification changes, and does not contain the limited-license 3M APR DRG grouper and some of the other software enhancements. The SPSS software will no longer be supported after FY2006.

  2. Patient Safety Indicators FY2006 Coding Update (Version 3.0)
    AHRQ is pleased to announce an FY2006 coding update of the AHRQ Patient Safety Indicators (PSIs), Version 3.0. All updated PSI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (psi_download).

    PSI Version 3.0 is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2006 (FY 2006) or from October 1, 1994 through September 30, 2006. After a complete review of the ICD-9-CM codes and DRGs that were effective October 1, 2005 (FY 2006) it was determined that limited changes were required to the PSI definitions. In addition, the inclusion criteria modified when necessary to include only adults, and other specification changes were implemented to continue to improve the indicators. All changes included in Version 3.0 are detailed in two documents, the PSI Change Log and PSI Indicator Changes, available on the website. The PSI Technical Specification includes the coding details and inclusion and exclusion criteria.PSI Version 3.0 is available in SAS, Windows and SPSS. The SPSS version is only intended for users transitioning to the SAS or Windows applications, was updated only with coding and specification changes, and does not contain some of the other software enhancements. The SPSS software will no longer be supported after FY2006.

  3. Pediatric Quality Indicators (Version 3.0)
    AHRQ is pleased to announce the new Pediatric Quality Indicator (PedQI) module Version 3.0. All PedQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (pdi_download).

    The Pediatric Quality Indicator module is the result of phase I of the pediatric indicator development. The module consists of 13 provider level indicators and 5 area level indicators from the current AHRQ QI modules that were evaluated and reviewed for applicability to the pediatric population. The development process and results are detailed in the report "Measures of Pediatric Health Care Quality Based on Hospital Administrative Data" now available on the website (pdi_download).

    PedQI Version 3.0 is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2006 (FY 2006) or from October 1, 1994 through September 30, 2006. The PedQI Technical Specification includes the coding details and inclusion and exclusion criteria. PedQI Version 3.0 is available in SAS and Windows. There will not be an SPSS version.

  4. Prevention Quality Indicators (Version 3.0a)
    The Prevention Quality Indicator (PQI) module Version 3.0 was released in December, 2005. The new Version 3.0a contains a modification of the definition of newborn (used in the low birth weight indicator) to be consistent with the definition used in the new Pediatric Quality Indicator module. The specifications for the other indicators are the same. In addition, the risk adjustment method was modified to be consistent with the approach used in the current version of the remainder of the AHRQ QI modules and to provide confidence limits on the rates. All PQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (pqi_download)

For questions, please contact QIsupport@ahrq.hhs.gov

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February 3 2006 – Prevention Quality Indicator Composite and February Newsletter

The AHRQ Quality Indicators Support Team has posted the draft report from the Prevention Quality Indicator Composite Workgroup. The draft report is available for public comment until COB on Thursday, February 9th, 2006. Comments should be provided via email or as an email attachment and sent to Project_Officer@qualityindicators.ahrq.gov.

The February, 2006 issue of the AHRQ QI newsletter has been posted to the AHRQ QI web site. This special issue briefly reviews some of the highlights from the past year and previews plans for the coming year in the AHRQ Quality Indicators program, including the major changes implemented in Version 3.0 of the AHRQ QI. Any questions regarding theses posting may be directed to the AHRQ Quality Indicators Support Team via email: QIsupport@ahrq.hhs.gov

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