Prevention Quality Indicators Overview

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

The PQIs are a software tool distributed free by AHRQ. The software can be used to help hospitals identify quality of care events that might need further study. The PQI software programs can be applied to any hospital inpatient administrative data. These data are readily available and relatively inexpensive to use.

Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system or services outside the hospital setting. Patients with diabetes may be hospitalized for diabetic complications if their conditions are not adequately monitored or if they do not receive the patient education needed for appropriate self-management.

Patients may be hospitalized for asthma if primary care providers fail to adhere to practice guidelines or to prescribe appropriate treatments. Patients with appendicitis who do not have ready access to surgical evaluation may experience delays in receiving needed care, which can result in a life-threatening condition—perforated appendicitis.

The Prevention Quality Indicators are part of a set of Agency Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) developed by investigators at Stanford University and the University of California under a contract with AHRQ.

The AHRQ QIs expand the original Healthcare Cost and Utilization Project (HCUP) QIs.   The PQIs were released in November 2001. The Inpatient Quality Indicators, the second set, were released in May 2002.  The third set, the Patient Safety Indicators, were released in March 2003.

PQI Facts

Prevention Quality Indicators:

• Can be used as a "screening tool" to help flag potential health care quality problem areas that need further investigation.
• Can provide a quick check on primary care access or outpatient services in a community by using patient data found in a typical hospital discharge abstract.
• Can help public health agencies, State data organizations, health care systems, and others interested in improving health care quality in their communities.
• Are population based and adjusted for age and sex.
• Are publicly available without cost.
• Are available for download.

The Prevention Quality Indicators represent hospital admission rates for the following 14 ambulatory care sensitive conditions:

• Diabetes, short-term complications (PQI 1)
• Perforated appendicitis (PQI 2)
• Diabetes, long-term complications (PQI 3)
• Chronic obstructive pulmonary disease (PQI 5)
• Hypertension (PQI 7)
• Congestive heart failure (PQI 8)
• Low birth weight (PQI 9)
• Dehydration (PQI 10)
• Bacterial pneumonia (PQI 11)
• Urinary infections (PQI 12)
• Angina without procedure (PQI 13)
• Uncontrolled diabetes (PQI 14)
• Adult asthma (PQI 15)
• Lower extremity amputations among patients with diabetes  (PQI 16)

With high-quality, community-based primary care, hospitalization for these illnesses often can be avoided.

Although other factors outside the direct control of the health care system, such as poor environmental conditions or lack of patient adherence to treatment recommendations, can result in hospitalization, the PQIs provide a good starting point for assessing quality of health services in the community. Because the PQIs are calculated using readily available hospital administrative data, they are an easy-to-use and inexpensive screening tool. They can be used to provide a window into the community—to identify unmet community heath care needs, to monitor how well complications from a number of common conditions are being avoided in the outpatient setting, and to compare performance of local health care systems across communities.