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

NEWS from 2009

December 29 2009 – Webinar on Quality Indicators Version 4.1 Changes

The AHRQ Quality Indicators team is providing a two-part webinar series to review the changes from Version 3.2 to Version 4.1 of the Quality Indicators. Different aspects of the Version 4.1 changes will be covered in these sessions, so interested users should try to attend both sessions.

The webinar schedule is below. Each session is offered twice to provide participants a choice of available times. Access information for these webinars will be sent to the listserv® and posted to the Quality Indicators website in early January.

Session 1: January 12, 2010 or January 14, 2010, 1:00-3:00pm EST.
Session 2: January 25, 2010 or January 27, 2010, 2:00-4:00pm EST.

A summary of the Version 4.1 changes was provided in the previous listserv announcement. (That announcement can be found at this link: http://www.qualityindicators.ahrq.gov/archive/News2009.aspx.) Users may find this summary helpful to review prior to attending these webinars.

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December 18 2009 – Release of AHRQ Quality Indicators for SAS Version 4.1

The Agency for Healthcare Research and Quality (AHRQ) announces the release of the AHRQ Quality Indicators for SAS Version 4.1 for the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Pediatric Quality Indicators (PDI) modules. The software and documentation are now available for download from the AHRQ QI web site at: (http://www.qualityindicators.ahrq.gov/software/). The AHRQ Quality Indicators team apologies for any inconveniences caused by the delay of this release.

Please note that the AHRQ Quality Indicators for Windows® Version 4.1 is not being released at this time. An announcement will be sent to the listserv when this software is released.

This announcement provides a summary of the changes from Version 3.2 to Version 4.1. However, in order to provide AHRQ QI users with information about these changes, two web conferences will be offered to the public. This will be a two part web conference, and different aspects of the Version 4.1 changes will be discussed in each event. Participation in the events is free of charge. The web conferences dates and times will be provided in a separate announcement.

Access information for the web conferences will be sent to those who express interest in attending. Please send an email to QIsupport@ahrq.hhs.gov if you would like to participate.

Summary of Major Changes from Version 3.2 to Version 4.1

  1. FY2009 coding update – The numerator and denominator specifications have been updated to incorporate the FY2009 ICD-9-CM and DRG coding updates (effective October 1, 2008). In particular, there is new staging coding (I-IV) for pressure ulcers (formerly called decubitus ulcer).
  2. Specification changes – Several specification changes were implemented that were recommend by expert panels, user queries or published literature. These include changes to esophageal resection volume and mortality, hip replacement mortality, hip fracture mortality, incidental appendectomy, bilateral catheterization, hypertension admission rate, CHF admission rate, bacterial pneumonia admission rate, pressure ulcers, iatrogenic pneumothorax, postoperative hip fracture, postoperative physiologic and metabolic derangements, postoperative respiratory failure, postoperative sepsis and OB Trauma (instrument and non-instrument assisted).
  3. Implement UB-04 – The UB-04 (effective October 1, 2007) changes were implemented including new data elements for point-of-origin and present on admission.
  4. MS-DRG specification – The MS-DRG (version 25) was adopted October 1, 2007; as a result, several of the numerator, denominator and risk category definitions were redeveloped to be based on ICD-9-CM codes rather than CMS DRG codes (version 24). These included code based definitions for cardiac surgery, cardiac arrhythmia and abdominal surgery. In addition, the craniotomy mortality denominator definition and medical and surgical denominator definitions were redefined to MS-DRGs.
  5. Implement the NQF Composites – The SAS software includes the recently endorsed composite measures. The composites are Mortality for Selected Conditions, Patient Safety for Selected Indicators and Pediatric Patient Safety for Selected Indicators.
  6. Neonatal indicators– Two new neonatal indicators for Neonatal Mortality and Blood Stream Infections in Neonates are included. There is an additional existing neonatal indicator for Iatrogenic Pneumothorax in Neonates.
  7. Update benchmarking data to 2007 – In prior releases we have used a three-year pooled State Inpatient Databases (SID) database for computing the national benchmarks. The rationale for this was to balance the currency of the data and the stability of the trends. However, the pace of change in coding and data is accelerating and will only continue through the implementation of ICD-10-CM in 2013 and beyond. Therefore the importance of using current data has greatly increased, and this release uses data from the 2007 SID for computation of benchmarks.
  8. Removal of indicators – PSI 1 (Complications of Anesthesia) and PSI 20 (Obstetric Trauma – Cesarean Delivery) have been removed from the Patient Safety Indicators module. These indicators have historically presented validity and coding issues, and were deemed by AHRQ to be unsuitable for comparative reporting. They continue to be available in the Windows Application as ‘experimental’ indicators.
  9. Present on Admission (POA) methodology change – There are no longer separate models with and without POA data for the IQIs, PSIs and PDIs. For users without POA data, the model will incorporate the likelihood that the numerator event or the co-morbidity was present on admission. For users with POA data, the model will be based on that data element.
  10. Measures moved to other SAS modules – PSI 17 (Birth trauma – Injury to Neonate) and PQI 9 (Low Birth Weight) have been moved to the PDI SAS module, which now includes all the indicators based on pediatric discharges. However, the technical specification for PSI 17 remains with the other PSI indicators and continues to be referenced as PSI 17. The technical specification for PQI 9 remains with the other PQI indicators and continues to be referenced as PQI 9. In addition, PDI 4 (Iatrogenic Pneumothorax, Neonate) has been renamed as Neonatal Quality Indicator 1.
  11. Removal of risk adjustment – Risk adjustment has been removed from the following process measures: IQI 21 (Cesarean Section Delivery); IQI 22 (Vaginal Birth After Cesarean, Uncomplicated); IQI 23 (Laparoscopic Cholecystectomy); IQI 24 (Incidental Appendectomy in the Elderly); IQI 25 (Bi-lateral Cardiac Catheterization); IQI 33 (Primary Cesarean Delivery); and IQI 34 (Vaginal Birth After Cesarean, All). In general, process measures are not risk-adjusted. In addition, risk adjustment has been removed from PSI 18 (OB Trauma – Vaginal w/ Instrument) and PSI 19 (OB Trauma – Vaginal w/o Instrument) because there are not materially important risk factors available in the state inpatient discharge data.

Relevant links to software and documentation are provided below.

  1. Prevention Quality Indicators FY2009 Coding Update (Version 4.1)
    Version 4.1 includes the FY2009 coding update of the AHRQ Prevention Quality Indicators. All PQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/Default.aspx#pqi) in Microsoft® Word® and PDF format.
  2. Inpatient Quality Indicators FY2009 Coding Update (Version 4.1)
    >Version 4.1 includes the FY2009 coding update of the AHRQ Inpatient Quality Indicators. All IQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/Default.aspx#iqi) in Microsoft Word and PDF format.
  3. Patient Safety Indicators FY2009 Coding Update (Version 4.1)
    Version 4.1 includes the FY2009 coding update of the AHRQ Patient Safety Indicators. All PSI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/Default.aspx#psi) in Microsoft Word and PDF format.
  4. Pediatric Quality Indicators FY2009 Coding Update (Version 4.1)
    Version 4.1 includes the FY2009 coding update of the AHRQ Pediatric Quality Indicators and Neonatal Quality Indicators. All PDI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/Default.aspx#pdi) in Microsoft Word and PDF format.

For questions, please contact QIsupport@ahrq.hhs.gov or leave a voicemail at (301) 427-1949.

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September 30 2009 – Update: Release of AHRQ Quality Indicators for SAS Beta Version 4.0a

As you may be aware, the Agency for Healthcare Research and Quality (AHRQ) released the AHRQ Quality Indicators for SAS Beta Version 4.0a earlier this month. Beta testing has occurred with many QI users and other external parties. We appreciate the feedback provided and are continuing to refine version 4.0a. We expect testing and refinement to continue for several more weeks with a final version of the SAS and Windows software available to the public within the next 45 – 60 days.

Due to the extensive modifications and enhancements made this year, particularly with regards to better incorporation of POA information, we believe this additional testing time is necessary. We apologize for any inconvenience this may cause. Please note that Quality Indicators version 3.2 is available for your use until the final release of version 4.0a.

To request the beta version 4.0a please contact QIsupport@ahrq.hhs.gov or leave a voicemail at (301) 427-1949.

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September 4 2009 – Release of AHRQ Quality Indicator Beta Version 4.0a for SAS

The Agency for Healthcare Research and Quality (AHRQ) announces the release of the AHRQ Quality Indicators (AHRQ QIs) for SAS Beta Version 4.0a for the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Pediatric Quality Indicators (PDI) modules. Due to extensive enhancements made to version 4.0a, AHRQ is releasing this version as a beta for approximately the next 10 business days. The beta version will be provided to AHRQ QI users upon request.

To request the beta version 4.0a please contact QIsupport@ahrq.hhs.gov or leave a voicemail at (301) 427-1949.

The date the final version will be released is dependent on the outcome of the beta process. If no material issues are discovered, the final version is expected to be released approximately September 30th, 2009.

The same process outlined above is anticipated in regard to the release of beta version 4.0a of the Windows software. We anticipate the beta will be released September 30th, 2009. The Listserv will be notified when that Windows software beta version 4.0a will be available for request.

The SAS Beta Version 4.0a includes a new risk-adjustment methodology that provides risk-adjusted rates based on the specific case-mix of each hospital and on the availability of present on admission (POA) information. The beta version also includes some minor corrections and revisions to other aspects of the software.

The risk adjustment methodology implemented in Version 4.0a was adopted to take better advantage of POA information that potentially impacts the identification of cases and hospital rates. The new methods apply POA information more uniformly than previous versions and are expected to ease the transition to greater POA reporting, but their implementation has taken more time than planned. The AHRQ QI support team apologizes for any inconvenience caused by delays in the release of the new risk-adjustment methodology and any confusion due to releasing the software as separate components.

For questions, please contact QIsupport@ahrq.hhs.gov or leave a voicemail at (301) 427-1949.

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August 20 2009 – PLEASE READ Important Information Regarding Risk-Adjustment for AHRQ Quality Indicator Version 4.0

Users should be aware that the SAS and Windows software for Version 4.0 currently posted on the AHRQ QI web site does not calculate the expected or risk-adjusted rate based on the specific case-mix of each hospital. Therefore, the risk-adjusted rate does not reflect an “apples-to-apples” comparison of performance to the reference population benchmark, and the risk-adjusted rate as currently implemented should not be used for comparative reporting and should not be used for trending the risk-adjusted rate for an individual hospital over time.

Version 4.0 was intended to include a number of enhancements to the risk adjustment, but have taken longer to implement than originally estimated. In an effort to provide an updated version to the AHRQ QI user community we decided to release the software in components. We regret not communicating this earlier to the user community. The AHRQ QI support team will post an updated version of the SAS and Windows software that does calculate the expected rate and risk-adjusted rate on August 31, 2009 (SAS) and September 30, 2009 (Windows). The software will be posted along with supporting documentation on the risk-adjustment methodology. The listserv will be notified the day that the SAS and Windows software is released.

The AHRQ QI support team apologizes for any inconvenience.

For questions, please contact QIsupport@ahrq.hhs.gov or leave a voicemail at (301) 427-1949.

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