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The software allows organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute hospital settings.

The software allows organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute hospital settings.

AHRQ wants to hear from you to help improve the QI program. We would like to better understand how different organizations use the AHRQ QIs and/or other quality measures, challenges and barriers these organizations face, and what resources are helpful in using measurement to guide quality improvement efforts. If you are involved in quality improvement efforts within care delivery or quality improvement-focused organizations, we want to hear from you! Please complete the AHRQ Quality Indicator (QI) Survey. The survey takes less than 10 minutes to complete. Your feedback will help AHRQ make improvements to AHRQ QI resources (e.g., Hospital QI Toolkit), the QI software, and overall improvements to enhance your experience with the AHRQ QI program. Thank you!

Program discovered that the QI Population Files contain some inaccurate county-level age- sex- and race-specific county population estimates beginning with 2012 calendar year. These files are currently under review. In the interim, we have temporarily removed, these QI Population Files and the WinQI software program which embeds QI Population Files, as well as all related documentation from the AHRQ website. We encourage users to compute the area-level indicator rates with their own population files. As a result, the links to archived population files and WinQI software are disabled.This primarily affects the Prevention Quality Indicators (PQIs), although a few area-level indicators are embedded in the other three QI modules [Pediatric Quality Indicators (PDI 14-PDI 18. PDI 90-PDI 92), Patient Safety Indicator(PSI 21-PSI 27, all of which were retired in v7.0), and Inpatient Quality Indicators (IQI 26-IQI 29, all of which were retired in v7.0)]. View details (PDF File, 1.1 MB)

The MapIT tool has been updated to use FYI 18 data to facilitate conversion of set names to ICD-10-CM/PCS codes. The Software Users Guide provides detailed information on installing and using the software and exporting using the results.

Through a Request for Information (RFI), AHRQ is seeking input from the public, hospitals and other healthcare organizations, clinicians, quality improvement experts, researchers, and quality measure developers about current use of the AHRQ Quality Indicators (AHRQ QIs) for quality improvement efforts. Please see the link to the RFI here: - 2018-03243. The deadline to receive the comments is Mar 20, 2018, the link to the extended deadline can be found here: 2018-03964.

The updated version supports the 2017 Population file and an update to PSI 03.

View IQI Area Level (PDF File, 342 KB)
View IQI Hospital Level (PDF File, 356 KB)
View PSI Area Level (PDF File, 349 KB)

Further details can be found here: v7.0 ICD-10-CM/PCS FAQs (PDF File, 353 KB).

The Patient Safety and Adverse Events Composite for the International Classification of Diseases, 9th Revision, Clinical Modification v6.0 ICD-9-CM, 2016, is an updated and modified version of the Patient Safety Indicator for Selected Indicators Composite (v5.0 and prior). Further details about these changes are available in the updated factsheet here: PSI 90 Fact Sheet (PDF File, 526 KB)

Release of October 2016 AHRQ PQI and PSI Quality Indicators for v6.0 ICD-9-CM WinQI software for organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings.

Minor release of WinQI v6.0.2 ICD-10-CM/PCS software for organizationsto apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings

Release of September 2016 AHRQ PQI and PSI Quality Indicators for v6.0 ICD-9-CM SAS QI software For organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings

The Patient Safety and Adverse Events Composite for the International Classification of Diseases, 9th Revision, Clinical Modification v6.0 ICD-9-CM, 2016, is an updated and modified version of the Patient Safety Indicator for Selected Indicators Composite (v5.0 and prior). Further details about these changes are available in the updated factsheet here: PSI 90 Fact Sheet (PDF File, 563, KB)

Announcing the AHRQ Quality Indicators v6.0 ICD-10-CM/PCS SAS QI and WinQI software release webinar. This webinar will inform users about changes to AHRQ QI software due to the ICD-10-CM/PCS transition, highlight enhancements to select AHRQ QIs, discuss improvements to the v6.0 ICD-10-CM/PCS software (SAS and WinQI), and address user questions.

Release of July 2016 AHRQ Quality Indicators v6.0 ICD-10 SAS QI and WinQI. For organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings

The Patient Safety and Adverse Events Composite for the International Classification of Diseases, 9th Revision, Clinical Modification v6.0 ICD-9-CM, 2016, is an updated and modified version of the Patient Safety Indicator for Selected Indicators Composite (v5.0 and prior). Highlights of the changes in the modified version include:

• Addition of three Patient Safety Indicators (PSIs) to the composite including PSIs 09 (Perioperative Hemorrhage or Hematoma Rate), PSI 10 (Postoperative Acute Kidney Injury Rate), and PSI 11 (Postoperative Respiratory Failure Rate) and removal of PSI 07 (Central Venous Catheter-Related Blood Stream Infection Rate).
• Refinement to three PSIs, including PSI 08 (In-Hospital Fall with Hip Fracture Rate), PSI 12 (Perioperative Pulmonary Embolism and Deep Vein Thrombosis Rate) and PSI 15 (Unrecognized Abdominopelvic Accidental Puncture or Laceration Rate)
• Updated reference population using the 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 36 participating states that provide complete "present on admission" information
• Modified composite weighting approach to include both volume and harms of associated with an adverse event. Further details about these changes are available in the factsheet here: PSI 90 Fact Sheet (PDF File, 535 KB)

Request for expert nominations to a Standing Work Group (SWG) for the AHRQ Quality Indicators^TM (QIs) (PDF File, 337 KB). The Agency for Healthcare Research and Quality (AHRQ) is seeking nominations for a Standing Work Group (SWG) to be convened by an AHRQ contractor. The work group shall be comprised of individuals with knowledge of the AHRQ Patient Safety Indicators (PSIs), AHRQ Inpatient Quality Indicators (IQIs), International Classification of Diseases Clinical Modification (ICD-9-CM and ICD-10-CM/PCS) code sets, and associated methodological issues.

Retirement of PQI 13, "Angina without Procedure Admission Rate" in v6.0 (PDF File, 231 KB). This announcement is to inform users of AHRQ Quality Indicators (QIs) that v6.0 (2016) of the QI software will not include PQI 13, "Angina without Procedure Admission Rate." Version v5.0 of the QI software will be the last release in which this indicator is included.

The Agency for Healthcare Research and Quality (AHRQ) would like to invite you to join a panel discussion about the AHRQ Quality Indicators (QIs). Representatives from Yale New Haven Health Systems and Essentia Health will share their experiences implementing the Patient Safety Indicators (PSIs) as part of a larger effort to improve the quality and safety of the care they provide.

Essentia Health and Yale New Haven Health System share how their organizations use the AHRQ QIs to improve the quality and safety of care.

The Agency for Healthcare Research and Quality (AHRQ) announces the plan for releasing the ICD-10 versions of SAS QI v6.0 and WinQI v6.0 software and supporting technical documentation in late spring of 2016.

The Agency for Healthcare Research and Quality (AHRQ) would like to invite you to participate in a webinar about the AHRQ Quality Indicators (QIs), a set of measures that can be used to improve quality of care in the hospital setting. The webinar will highlight the experiences of specific hospitals currently implementing the QIs and the results of their efforts.

For organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings

New FAQs on using the AHRQ Quality Indicators and the AHRQ QI software including installing and using the software, troubleshooting, interpreting AHRQ QI results, and specific codes and indicators

For organizations to apply the AHRQ Quality Indicators (QIs) to their own data to assist quality improvement efforts in acute care hospital settings

The ICD-10 Alpha software can be used to test ICD-10 data that has been converted, in order to assess any impacts as a result of that data conversion. This software – currently in the Alpha stage – was developed to help organizations convert to the use of ICD-10 codes and address technical challenges that may arise in the process.

The MapIT Software Users Guide provides detailed information on installing and using the software and exporting and using the results. The 2015 MAP IT Tool and installation and setup instructions are also available.

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. Users may find this summary helpful to review prior to attending these webinars.

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.

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 and Adverse Events Composite 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 (PQI Resources) 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 (IQI Resources) 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 (PSI Resources) 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 (PDI Resources) in Microsoft Word and PDF format.

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

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.

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.

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.

For AHRQ QI users who have not yet registered for the AHRQ 2008 Annual Conference, these are updated instructions for indicating your intent to attend the AHRQ QI Users Meeting. On the meeting registration page http://www.blsmeetings.net/2008ahrqannual/registration.cfm, please select "AHRQ QI Meeting" from the "Invitation Only Meetings" list and enter the code QIM301 as the 'Invitation Code'

Users that have already registered for the annual meeting do not need to submit another registration in order to attend the AHRQ QI meeting.

We look forward to seeing you in September!

AHRQ's 2008 Annual Conference: Promoting Quality … Partnering for Change

Register now for AHRQ's 2008 Annual Conference, which will be held September 7-10 in Bethesda, MD. Leading national experts will hold sessions on comparative effectiveness research, health information technology, disease prevention and care management, patient safety, and innovations in health care.

For additional information about attending this year's conference, see: (www.blsmeetings.net/2008ahrqannual).

Part of the Annual Conference, the 2008 AHRQ QI Users Meeting is scheduled for Wednesday, September 10 from 8am to 1pm. The one-day meeting will focus on comparative reporting of the AHRQ Quality Indicators, and will feature results from recent validation studies, an update on the National Quality Forum process, guidance on comparative reporting of the AHRQ QI, and perspectives on comparative reporting from national and state policymakers.

AHRQ's 2008 Annual Conference: Promoting Quality - Partnering for Change

Register now for AHRQ's 2008 Annual Conference, which will be held September 7-10 in Bethesda, MD. Leading national experts will hold sessions on comparative effectiveness research, health information technology, disease prevention and care management, patient safety, and innovations in health care.

For additional information about attending this year's conference, see: (www.blsmeetings.net/2008ahrqannual).

Part of the Annual Conference, the 2008 AHRQ QI Users Meeting is scheduled for Wednesday, September 10 from 8am to 1pm. The one-day meeting will focus on comparative reporting of the AHRQ Quality Indicators, and will feature results from recent validation studies, an update on the National Quality Forum process, guidance on comparative reporting of the AHRQ QI, and perspectives on comparative reporting from national and state policymakers.

When registering for the Annual Conference, be sure to indicate your interest in attending the AHRQ QI Users Meeting at: (http://www.blsmeetings.net/2008ahrqannual/polling.cfm).

The Agency for Healthcare Research and Quality (AHRQ) is seeking an indication of interest from organizations willing to participate in Phase II of the AHRQ Quality Indicators Validation Pilot. The validation pilot is designed to gather evidence on the scientific acceptability of the AHRQ Patient Safety Indicators (PSI) in an effort to consolidate the evidence base of the AHRQ PSI, to improve guidance on the interpretation and use of 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: (AHRQ QI Validation Pilot Phase II_Interest Form_Final.doc (Word File, 63 KB)).

The Agency for Healthcare Research and Quality (AHRQ) announces the release of the AHRQ Quality Indicator Version 3.2 for the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Pediatric Quality Indicator (PedQI) modules. The software and documentation are now available for download from the AHRQ QI web site at: (www.qualityindicators.ahrq.gov/archive/software).This release will incorporate several indicator revisions made pursuant to the submission of the AHRQ Quality Indicators to the NQF consensus development process for National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 (https://www.qualityforum.org/Projects/h/Hospital_Care_2007_Additional_Measures/Hospital_Care_Measures.aspx).

Relevant links to software and documentation are provided below.

1. Prevention Quality Indicators FY2008 Coding Update (Version 3.2)
   Version 3.2 includes the FY2008 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/archive/qi_modules?1) in Microsoft® Word® and PDF format.
2. Inpatient Quality Indicators FY2008 Coding Update (Version 3.2)
   Version 3.2 includes the FY2008 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/archive/qi_modules?2) in Microsoft Word and PDF format.
3. Patient Safety Indicators FY2008 Coding Update (Version 3.2)
   Version 3.2 includes the FY2008 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/archive/qi_modules?3) in Microsoft Word and PDF format.
4. Pediatric Quality Indicators FY2008 Coding Update (Version 3.2)
   Version 3.2 includes the FY2008 coding update of the AHRQ Pediatric Quality Indicators. All PedQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/archive/qi_modules?4) in Microsoft Word and PDF format.

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

The Agency for Healthcare Research and Quality (AHRQ) invites you to attend the AHRQ 2007 Quality Indicators User Meeting to be held at the Bethesda North Marriott Convention Center, in Bethesda, MD on Friday, September 28, 2007 from 10:30 – 3:00 p.m.

The user meeting is intended both for active users of the AHRQ Quality Indicators and for those interested in how the AHRQ QI might be used in their organizations. The sessions will focus on lessons learned from current validation studies and plans for future validation efforts:

• Validation studies in the literature and current research activities
• Results from the AHRQ QI Validation Collaborative Pilot for selected Patient Safety Indicators
• Guidance on use of the AHRQ QI medical record data collection tools to improve data quality and processes of care
• Future directions for collaborative validation studies of the AHRQ QI

The User Meeting is being held in conjunction with the AHRQ 2007 Annual Meeting: Improving Healthcare, Improving Lives. Additional general conference information, hotel accommodations and registration information is available on the AHRQ 2007 Annual Meeting conference web site at www.blsmeetings.net/2007ahrqannual

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

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Quality Indicator Version 3.1 for the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Pediatric Quality Indicator (PedQI) modules. The software and documentation are now available for download from the AHRQ QI web site at: www.qualityindicators.ahrq.gov/archive/software

Some of the features incorporated into Version 3.1 are described in the AHRQ QI newsletter at: 2007-February-AHRQ-QI-Newsletter (PDF File, 103 KB).

The Agency for Healthcare Research and Quality (AHRQ) announces the release of the AHRQ Quality Indicator Version 3.2 for the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Pediatric Quality Indicator (PedQI) modules. The software and documentation are now available for download from the AHRQ QI web site at: (www.qualityindicators.ahrq.gov/archive/software).

This release will incorporate several indicator revisions made pursuant to the submission of the AHRQ Quality Indicators to the NQF consensus development process for National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 (https://www.qualityforum.org/Projects/h/Hospital_Care_2007_Additional_Measures/Hospital_Care_Measures.aspx).

Relevant links to software and documentation are provided below.

1. Prevention Quality Indicators FY2007 Coding Update (Version 3.2)
   Version 3.2 includes the FY2007 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/archive/qi_modules?1) in Microsoft® Word® and PDF format.
2. Inpatient Quality Indicators FY2007 Coding Update (Version 3.2)
   Version 3.2 includes the FY2007 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/archive/qi_modules?2) in Microsoft Word and PDF format.
3. Patient Safety Indicators FY2007 Coding Update (Version 3.2)
   Version 3.2 includes the FY2007 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/archive/qi_modules?3) in Microsoft Word and PDF format.
4. Pediatric Quality Indicators FY2007 Coding Update (Version 3.2)
   Version 3.2 includes the FY2007 coding update of the AHRQ Pediatric Quality Indicators. All PedQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (http://www.qualityindicators.ahrq.gov/archive/qi_modules?4) in Microsoft Word and PDF format.

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

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.

• The Risk Adjustment and Hierarchical Modeling draft report: AHRQ_QI_RAHM_Draft.doc (Word File, 1.2 MB) / AHRQ_QI_RAHM_Draft.pdf (PDF file, 1.3 MB)
• The IQI Composite Measure draft report: AHRQ_IQI_Composite_Draft.pdf (PDF File, 1.6 MB)
• The PSI Composite Measure draft report: AHRQ_PSI_Composite_Draft.pdf (PDF File, 1.6 MB)

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.

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 (PDF File, 1.6 MB) and the PSI Composite Measure draft report can be found at AHRQ_PSI_Composite_Draft.pdf (PDF File, 1.6 MB).

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 (May 25 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).

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.

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)

The National Quality Forum: Call for Steering Committee and Technical Panel Nominations

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

• Call For Nominations: txQInominations-Jun06.pdf (PDF File, 92 KB)
• Nominations Form: fmQInominations-Jun06.doc (Word File, 54 KB).

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.

• Attachment: EDPerformanceMeasures-ConsensusStatement.pdf (PDF File, 76 KB)

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.

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.

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
• Bob Houchens, M
• Bill Rogers, Rogers Ass
• Chunliu Zhan, Agency for Healthcare Research and Quality

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 PDF format (PDF File, 67 KB).

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: https://www.powershow.com/view4/51ba19-NTU1M/Pay-for-Performance_Practical_Guidance_for_Decision-Making_and_the_Latest_Evidence_powerpoint_ppt_presentation

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.

The Agency for Healthcare Research and Quality (AHRQ) has posted an update to the 3M^TM 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^TM APR-DRG Limited License Grouper
   The updated 3M^TM 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

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

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^TM APR^TM DRG Version 20.0. In addition, the software now includes a limited-license 3M^TM APR^TM DRG grouper to assign the APR^TM 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^TM APR^TM 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

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

1. AHRQ QI Windows Application Version 2.0

   The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Quality Indicator Windows Application Version 2.0. The software, installation guide and user guide are now available for download from the AHRQ QI web site (www.qualityindicators.ahrq.gov).

   The AHRQ QI Windows Application Version 2.0 incorporates limited enhancements to the performance, features and functionality of application based on recommendations from users. AHRQ plans for future releases of the AHRQ QI Windows Application are included in the AHRQ QI Windows Application Release Notes that is posted on the web site along with the software and documentation.

   The AHRQ Quality Indicator Support team will hold one web-based training session to introduce the updated software and to describe the major features and functionality. The session will be held at 3:00pm ET on Friday, December 9th, 2005. To register send an email to webmeetings@qualityindicators.ahrq.gov with your name, organization, email address. The Support team will send you a meeting invitation that includes a link to the web presentation and a telephone number and access code for the voice presentation. This email confirmation will be sent on Thursday, December 8.

2. Prevention Quality Indicators FY2006 Coding Update (SAS ONLY)

   AHRQ is pleased to announce an FY2006 coding update of the AHRQ Prevention Quality Indicators (PQIs), Version 3.0. All updated PQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (pqi_download).

   PQI 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 PQI definitions. The documentation accompanying this release was modified to reflect the coding and timeframe update.

   In addition to updating the documentation to reflect the currency of PQI definitions, the two pediatric PQIs were moved to the new Pediatric Indicator Module scheduled for release in January, 2006. Additional exclusion criteria were added to other indicators. All changes included in version 3 are detailed in two documents, the PQI Change Log and PQI Indicator Changes, also available on the website. All PQI documents have been updated including new versions of the Guide to the Prevention Quality Indicators (Appendix A is now a separate Technical Specifications document) and the PQI SAS Software Documentation.

Documents are available for download from the AHRQ Quality Indicators Web Site pqi_download in Microsoft® Word® and PDF format.

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

OBJECTIVE: The Agency for Healthcare Research and Quality (AHRQ) is seeking nominations for members of the AHRQ Quality Indicators Workgroup on Composite Measures for the Prevention Quality Indicators (PQIs). The AHRQ QI Workgroup is being formed as part of a structured approach for developing composite measures at the national and state level. The Workgroups will evaluate appropriate technical and feasible methodological approaches currently available. Their role will be to discuss and suggest strategies as to what composite measure methodology would best fit the AHRQ QI user needs.

As part of this effort, Workgroup members will be addressing several key issues for each composite measure, including:

• What quality concept is the composite intended to measure?
• What individual indicators should be included in the composite?
• How should the individual indicators be combined?
• Should the composite be condition-specific (e.g., cardiovascular disease, or diabetes) or population-specific (e.g., pediatrics, women, or geriatrics) or by domains?

All nominations MUST be submitted by 6:00 pm EST, December 2, 2005.

BACKGROUND: The AHRQ Quality Indicators (AHRQ QIs) are a unique set of measures of health care quality that make use of readily available hospital inpatient administrative data and have been used for various purposes. Some of these include tracking, hospital self-assessment, reporting of hospital-specific quality or pay for performance. The AHRQ QI are provider- and area-level quality indicators based on hospital discharge data and consist of three modules: the Prevention Quality Indicators (PQI), the Inpatient Quality Indicators and the Patient Safety Indicators (PSI). Additional information on the AHRQ QI can be found on the web site at http://www.qualityindicators.ahrq.gov.

In response to feedback from the AHRQ QI user community, AHRQ is committed to developing composite measures in an effort to provide an overall view of quality that is complete and easily understandable to consumers and others within the health care field.

COMPOSITION OF THE COMPOSITE MEASURES WORKGROUP: Each Workgroup, of which there will be three, one for each module, will consist of 7 members from a variety of fields (epidemiology, health services research, medicine, performance measurement etc.). Candidates should have technical expertise in measurement development, and a familiarity with statistical methods and risk adjustment strategies in the area of composite measure development.

COMMITMENT: In an effort to provide for expert input and for recommendations to develop a composite measure methodology, we are initiating a review process that will require participation in one or two conference calls with some pre and post evaluation time (approximately 5 hours). Results from this process will directly influence the development of composite measures for the Quality Indicators. The first set of development activities will focus on the Prevention Quality Indicators. The schedule for the first review is below.

As a workgroup member, you will be asked to participate in four stages:

1. mid-December, 2005: Complete a short questionnaire on current methodology (2.0 hour)
2. early-January, 2006: Participate in one conference call to discuss recommended changes to the methodology (1.5 hours)
3. January, 2006: Respond to questions or provide additional clarifications after the conference call in early January.
4. mid-January, 2006: Complete the same questionnaire on new methodology (1.5 hour)

Composite measures workgroup for the Inpatient Quality Indicator and the Patient Safety Indicators will follow a similar process beginning in Spring 2006 and Fall 2006, respectively. A separate Call for Nominations will be disseminated at the appropriate times.

The Workgroups will conduct its business by telephone, e-mail, or other electronic means as needed.

SELECTION CRITERIA: Candidates will be selected based upon the following criteria:

• Familiarity and experience with the relevant methods and literature relating to composite measures, performance measures, and reporting;
• Familiarity with the AHRQ Quality Indicators and its application;
• Availability to complete surveys and conference calls during December 2005 and January 2006.

NOTIFICATION: Selected candidates will be contacted by AHRQ no later than December 9, 2005.

MATERIAL TO SUBMIT: Self-nominations are welcome. Third-party nominations must indicate that the individual has been contacted and is willing to serve. To be considered for appointment to the AHRQ QI Workgroups, please send the following information for each nominee:

1. A 1-page letter of interest (including full contact information of nominee) highlighting experience/knowledge relevant in the development and use of composite performance measures.
2. Curriculum vitae and/or list of relevant experience (e.g., publications).

Materials can be submitted by fax, U.S. mail, and e-mail.

DEADLINE FOR SUBMISSION: All nominations MUST be submitted by 6:00 pm EST, December 2, 2005.

QUESTIONS: If you have any questions, please contact Mamatha Pancholi via email mpanchol@ahrq.gov or send an email to QIsupport@ahrq.hhs.gov.

Thank you for your assistance!

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the AHRQ Quality Indicator Windows Application Version 1.0. The software, installation guide and user guide are now available for download from the AHRQ QI web site (www.qualityindicators.ahrq.gov).

The AHRQ QI Windows Application Version 1.0 replicates the indicator specification and rate calculation of the currently available versions of the SAS and SPSS® syntax for the PQI, IQI and PSI modules. AHRQ plans for future releases of the AHRQ QI Windows Application are included in the AHRQ QI Windows Application Release Notes that is posted on the web site along with the software and documentation.

The AHRQ QI Windows Application Version 1.0 requires Microsoft Windows 2000 or Microsoft Windows XP, with the Microsoft.NET platform and an available Microsoft SQL Server® database. A public-use version of Microsoft .NET and the SQL Server database are included with the software.

The AHRQ Quality Indicator Support team will hold two web-based training sessions to introduce the new software and to describe the major features and functionality. The first session will be held at 3:00pm ET on Friday, September 9th, 2005. The second session will be held at 3:00pm ET on Wednesday, September 14th, 2005. You only need to attend one of the sessions. Attendance will be limited to 75 participants per session. To register send an email to webmeetings@qualityindicators.ahrq.gov with your name, organization, email address and indicate the session you would like to attend. The Support team will send you a meeting invitation that includes a link to the web presentation and a telephone number and access code for the voice presentation.

For individuals attending the AHRQ QI User Meeting on September 26 and 27th, 2005, the Support team will also conduct informal demonstrations of the Windows Application during breaks in the program.

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

The Agency for Healthcare Research and Quality (AHRQ) will release the AHRQ Quality Indicator Windows Application Version 1.0 on Wednesday, September 7th. A listserv® announcement will be sent when the software, installation guide and user guide are available for download from the AHRQ QI web site (www.qualityindicators.ahrq.gov).

The AHRQ QI Windows Application Version 1.0 replicates the indicator specification and rate calculation of the currently available versions of the SAS and SPSS syntax for the PQI, IQI and PSI modules. AHRQ plans for future releases of the AHRQ QI Windows Application will be included in the AHRQ QI Windows Application Release Notes that will be posted on the web site along with the software and documentation.

The AHRQ QI Windows Application Version 1.0 requires Microsoft Windows 2000 or Microsoft Windows XP, with the Microsoft.NET platform and an available Microsoft SQL Server database. A public-use version of Microsoft .NET and the SQL Server database are included with the software.

The AHRQ Quality Indicator Support team will hold two web-based training sessions to introduce the new software and to describe the major features and functionality. The first session will be held at 3:00pm ET on Friday, September 9th, 2005. The second session will be held at 3:00pm ET on Wednesday, September 14th, 2005. You only need to attend one of the sessions. Attendance will be limited to 75 participants per session. To register send an email to webmeetings@qualityindicators.ahrq.gov with your name, organization, email address and indicate the session you would like to attend. The Support team will send you a meeting invitation that includes a link to the web presentation and a telephone number and access code for the voice presentation.

For individuals attending the AHRQ QI User Meeting on September 26 and 27th, 2005, the Support team will also conduct informal demonstrations of the Windows Application during breaks in the program.

AHRQ QI User Meeting
AHRQ and AHCA State Summit on Public Reporting
2005 User Meeting

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce that registration is now open for the 2005 AHRQ Quality Indicators User Meeting to be held at the AHRQ Conference Center located in Rockville, Maryland on September 26 – 27, 2005.

The two-day AHRQ Quality Indicators User Meeting is intended both for active users of the AHRQ Quality Indicators (AHRQ QI) and for those interested in how the AHRQ QI might be used in their organizations. The sessions will focus on lessons learned from actual applications on these topics:

• New Pediatric Indicator Module
• Applying the AHRQ QI to improve population health
• Using the AHRQ QI as a catalyst for quality improvement
• Implications of ICD-9-CM coding practices
• Use of the AHRQ QI in the National and State Healthcare Quality Reporting
• Methods for creating aggregate performance indices
• Considerations in using the AHRQ QI for comparative reporting and pay-for-performance

In addition to presentations by content experts, the AHRQ QI development team and AHRQ QI users, the User Meeting will include an opportunity for open discussion on frequently asked questions, recommendations for future AHRQ QI development, and other considerations related to the use and interpretation of the AHRQ QI. There will be panel discussions on quality improvement, comparative reporting and pay-for-performance with representatives from multiple perspectives, and informal demonstrations of the SAS syntax and new Windows application.

Following the AHRQ QI User Meeting there will be a one-day State Summit on Public Reporting co-sponsored by AHRQ and the Florida Agency for Health Care Administration on Wednesday, September 28, 2005.

This one-day meeting will build on the information presented at the AHRQ QI User Meeting, proposing consensus-based cooperation among states on public reporting of healthcare quality information. The morning presentations will frame the difficulties inherent in fulfilling the state's reporting obligation, and the afternoon session will be an open discussion of collaborative steps that can lead to best practices for reporting and ongoing improvement.

Information on how to register, the meeting agendas, location, and hotel accommodations is available on the AHRQ Quality Indicators Web site at: 2005 User Meeting

Space at the meeting will be limited to 100 individuals on a first-come, first-served basis. For questions, please contact QIsupport@ahrq.hhs.gov or call the AHRQ QI voicemail at (301) 427-1949.

The Agency for Healthcare Research and Quality (AHRQ) invites you to attend the first annual AHRQ Quality Indicators User Meeting to be held at the AHRQ Conference Center located in Rockville, Maryland on September 26 - 27, 2005.

The two-day meeting is intended both for active users of the AHRQ Quality Indicators (QIs) and for those interested in how the QIs might be used in their organizations. The sessions will focus on lessons learned from actual applications on these topics:

• Applying the QI to improve population health
• Using the QI as a catalyst for quality improvement
• Impact of ICD-9-CM coding practices
• Issues in using the QI for comparative reporting
• Creating aggregate performance indices
• Training on the new QI Windows Application
• Training on the new Pediatric Indicator Module

Additional general conference information, hotel accommodations and registration information will be distributed in the coming weeks. Space at the meeting will be limited to 100 individuals on a first-come, first-served basis.

The AHRQ Quality Indicators Support Team has posted to the AHRQ Quality Indicators Web Site updated files for the Inpatient Quality Indicators Version 2.1, Revision 4, originally released on December 22, 2004. THE UPDATE ONLY IMPACTS THE CALCulATION OF THE IQI EXPECTED AND RISK-ADJUSTED RATES.

The update is necessary to correct the calculation of the IQI expected rates. IQI Version 2.1, Revision 4 overestimates the expected rate for individual hospitals based on the 2002 reference population (that is, overestimates the case-mix severity) and (consequently) underestimates the risk-adjusted rate. The Revision 4a update corrects this problem.

The following updated files have been posted to the AHRQ Quality Indicators Web Site.

1. Parameter Files. The parameter files COVIQP02.TXT, MSXIQP02.TXT (SAS) and MSXIQP_2.TXT (SPSS).
2. IQI Covariates Table. The IQI Covariates Table (iqi_covariates_rev4a.doc and iqi_covariates_rev4a.pdf).

Users wishing to calculate expected, risk-adjusted and smoothed rates for IQI Version 2.1, Revision 4 based on the 2002 reference population must re-download the iqi_sas_software_rev4a.zip (SAS) or iqi_spss_software_rev4a.zip (SPSS) containing the parameter files listed in item #1 above. Only the iqsasp3.sas (SAS) or iqspsp3.sps (SPSS) module must be re-run.

The update does not impact the observed rates or the FY05 coding updates. The iqsas1.sas, iqsasp2.sas (SAS) or iqsps1.sps*, iqspsp2.sps (SPSS) modules remain unchanged and do not need to be re-run.

*The update also includes a minor correction to the SPSS syntax for Pediatric Heart Surgery Volume (IQI #3) and Mortality (#10) to the exclusion for single procedure of vessel repair or occlusion. The correction impacts less than 0.5% of denominator cases.

The updated files are available for download at the AHRQ Quality Indicators Web site: (iqi_download).

Any questions regarding this update may be directed to the AHRQ Quality Indicators Support Team via email: QIsupport@ahrq.hhs.gov

The AHRQ Quality Indicators Support Team will be posting to the AHRQ Quality Indicators Web Site updated files for the Inpatient Quality Indicators Version 2.1, Revision 4, originally released on December 22, 2004. THE UPDATE WILL ONLY IMPACT THE CALCulATION OF THE IQI EXPECTED AND RISK-ADJUSTED RATES.

The update is necessary to correct the calculation of the IQI expected rates. Currently, IQI Version 2.1, Revision 4 overestimates the expected rate for individual hospitals based on the 2002 reference population (that is, overestimates the case-mix severity) and (consequently) underestimates the risk-adjusted rate. The update will correct this problem.

The following updated files will be posted to the AHRQ Quality Indicators Web Site by MAY 13, 2005.

1. Parameter Files. The parameter files COVIQP02.TXT, MSXIQP02.TXT (SAS) and MSXIQP_2.TXT (SPSS).
2. IQI Covariates Table. The IQI Covariates Table (iqi_covariates_rev4a.doc and iqi_covariates_rev4a.pdf).

Users wishing to calculate expected, risk-adjusted and smoothed rates for IQI Version 2.1, Revision 4 based on the 2002 reference population must re-download the iqi_sas_software_rev4a.zip (SAS) or iqi_spss_software_rev4a.zip (SPSS) containing the parameter files listed in item #1 above. Only the iqsasp3.sas (SAS) or iqspsp3.sps (SPSS) module must be re-run.

The update will not impact the observed rates or the FY05 coding updates. The iqsas1.sas, iqsasp2.sas (SAS) or iqsps1.sps, iqspsp2.sps (SPSS) modules will remain unchanged and will not need to be re-run.

A listserv announcement will be posted when the updated files are available for download at the AHRQ Quality Indicators Web site: (iqi_download).

Any questions regarding this update may be directed to the AHRQ Quality Indicators Support Team via email: QIsupport@ahrq.hhs.gov

The AHRQ Quality Indicators Support Team has posted updated files for the Patient Safety Indicators Version 2.1, Revision 3, originally released on January 17, 2005. THE UPDATE IMPACTS THE CALCulATION OF PSI RISK-ADJUSTED RATES.

1. Parameter Files. The parameter files COVPSP02.TXT, MSXPSP02.TXT (SAS) and MSXPSP_2.TXT (SPSS) have been updated to the 2002 reference population.
2. PSI Covariates Table. The PSI Covariates Table (psi_covariates_rev3a.doc and psi_covariates_rev3a.pdf) has been updated to include the coefficients and odds ratios for the 2002 reference population.
3. SAS and SPSS Software Documentation. The references to the State Inpatient Data (SID) used in calculating the risk-adjusted rates have been updated to 2002 and 35 HCUP participating states.

Users wishing to calculate risk-adjusted, expected and smoothed rates for PSI Version 2.1, Revision 3 based on the 2002 reference population must re-download the psi_sas_software_rev3a.zip (SAS) or psi_spss_software_rev3a.zip (SPSS) containing the parameter files listed in item #1 above. Only the pssasp3.sas (SAS) or psspsp3.sps (SPSS) module must be re-run. The pssasp1.sas, pssasp2.sas (SAS) or psspsp1.sps, psspsp2.sps (SPSS) modules remain unchanged and do not need to be re-run.

The updated files are available for download at the AHRQ Quality Indicators Web site: (psi_download). Any questions regarding this update may be directed to the AHRQ Quality Indicators Support Team via email: QIsupport@ahrq.hhs.gov

AHRQ is pleased to announce an update of the AHRQ Patient Safety Indicators (PSIs), Version 2.1, Revision 3. All updated PSI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website(psi_download).

Revision 3 incorporates changes to ICD-9-CM codes and DRGs effective October 1, 2004 (Fiscal Year 2005). With this software update, the PSI definitions now include ICD-9 CM codes valid from October 1, 1994 through September 30, 2005.

The indicator changes and ICD-9 CM coding updates are detailed in two documents, the PSI Change Log and PSI Indicator Changes, also available on the website. All PSI documents have been updated including the Guide to the Patient Safety Indicators, the PSI SAS Software Documentation, and PSI SPSS Software Documentation. These documents incorporate stylistic changes, are available in Microsoft Word and PDF format, and include the updated PSI indicator definitions. In addition, the ICD-9-CM major operating room procedure codes are now included in a separate, downloadable document.

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-II) contract team is currently reviewing the literature related to each QI to both update the knowledge base underlying the indicators and 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.

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.

AHRQ is pleased to announce an update of the AHRQ Inpatient Quality Indicators (IQIs), Version 2.1, Revision 4. All updated IQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (iqi_download).

Revision 4 incorporates changes to ICD-9-CM codes and DRGs effective October 1, 2004 (Fiscal Year 2005). With this software update, the IQI definitions now include ICD-9 CM codes valid from October 1, 1994 through September 30, 2005.

The IQI software has been enhanced to offer the calculation and reporting of the expected rate at the stratification level selected by the user. The SAS® and SPSS® software syntax now calculates and reports the observed rate, risk-adjusted rate, expected rate and the smoothed rate.

The indicator changes and ICD-9 CM coding updates are detailed in two documents, the IQI Change Log and IQI Indicator Changes, also available on the website. All IQI documents have been updated including the Guide to the Inpatient Quality Indicators, the IQI SAS Software Documentation, and IQI SPSS Software Documentation. These documents incorporate stylistic changes, are available in Microsoft® Word® and PDF format, and include the updated IQI indicator definitions.

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-II) contract team is currently reviewing the literature related to each QI to both update the knowledge base underlying the indicators and 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.

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.

AHRQ is pleased to announce an update of the AHRQ Prevention Quality Indicators (PQIs), Version 2.1, Revision 4. All updated PQI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (pqi_download).

PQI Revision 4 is valid for use with discharges occurring in Fiscal Year 1995 (FY 1995) through Fiscal Year 2005 (FY 2005) or from October 1, 1994 through September 30, 2005. After a complete review of the ICD-9-CM codes and DRGs that were effective October 1, 2004 (FY 2005) it was determined no changes were required to the PQI definitions. The documentation accompanying this release was modified to reflect the timeframe update.

In addition to updating the documentation to reflect the currency of PQI definitions, the four PQIs related to diabetes now have the option of calculating a state and age level condition-specific rate using prevalence data from the National Diabetes Surveillance System at CDC. The PQI software includes a new module in SAS (PQSASC2.SAS) and SPSS (PQSPSC2.SPS) to calculate the state and age level condition-specific observed rates.

All changes included in Revision 4 are detailed in two documents, the PQI Change Log and PQI Indicator Changes, also available on the website. All PQI documents have been updated including new versions of the Guide to the Prevention Quality Indicators, the PQI SAS Software Documentation, and PQI SPSS Software Documentation. The revised documents incorporate several stylistic changes, and reference the new option available for calculating condition-specific rates for each of the four diabetes indicators (PQIs 1, 3, 14, and 16).

Documents are available for download from the AHRQ Quality Indicators Web Site (pqi_download) in Microsoft Word and PDF format.

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-II) contract team is reviewing the literature related to each QI 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.

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.

Please submit feedback, questions and comments regarding the AHRQ Quality Indicators to QIsupport@ahrq.hhs.gov.

The AHRQ Quality Indicators Support Team has posted updated files for the Patient Safety Indicators Version 2.1, Revision 2, originally released on October 22, 2004. NONE OF THE UPDATES IMPACT THE CALCULATION OF PSI RATES.

1. Output of comma-delimited files. This change pertains to an option provided for PSSASP2.SAS and PSSASP3.SAS to export program output to comma-delimited files that can then be read by EXCEL. The update corrects the syntax for this option in PSSASP3.SAS and corrects a duplicate column heading in both PSSASP2 and PSSASP3. The change does not affect the SPSS syntax.
2. U.S. Census Data. The SAS and SPSS zip files were changed to exclude the QICTYAxx.TXT census files, which are used in the calculation of risk-adjusted area rates. Because the PSI area indicators are not risk-adjusted, these files are not required for the PSI module.
3. PSI Covariates Table. The PSI Covariates Table (psi_covariates_rev2.doc and psi_covariates_rev2.pdf) has been updated to include additional columns (i.e. the number of covariates and the odds ratio) and to correct the covariate labels. The change does not affect the covariate values, the risk-adjustment model or the calculation of risk-adjusted rates. The Table is for documentation purposes only.

The updated files are available for download at the AHRQ Quality Indicators Web site: psi_download

Any questions regarding this update may be directed to the AHRQ Quality Indicators Support Team via email: QIsupport@ahrq.hhs.gov

This intensive, 6-hour session will be conducted over 2 days by experienced RTI, International and AHRQ Staff; and is intended to help participants understand how: (1) QIs are constructed, (2) resulting data output can be interpreted, and (3) results can be used for surveillance and quality improvement activities. Part of the session will include the opportunity to do some hands on work with the data based on case studies tailored to the needs of hospital association and health system users. All participants will receive a training manual of workshop materials that will serve as a reference tool to support future applications of the QIs.

Session Objectives

By the completion of the 6 hour program participants will:

1. Have a general understanding of the development of the QIs, the purpose of each type of QI, the evidence base for their inclusion as part of the suite of AHRQ quality tools, where to access data and software used to construct the QIs and benefits and limitations of using the QIs for quality improvement or comparative reporting.
2. Have an understanding of select measurement issues that are likely to be encountered when using the QIs.
3. Use activity-based learning experiences related to indicator construction, data output interpretation, and application of results for quality monitoring and surveillance activities.
4. Have an opportunity for an interactive forum for participant Q&A.
5. Leave with a set of reference tools that can be used to support future application.

When and Where

Part I: December 7, 2004 at 3:30-5:30 pm

Part II: December 8, 2004 at 8:00 am - 12:30 pm

Both sessions will be held at the Hyatt Regency Washington on Capitol Hill Washington, DC.

Registration

To reserve a spot please contact NAHDO at nahdoinfo@nahdo.org or call DeAna Clark at 801-587-9104. Attendees can also register by mailing or faxing the attached registration form (PDF File, 108 KB).

AHRQ is pleased to announce an update of the AHRQ Patient Safety Indicators (PSIs), Version 2.1, Revision 2. All updated PSI documentation and software are now available for download or viewing on the AHRQ Quality Indicators website (psi_download).

Revision 2 incorporates changes to ICD-9-CM codes and DRGs effective October 1, 2003 (Fiscal Year 2004). With this software update, the PSI definitions now include ICD-9 CM codes valid from October 1, 1994 through September 30, 2004. In addition to the ICD-9 coding update, several PSIs had minor definitional changes for the purpose of improving the performance of these indicators (PSIs 1, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 16). AHRQ is also offering three new provider-level PSIs with this release: PSI 27, Obstetric trauma with 3rd degree - vaginal with instrument; PSI 28, Obstetric trauma with 3rd degree - vaginal without instrument; and PSI 29, Obstetric trauma with 3rd degree - cesarean section.

The PSI software was enhanced to offer the calculation and reporting of the expected rate at the stratification level selected by the user. The SAS (PSSASP3.SAS) and SPSS (PSSPSP3.SPS) software syntax now calculates the risk-adjusted rate, the expected rate and the smoothed rate.

All changes to the indicators and the ICD-9 CM coding updates are detailed in two documents, the PSI Change Log and PSI Indicator Changes, also available on the website. All PSI documents have been updated including new versions of the Guide to the Patient Safety Indicators, the PSI SAS Software Documentation, and PSI SPSS Software Documentation. The revised documents incorporate several stylistic changes, are available in Microsoft Word and PDF format, and include the updated PSI 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-II) contract team is reviewing the literature related to each PSI 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.

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.

Please submit feedback, questions and comments regarding the AHRQ Quality Indicators to QIsupport@ahrq.hhs.gov.

Where is the value in health care purchasing? Can hospital quality be measured well enough to link payment to quality? As health care costs continue to escalate and shortfalls remain in health care quality, employers and other purchasers are pursuing "quality-based purchasing" strategies. The Agency for Healthcare Research and Quality (AHRQ) is sponsoring two interactive web conferences in October that will help purchasers, plans and providers understand the evidence base for quality-based purchasing and public reporting and increase their understanding of an important tool set available to assist with evaluations of health care quality.

Event #1: "Paying for Performance"

Thursday, October 21, 2004, 3:00-4:30pm, EDT

The first conference in the series features a current look at the evidence base for quality-based purchasing with an emphasis on practical implications for purchasers and providers.

Event #2: "Using Quality Indicators for Hospital-Level Public Reporting & Payment"

Wednesday, October 27, 2004, 1:00-2:30pm, EDT

The second conference in the series will provide guidance on the benefits and limitations of using AHRQ’s quality indicators for public reporting of quality or to inform purchasing decisions.

A brochure for these two conferences is available on the AHRQ Quality Indicators Web site at The Buy-Right for Health Care Quality Series, Free Web Conferences.pdf (PDF File, 4.8 MB).

Intended Audience

These Web conferences will be of direct value to the following stakeholders:

• Employers and employer coalitions
• Health plans, insurers, and other payers
• State Medicaid Directors
• Federal purchasers, including CMS, VA, and DOD
• Federal and State policy makers
• Health care delivery systems, hospitals, physicians, and other providers
• Accreditation and other intermediary organizations

Web Conference Format

These interactive Web conferences will last 90 minutes. A panel of experts will discuss various aspects of these topics and engage the audience in a live discussion of their questions and concerns. Participants can connect to the Web conference in three ways – via Internet only, via Internet and phone, or via phone only.

The Buy-Right for Health Care Quality Series will help purchasers make well-informed decisions about whether and how to pursue quality-based purchasing. The series will also help plans and providers prepare for and participate in quality-based purchasing and public reporting initiatives. For more information about the web conference series, please open the attached agenda. To register for the web conferences, please visit the conference series website: www.academyhealth.org/ahrq/valuepurchasing. Registration is free.

For detailed information on the two conferences such as a list of panelists, content of the conference, and what users should gain by the end of the session, please see the attached Word document, Narrative Agenda of the Conferences for Health Care Purchasers and Providers (Word File, 154 KB). For a general overview of the conferences, including the different ways one can connect to the web conference and the corresponding equipment needed, please see the attached Word document, General Overview of the Conferences for Health Care Purchasers and Providers (Word File, 144 KB).

HHS' Agency for Healthcare Research and Quality today announced the availability of a new guide for using the Agency's Inpatient Quality Indicators or Patient Safety Indicators to report on hospital quality or make payment decisions. The Guidance for Using the AHRQ Quality Indicators for Hospital-Level Public Reporting or Payment can be downloaded from AHRQ's Quality Indicators Web site (http://www.qualityindicators.ahrq.gov/resources ).

AHRQ's Quality Indicators are measurement tools that were originally developed by AHRQ and researchers at the University of California at San Francisco and Stanford University to help individual hospitals use their own discharge data to better understand and improve the care they provide. Hospitals and hospital associations have used them extensively for this purpose. More recently, the indicators have been used by state data organizations, employers, health plans and others seeking to improve quality through public reporting and pay-for-performance initiatives. Given the expanding use and interest in the Quality Indicators, AHRQ created the guide to help answer questions about if, when, and how to use them for these new purposes.

"Improving the quality of America's health care system is a key priority for AHRQ, and the new guide will help those designing public reporting and payment initiatives identify measures that fit their local priorities and needs," said AHRQ Director Carolyn M. Clancy, M.D. "While the Quality Indicators aren’t a one-size-fits-all solution and must be used carefully, they can help local hospitals and their communities use data right now to evaluate performance and ultimately provide better care."

The Quality Indicators measure outcomes that consumers care about such as patient safety and complication rates. The indicators are also based on data that hospitals already collect, which makes their use relatively accessible and inexpensive.

This guide is the first in a series of activities that will help users evaluate which individual indicators or groups of indicators they may want to incorporate into their local quality reporting or payment programs. The new guide helps users customize their use of the Quality Indicators, for example, if they wish to place greater or lesser emphasis on cardiac care, if they are in markets with a large or small number of high-volume hospitals, or if hospitals in their area have large variations in the quality of their data. The guide also suggests ways to best use the Quality Indicators, such as pairing data on deaths and volume indicators or using multiple years of data.

"The Quality Indicators are a boon to purchasers, consumers, and providers looking for insight into the quality of care provided in hospitals," said Christopher Queram, CEO of Employer Health Care Alliance Cooperative in Madison, Wis. "In our experience, using the Quality Indicators to compare hospital performance has been a powerful tool to drive health care improvement."

For more information on AHRQ’s Quality Indicators, go to http://www.qualityindicators.ahrq.gov.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) were created to inform health care planning, support evidence-based policy development, and facilitate quality monitoring and surveillance activities. These QIs are constructed using existing hospital discharge data and can be integrated into existing information infrastructures. AHRQ has developed software, which can be used in conjunction with SAS(r) or SPSS(r), to calculate QI rates from inpatient discharge data derived from the Nationwide Inpatient Sample (NIS), the State Inpatient Database (SID) that are part of AHRQ's Healthcare Cost and Utilization Project (HCUP), or any hospital administrative data.

In response to user requests, AHRQ is developing a curriculum to assist current and future QI users. As part of the curriculum development, three training sessions are planned. The first session was held in May 2004 in conjunction with the Annual A2IRNET 2004 Meeting. This message is to announce the availability of the second session November 17 and 18, 2004. A third training session will be held December 2004 in conjunction with the National Association of Health Data Organizations (NAHDO) annual meeting; additional information on that session will be distributed at a later date.

Date and Time: Tuesday, November 16, 2004 from 2:00 p.m. to 6:00 pm and continue on Wednesday, November 17, 2004 from 8:00 a.m. to Noon; adjacent to the National Business Coalition on Health (NBCH) Ninth Annual Conference "Employers Leading by Example: Partnerships for Health Care Value."

Location: Hyatt Regency, Atlanta, Georgia

Registration: Is required. Please see the attached brochure for the NBCH registration information and details on the other exciting opportunities available for you at the NBCH meeting. If you wish to register for just the QI training session and not the entire NBCH meeting, please contact Asta Sorenson, RTI, by e-mail at asorensen@rti.org.

The training sessions are made possible through a contract with RTI, International. The November training program will be a 8-hour session conducted over 2 days; and is intended to help participants understand how: (1) QIs are constructed, (2) resulting data output can be interpreted, and (3) results can be used for surveillance, comparative reporting, and to drive quality improvement activities. Part of the session will include the opportunity to do some hands on work with the data based on case studies tailored to the needs of business coalition and employer representatives. All participants will receive a training manual of workshop materials that will serve as a reference tool to support future applications of the QIs.

Program Objectives: By the completion of the 8 hour program participants will:

1. Have a general understanding of the development of the QIs, the purpose of each type of QI, the evidence base for their inclusion as part of the suite of AHRQ quality tools, where to access data and software used to construct the QIs and benefits and limitations of using the QIs for quality improvement, comparative reporting or pay for performance.
2. Have an understanding of select measurement issues that are likely to be encountered when using the QIs.
3. Use activity-based learning experiences related to indicator construction, data output interpretation, and application of results for quality monitoring and surveillance activities.
4. Have an opportunity for an interactive forum for participant Q&A.
5. Leave with a set of reference tools that can be used to support future application.

Who Should Attend? Current or future QI users. Case studies will be tailored to the purchaser and business coalition audiences.

The Agency for Healthcare Research and Quality (AHRQ) announces the redesign of the AHRQ Quality Indicators (QIs) Web site. Features of the new QI Web site include:

1. More intuitive navigation
2. Related topics grouped together
3. Cleaner layout and presentation of content
4. Frequently Asked Questions section is now classified by topic and lists all questions at the beginning to make it easier for users to review
5. Messages sent from the Quality Indicators Listserv® since 2002 can be viewed

Along with the redesign, the Inpatient Quality Indicators (IQIs) software has been updated and is now available on the QI Web site. This IQI release, Version 2.1 Revision 3, includes updates related to new FY 2004 ICD-9-CM coding guidelines as well as enhancements to the indicators based on new evidence and user feedback. Notably these changes include three new indicators, which provide alternative information regarding AMI mortality, Cesarean delivery, and Vaginal Birth After Cesarean (VBAC).

The AHRQ Quality Indicators Web site (http://www.qualityindicators.ahrq.gov) offers providers, state data organizations, hospital associations, researchers and many others easy access to the AHRQ Quality Indicators (QIs), documentation and user support. The AHRQ QIs use readily available hospital administrative data to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time. They include three modules-- the Inpatient Quality Indicators (IQIs), Prevention Quality Indicators (PQIs), and Patient Safety Indicators (PSIs). The AHRQ QI software is available free of charge in SAS and SPSS format.

The Web site, user services and research and development on the indicators are maintained and enhanced by the Support for Quality Indicators team led by Denise Remus (AHRQ) and Kathryn McDonald (Stanford University) along with Sheryl Davies and Jeffrey Geppert at Stanford; Patrick Romano and colleagues at University of California Davis; Mark Gritz, Gregory Hubert, Rajin Mangru and colleagues at Battelle Memorial Institute. User support is available through the website or by emailing QIsupport@ahrq.hhs.gov.

National benchmarks for the Patient Safety Indicators (PSIs), indicators of potentially avoidable complications and adverse events, are now available on the HCUPnet Web site at http://hcup.ahrq.gov/hcupnet.asp. In addition, the description and definition for each indicator of the PSIs are available. These PSIs were calculated using Version 2.1, Revision 1 of the PSI software and the Nationwide Inpatient Sample (NIS), 2000. For details, see the Guide to the Patient Safety Indicators on the AHRQ Quality Indicators Web site: psi_download.

Benchmarks for the Prevention Quality Indicators (PQIs), Version 2.1, Revision 2, continue to be available. Benchmarks for the Inpatient Quality Indicators (IQIs) are forthcoming.

The Agency for Healthcare Research and Quality has redesigned its interactive HCUPnet software tool (available on the Web at https://www.hcup-us.ahrq.gov) to make it easier to obtain hospital care trend data for the nation and for individual states. The data represent 90 percent of all hospital stays in the nation and are drawn from 36 states.

HCUPnet's databases include statistics on the conditions for which patients were hospitalized, the diagnostic and surgical procedures they underwent, patient death rates, hospital charges, hospital costs, length of stay, and other aspects of inpatient care. The data are for all patients, regardless of type of insurance or whether they were insured.

For example, using HCUPnet to research the impact of the obesity epidemic on hospital care and costs shows that more than 58,000 surgical procedures for obesity were performed in 2001.

In addition, the data show that between 1993 and 2001:

The number of patients admitted for treatment of diabetes with complications-a condition often linked to obesity-rose 23 percent, from 373,666 to 461,161.

• The number of lower extremity amputations, a diabetic complication, increased 14 percent from 99,522 to 113,379, and the average hospital charge for this procedure increased 38 percent, from $24,332 to $33,562.
• Admissions for heart attack-which obese persons have a higher risk of suffering-rose 13 percent, from 682,763 to 773,871, and charges increased 61 percent-from an average of $19,178 per hospital stay to $30,875 per stay.
• Knee replacements, also more common among obese patients, increased roughly 29 percent, from 282,177 to 363,536, and the average hospital charge rose 38 percent, from $18,352 to $25,309.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) were created to inform health care planning, support evidence-based policy development, and facilitate quality monitoring and surveillance activities. These QIs are constructed using existing hospital discharge data and can be integrated into existing information infrastructures. AHRQ has developed software, which can be used in conjunction with SAS or SPSS, to calculate QI rates from inpatient discharge data derived from the Nationwide Inpatient Sample (NIS), the State Inpatient Database (SID) that are part of AHRQ's Healthcare Cost and Utilization Project (HCUP), or any hospital administrative data.

In response to user requests, AHRQ is developing a curriculum to assist current and future QI users. As part of the curriculum development, three training sessions will be offered in 2004. Details on the first session are noted below and registration information is available at the A2IRNET Web site under 'AHRQ' (http://www.aairnet.com). The first session is designed to provide an overview of the QIs then more detail on application and interpretation. The May program is structured for healthcare providers and others involved with hospital quality improvement programs. Additional programs will be offered in November and December 2004 (when the session details are finalized information will be posted on the QI Web site and another notice will be sent to the QI liSTSERV).

Date and Time: Tuesday, May 25, 2004 from 1p.m. to 4:30pm and continue on Wednesday, May 26, 2004 from 8:30 a.m. to Noon; adjacent to the Annual A2IRNET 2004 Meeting.

Location: Snow King Resort in Jackson Hole, Wyoming

The training sessions are made possible through a contract with RTI, International. The May training program will be a 6-hour session conducted over 2 days; and is intended to help participants understand how: (1) QIs are constructed, (2) resulting data output can be interpreted, and (3) results can be used for surveillance and quality improvement activities. Part of the session will include the opportunity to do some hands on work with the data based on case studies tailored to the needs of hospital association and health system users. All participants will receive a training manual of workshop materials that will serve as a reference tool to support future applications of the QIs.

Program Objectives: By the completion of the 6 hour program participants will:

1. Have a general understanding of the development of the QIs, the purpose of each type of QI, the evidence base for their inclusion as part of the suite of AHRQ quality tools, where to access data and software used to construct the QIs and benefits and limitations of using the QIs for quality improvement or comparative reporting.
2. Have an understanding of select measurement issues that are likely to be encountered when using the QIs.
3. Use activity-based learning experiences related to indicator construction, data output interpretation, and application of results for quality monitoring and surveillance activities.
4. Have an opportunity for an interactive forum for participant Q&A.
5. Leave with a set of reference tools that can be used to support future application.

Who Should Attend? Current or future QI users including health care quality managers, quality improvement staff, data analysts, and administrators.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) support team has updated the list of Frequently Asked Questions (FAQs) in response to inquiries submitted to the e-mail support system. The new FAQs are located at here and address questions about use of the 3M All-Patient Refined DRGs (APR-DRGs), location of technical support documentation and availability of benchmark data.

Technical support is available by contacting the QI support team. The QI support e-mail address is QIsupport@ahrq.hhs.gov. We are also available by phone at (301)427-1949, if you call this number you will reach our voice mail system, messages are responded to within three business days. The QI support e-mail address may also be used to send AHRQ comments, suggestions, or other feedback related to the QIs and their use. We welcome your input!

Thank you for your continued interest in the AHRQ Quality Indicators!

AHRQ is pleased to announce an update of the AHRQ Prevention Quality Indicators (PQIs), Version 2.1, Revision 3. All updated PQI documentation and software are now available for download on the AHRQ Quality Indicators Web site.

Revision 3 incorporates changes to ICD-9-CM codes and DRGs effective October 1, 2002 (Fiscal Year 2003) and October 1, 2003 (Fiscal Year 2004). With this software update, the PQI definitions now incorporate ICD-9 CM codes valid from October 1, 1994 through September 30, 2004.

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 PQI software have been updated including new versions of the Guide to the Prevention Quality Indicators, the PQI SAS Software Documentation, and PQI SPSS Software Documentation. These new documents incorporate several stylistic changes, are available in Microsoft Word and PDF format, and include the updated PQI indicator definitions. The new software manuals also outline the treatment of missing data by the software.

The full log of revisions which summarizes all of the revisions made to the PQIs software, software documentation, the list of ICD-9 coding changes, and the Guide to Prevention Quality Indicators are available for download or viewing on the AHRQ Quality Indicators Web site.

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 PQI 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.

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.

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.

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.

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.

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.

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 https://www.hcup-us.ahrq.gov/nisoverview.jsp

Selected data from the 2001 NIS also are available on HCUPnet at https://www.hcup-us.ahrq.gov.

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

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 https://www.hcup-us.ahrq.gov. 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.

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.

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

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.

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.

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.

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.

The AHRQ Inpatient Quality Indicators (IQIs) software is now available in SPSS format. The new SPSS software is an alternative to the currently available SAS® version, and requires the SPSS® statistical software available from SPSS, Inc. Both SAS and SPSS® are commercially licensed software. Neither SAS Institute, Inc., nor SPSS®, Inc., has any affiliation with the development of the AHRQ QIs.

The SPSS® version of the iqi_download from the AHRQ QI Web site.

The Inpatient Quality Indicators (IQIs) are a set of measures that provide a perspective on hospital quality of care using hospital administrative data. These indicators reflect quality of care inside hospitals and include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality.

The technical report, "Measures of Patient Safety Based on Hospital Administrative Data - The Patient Safety Indicators" written by the Stanford-UCSF Evidence-based Practice Center is now available on the AHRQ Web site (http://www.ahrq.gov/clinic/evrptfiles.htm#psi). A print copy can be ordered by contacting the AHRQ Publication Clearinghouse (800-358-9295), and requesting publications no. 02-0038.

The technical report summarizes the development and evidence related to the Patient Safety Indicators (PSIs).

The Patient Safety Indicators (PSIs) are a set of quality measures providing information on potential in-hospital complications and patient safety concerns that can be identified with readily available inpatient discharge data. Most of the indicators provide hospital provider level or area level rates of potentially preventable complications that occur following surgeries, other procedures, and childbirth. The PSIs were developed based on appraisal of the pertinent literature, close examination of ICD-9-CM codes, clinician panel review and data analyses.

Software for the Patient Safety Indicators, written in both SAS and SPSS programming language, will be available in late 2002. The release of this software will be announced on this LISTSERV®.