=============================================================================================
Inpatient Quality Indicators (IQI) Software Version SAS v2024
RELEASE DATE: July 2024
-----------------------------------------
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This version of AHRQ's all-payers software is named SAS QI v2024
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- Reflects coding changes based on fiscal year 2024 coding updates to the International Classification 
  of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). These coding 
  changes impact all software modules.
- Includes modified code sets, labels, and output in multiple modules. See log of changes for 
  indicator-by-indicator changes.
- Updates risk-adjustment, signal variance, reference population rates, and composite weights using 
  data from the 2019, 2020, and 2021 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID).
  In the IQI module, the following changes are new in v2024:
     • The software no longer provides options to include or exclude COVID discharges. The risk adjustment 
       models have accounted for the case-mix by considering the diagnosis of COVID present on admission as
       well as a COVID time trend.
     • A single risk adjustment model is used across all strata for IQI 11 and IQI 17, so the software 
       no longer outputs risk-adjusted rates for the strata of these indicators.
- Revised Major Diagnostic Category (MDC) Requirements
     • SAS QI v2024 now includes additional checks on user input for MDC_PROVIDED to avoid software errors. 
       In the case where MDC_PROVIDED is not 0 or 1, or if MDC_PROVIDED = 1 but the MDC values are out of range of 
       0-25, the software will not execute to avoid errors or unexpected results. 
     • Different versions of the Medicare Severity-Diagnostic Related Group (MS-DRG) grouper produce
       slightly different results with respect to certain high resource intensity MS-DRGs. Specifically, MSDRGs
       001-019 and 981-989 are classified as "pre-MDC" MS-DRGs, which means that they are
       associated with such high length of stay and/or cost that they supersede the usual assignment of MSDRGs
       within body system or MDC categories. For records assigned to these MS-DRGs, some versions of
       the grouper software retain the MDC that would be assigned based on the principal diagnosis and
       procedure codes, whereas other versions of the grouper software overwrite the MDC assignment with a
       blank, missing, or nonnumeric value such as "PRE." Thus, users MUST PROVIDE the MDC generated
       by the Centers for Medicare & Medicaid Services (CMS) MS-DRG grouper software, without imputing
       or mapping from MS-DRGs. For accurate results, all eligible records should have an MDC between 01
       and 25. For those users who need to construct MDC, please view the documentation and software
       available here: https://www.cms.gov/files/zip/icd-10-ms-drg-definitions-manual-files-v411.zip.
     • CMS' MS-DRG grouper software is updated on October 1 of each year, to accommodate new ICD-10-CM/PCS 
       codes introduced on that date, and it is further updated on any other date when new codes take
       effect. As a result, the grouper software version that worked on discharge records dated between January
       1 and September 30 of any calendar year does NOT work correctly on discharge records dated between
       October 1 and December 31 of the same calendar year. MS-DRG grouper software is designed for
       backward compatibility, based on the discharge date of each record. Therefore, a user who wishes to
       analyze CY 2023 data must use the version 41 (FY 2024) grouper (or later), while a user who wishes to
       analyze CY 2022 data must use the version 40 (FY 2023) grouper (or later). Many errors will result if a
       user applies the version 40 (FY 2023) grouper to data from the last quarter of CY 2023.
- Requires Procedure Days (PRDAYn) to assign AHRQ Clinical Classifications Refined (CCSR) for ICD-10-PCS Procedures. 
  These categories are a feature in the risk-adjustment of procedure-based indicators (IQI 08, 09, 11, 12, 30, 31, 90). 
  Missing or incomplete PRDAYn information will impact risk-adjusted rates for these indicators. 
  Thus, PRDAYn must be supplied on the input data in the IQI module. In v2023, users can set the PRDAY macro variable 
  to "0" in the IQI CONTROL program when PRDAYn is missing or incomplete on the input data. The IQI module will then 
  suppress expected rates, risk-adjusted rates, smoothed rates, and composites for the procedure-based indicators.
- Continues to provide the option to produce stratified rates. Expected rates, risk-adjusted rates, smoothed rates, 
  and composites are suppressed in certain situations. Because age and gender are used in risk adjustment models,
  it is inappropriate to produce risk-adjusted rates for any stratum that includes these variables.

Measure specific changes are outlined on the AHRQ QI website;
IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2024/ChangeLog_IQI_v2024.pdf

=============================================================================================
Inpatient Quality Indicators (IQI) Software Version SAS v2023
Release date: AUGUST 2023
-----------------------------------------
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This version of AHRQ's all-payers version is named SAS QI v2023
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- Reflects coding changes based on fiscal year 2023 coding updates to the International Classification 
  of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). 
  These coding changes impact all software modules.
- Includes modified code sets, labels, and output in multiple modules. 
  See log of changes for indicator-by-indicator changes.
- Includes risk-adjustment, signal variance, reference population rates, and composite weights using 
  data from the 2019, 2020, and 2021 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID).
- Includes new and updated risk factors in the risk-adjustment models. The use of multiple years of 
  data serves several purposes, such as incorporating quarterly COVID-19 controls into the risk adjustment models
  and providing more robust estimation for hospital-level indicators with low observed rates. 
  In the IQI module, the following changes are new in v2023:
     • The risk-adjustment models account for COVID-19 and use quarterly COVID-time interaction terms to account for 
       changes in the association between COVID and the indicator outcomes across 2020 and 2021. 
       Only COVID-19 that is present on admission is accounted for during risk adjustment.
     • Replaced a risk category for non-ST-elevation myocardial infarction (non-STEMI) with a risk category for 
       ST-elevation myocardial infarction (STEMI) based on all diagnosis code positions for potential feature 
       selection to IQI 15 – Acute Myocardial Infarction (AMI) Mortality Rate
- Revised Major Diagnostic Category (MDC) Requirements
     • The software will suppress expected rates, risk-adjusted rates, smoothed rates, and composites for
       hospital-level indicators when major diagnostic categories (MDC) are missing or incomplete. 
	   Users should set the MDC_PROVIDED macro variable to "0" in the CONTROL program
       when MDC is missing or incomplete on the input data. If MDC is available and fully coded, users should
       set the MDC_PROVIDED macro variables to "1". If users set the MDC_PROVIDED macro variable to
       "1" in the CONTROL program, but a few MDC values are missing on input data, the software will
       exclude those discharges with missing MDCs. Additionally, if users set the MDC_PROVIDED macro
       variable to "1" in the CONTROL program, but all MDC values are missing on input data, the software
       will output an error message – "ERROR: MDC_PROVIDED = 1 in CONTROL program but all MDC
       values are missing on input data." In this scenario, users should set the MDC_PROVIDED macro variable
       to "0" in the CONTROL program.
     • Users interested in calculating expected, risk-adjusted, smoothed, or composite rates for hospital-level
       indicators must have MDCs assigned for each discharge on their input file. MDCs are used in measure
       specifications and risk adjustment. Since v2022, the AHRQ software does not impute MDC because the
       calculation was error-prone when the correct classification software was not applied to the input data.
       However, running the MS-DRG grouper is challenging for some users, so v2023 creates new assignments
       for MDC 14 (obstetrics) and MDC 15 (neonates), based on the diagnosis codes from MDC 14 and MDC
       15 code lists, in order to allow users to generate risk-adjusted, smoothed, or composite rates for hospital-level
       indicators where MDC 14 or MDC 15 are used in the measure specifications. 
     • Different versions of the Medicare Severity-Diagnostic Related Group (MS-DRG) grouper produce
       slightly different results with respect to certain high resource intensity MS-DRGs. Specifically, MSDRGs
       001-019 and 981-989 are classified as "pre-MDC" MS-DRGs, which means that they are
       associated with such high length of stay and/or cost that they supersede the usual assignment of MSDRGs
       within body system or MDC categories. For records assigned to these MS-DRGs, some versions of
       the grouper software retain the MDC that would be assigned based on the principal diagnosis and
       procedure codes, whereas other versions of the grouper software overwrite the MDC assignment with a
       blank, missing, or nonnumeric value such as "PRE." Thus, users MUST PROVIDE the MDC generated
       by the Centers for Medicare & Medicaid Services (CMS) MS-DRG grouper software, without imputing
       or mapping from MS-DRGs. For accurate results, all eligible records should have an MDC between 01
       and 25. For those users who need to construct MDC, please view the documentation and software
       available here: https://www.cms.gov/files/zip/icd-10-ms-drgs-v401-effective-april-1-2023.zip.
     • CMS' MS-DRG grouper software is updated on October 1 of each year, to accommodate new ICD-10-CM/PCS 
	   codes introduced on that date, and it is further updated on any other date when new codes take
       effect. As a result, the grouper software version that worked on discharge records dated between January
       1 and September 30 of any calendar year does NOT work correctly on discharge records dated between
       October 1 and December 31 of the same calendar year. MS-DRG grouper software is designed for
       backward compatibility, based on the discharge date of each record. Therefore, a user who wishes to
       analyze CY 2022 data must use the version 40 (FY 2023) grouper (or later), while a user who wishes to
       analyze CY 2021 data must use the version 39 (FY 2022) grouper (or later). Many errors will result if a
       user applies the version 39 (FY 2022) grouper to data from the last quarter of CY 2022.
- Requires Procedure Days (PRDAYn) to assign AHRQ Clinical Classifications Refined (CCSR) for ICD-10-PCS Procedures. 
  These categories are a feature in the risk-adjustment of procedure-based indicators (IQI 08, 09, 11, 12, 30, 31, 90). 
  Missing or incomplete PRDAYn information will impact risk-adjusted rates for these indicators. 
  Thus, PRDAYn must be supplied on the input data in the IQI module. In v2023, users can set the PRDAY macro variable 
  to "0" in the IQI CONTROL program when PRDAYn is missing or incomplete on the input data. The IQI module will then 
  suppress expected rates, risk-adjusted rates, smoothed rates, and composites for the procedure-based indicators.
- Includes methodology to adjust for COVID-19 discharges for hospital-level indicators. 
  Users have the following options to specify how to handle COVID discharges in the CONTROL program for each module:
	• Option 1: The user can exclude COVID discharges. The software will only calculate numerators,
      denominators, and observed rates.
	• Option 2 (default): The user can include all discharges, with and without COVID. This is
      recommended and is therefore the default choice. The software will calculate risk-adjusted rates,
      smoothed rates, and composites.
	• Option 3: The user can include only COVID discharges. The software will only calculate
      numerators, denominators, and observed rates.
  In v2022, because the 2019 HCUP reference population pre-dated the public health emergency, the
  software suppressed expected rates, risk-adjusted rates, smoothed rates, and composites for hospital
  indicators when a user includes COVID-19 discharges. For v2023, the reference population and risk
  adjustment models for hospital-level indicators incorporates HCUP data from 2019 to 2021 and allows
  for a COVID (present on admission) indicator. As a result, it is recommended that users utilize the default
  option 2 when calculating expected, risk-adjusted, smoothed rates, or composite rates, as this option
  adjusts for COVID-19. For options 1 and 3, the software will suppress the expected, risk-adjusted, and
  smoothed rates.
- Continues to provide the option to produce stratified rates. Expected rates, risk-adjusted rates, smoothed rates, 
  and composites are suppressed in certain situations. Because age and gender are used in risk adjustment models,
  it is inappropriate to produce risk-adjusted rates for any stratum that includes these variables.

Measure specific changes are outlined in the AHRQ SAS download page;
IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2023/ChangeLog_IQI_v2023.pdf

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2022.0.1
Release date: SEPTEMBER 2022
-----------------------------------------
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This version of AHRQ's All-Payers version is named SAS QI v2022.0.1
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- Updated the risk-adjustment program to remove the unintentional capping of observed-to-expected
  (risk-adjusted) ratios above 1.0. Ratios greater than 1.0 may now be observed. The program 
  will also limit lower-bound confidence interval estimates for both risk-adjusted rates and
  ratios at 0.0 and consistently includes columns for stratification variables in the TXT 
  output for all QI modules.
- For more information see the document "Stratification of Inpatient Quality Indicators (IQI),
  Patient Safety Indicators (PSI), and Pediatric Quality Indicators (PDI)" on the AHRQ QI website.
- Previous Release Notes for v2022 below also apply to v2022.0.1.

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2022
Release date: JULY 2022
-----------------------------------------
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This version of AHRQ's All-Payers version is named SAS QI v2022
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

- Added support for fiscal year 2022 code updates dictated by the Centers for Disease Control and Prevention (CDC) National
  Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services (CMS)
  These coding changes impact all software modules.
- Modified setnames, labels, and outputs in multiple modules. See log of changes for indicator-by-indicator changes.
- Updated risk-adjustment, signal variance, reference population rates, and composite weights for PSI, IQI, PDI, 
  and PQI modules using the 2019 HCUP state inpatient databases.
- AHRQ SAS QI v2022 includes new and updated risk factors in the risk-adjustment models. In the IQI module, 
  the following changes are new in v2022:
     • Added the Clinical Classifications Software Refined (CCSR) for ICD-10-PCS Procedures 
       categories to risk adjust for the procedure-based IQIs for procedures occurring on or prior to the day of the 
       IQI denominator procedures. As a result Procedure Day (PRDAY) is now a required data element.
     • Removed the All-Patient Refined Diagnosis Related Groups (APR-DRGs) for the risk adjustment of 
       procedure-based IQIs
     • Added an indicator for Do Not Resuscitate (DNR) to the condition based IQIs for potential
       feature selection.
     • Added a risk category for non-ST-elevation myocardial infarction (non-STEMI) for potential
       feature selection to IQI 15 – Acute Myocardial Infarction (AMI) Mortality Rate.
     • Added a risk category for cardiac arrest, cardiogenic shock, or anoxic brain injury that is 
       present on admission (POA) for potential feature selection to IQI 12 – Coronary Artery Bypass Graft Mortality Rate
       and IQI 30 – Percutaneous Coronary Intervention Mortality Rate.
- The software will suppress expected rates, risk-adjusted rates, smoothed rates, and composites for hospital-level IQIs 
  when major diagnostic categories (MDC) are missing or incomplete. Users should set the MDC_PROVIDED macro variable to "0" 
  in the CONTROL program when MDC is missing or incomplete on the input data. If MDC is available and fully coded, users 
  should set the MDC_PROVIDED macro variables to "1". If users set the MDC_PROVIDED macro variable to "1" in the CONTROL 
  program, but MDC values are missing on input data, the software will exclude those discharges with missing MDCs and 
  output an error message – "ERROR: MDC_PROVIDED = 1 in CONTROL program but all MDC values are missing on input data".
- Users interested in calculating expected, risk-adjusted, smoothed, or composite values for hospital-level indicators 
  must have MDCs assigned for each discharge on their input file. MDCs are used in measure specifications and risk 
  adjustment. The AHRQ v2022 software no longer imputes MDC as in v2021 since the calculation is error-prone when                                                                                                                    
  the correct classification software is not applied to the input data. Different versions of the Medicare 
  Severity-Diagnostic Related Group (MS-DRG) grouper produce slightly different results with respect to certain high 
  resource intensity MS-DRGs. Specifically, MS-DRGs 001-019 and 981-989 are classified as "pre-MDC" MS-DRGs, which means
  that they are associated with such high length of stay and/or cost that they supersede the usual assignment of MS-DRGs
  within body system or MDC categories. For records assigned to these MS-DRGs, some versions of the grouper software retain
  the MDC that would be assigned based on the principal diagnosis and procedure codes, whereas other versions of the grouper
  software overwrite the MDC assignment with a blank, missing, or nonnumeric value such as "PRE." 
  Thus, users MUST PROVIDE the MDC generated by the Centers for Medicare & Medicaid Services (CMS) MS-DRG grouper software, 
  without imputing or mapping from MS-DRGs. For accurate results, all eligible records should have an MDC between 01 and 25. 
  For those users who need to construct MDC, please view the documentation and software available here:
  https://www.cms.gov/files/zip/icd-10-ms-drgs-v391-effective-april-1-2022.zip.  
- In AHRQ software v2022, users continue to have two options to calibrate smoothed rates and composite values using observed to expected ratio: 
	• Option 1: Set Calibration_OE_to_ref_pop to 1 in SAS QI control programs to calibrate using the 2019 HCUP reference population 
      observed-to-expected (O-E) ratio. This is recommended and is therefore the default choice.
	• Option 2: Set Calibration_OE_to_ref_pop to 0 in SAS QI control programs to calibrate to the O-E ratio of the user's input data. 
      This option is provided to large health care systems or states who want to calibrate the predicted QI rates within the system. 
      Starting with AHRQ SAS QI v2021, there is a new step in the software to rescale the predicted probabilities if the O/E calibration 
      pushes them above 1.0. The caveat is that the interpretation of the rates may be different since the software would still use 2019 
      HCUP reference population rate as multiplier for risk adjustment rates.
  For more details about the O-E ratio adjustment, please refer to the Empirical Methods document.
  https://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2022/Empirical_Methods_2022.pdf
- The AHRQ SAS QI v2022 continues to include methodology to account for COVID-19 discharges for hospital-level indicators. Starting with 
  AHRQ SAS QI v2021 in modules that include hospital-level indicators (IQI, PDI, PSI), the user has the following options to specify 
  how to handle COVID-19 discharges in the CONTROL program for each module: 
	• Option 1: The user can exclude COVID-19 discharges. This is recommended and is therefore the default choice. The software will 
	  calculate risk-adjusted rates, smoothed rates, and composites.
	• Option 2: The user can include all discharges, with and without COVID-19. The software will only calculate numerators, denominators, 
	  and observed rates.
	• Option 3: The user can include only COVID-19 discharges. The software will only calculate numerators, denominators, and observed rates.
- Because the 2019 HCUP reference population pre-dates the public health emergency, the software will suppress expected rates, risk-adjusted 
  rates, smoothed rates, and composites for hospital indicators when a user includes COVID-19 discharges. In other words, users can only 
  calculate expected, risk-adjusted, smoothed rates, or composites when they select the default to exclude COVID-19 discharges. This approach 
  is consistent with the previously published user guidance. We will continue to monitor the published evidence on COVID-19 and update user 
  guidance as necessary.
  COVID-19 User Guidance is available here: https://qualityindicators.ahrq.gov/Downloads/Resources/COVID19_UserNote_July2021.pdf
- AHRQ SAS QI software users continue to have the option to produce stratified rates in v2022. Starting in AHRQ SAS QI v2021, expected rates, 
  risk-adjusted rates, smoothed rates, and composites will be suppressed in certain situations. Because age, gender, age in days, and 
  birth weight are used in risk adjustment models, it is inappropriate to produce risk-adjusted rates for any stratum that includes 
  these variables.

Measure specific changes are outlined in the AHRQ SAS download page;
IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2022/ChangeLog_IQI_v2022.pdf

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2021.0.2
Release date: MARCH 2022
-----------------------------------------
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This version of AHRQ's All-Payers version is named SAS QI v2021.0.2
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- Updated the APR_DRG limited-license grouper to allow for the calculation of admission-based
  APR-DRGs. The limited-license grouper software provided with prior versions of the 
  software produced discharge-based APR-DRGs resulting in inconsistencies with the 
  IQI risk-adjustment model methodology. The new limited-license grouper embedded in 
  2021.0.2 requires present on admission (POA) indicators to produce the admission-based
  APR-DRGs which aligns the risk-adjustment models with their intended methodology of 
  capturing risk at the time of admission. 
- More information is available in the user note, Inpatient Quality Indicators (IQI) Risk 
  Adjustment in the QI Software, available at:
  https://qualityindicators.ahrq.gov/Downloads/Resources/AHRQ_QI_v2021_IQI_APRDRG_User_Note_03_2022.pdf
- Previous Release Notes for v2021.0.1 below also apply to v2021.0.2

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2021.0.1
Release date: SEPTEMBER 2021
-----------------------------------------
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This version of AHRQ's All-Payers version is named SAS QI v2021.0.1
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- Updated IQI_HOSP_MEASURES.SAS to fix the issue in SAS QI v2021 when Option 1 or Option 3 were selected in 
  the CONTROL program for COVID-19 exclusions and users had 2020 data in their input file. This issue resulted 
  in no COVID-19 diagnosis-based exclusions for 2020 data in IQI, PDI, and PSI hospital-level indicators. 
  This issue is now fixed in SAS QI v2021.0.1 software and COVID-19 diagnosis-based exclusions are accurately 
  accounted for in computing rates with 2020 data when Option 1 or Option 3 are selected in the CONTROL program.
- For more information see previously released document Update to COVID-19 Exclusions in v2021 Software, available here: 
  https://www.qualityindicators.ahrq.gov/Downloads/Resources/SAS_QI_Release_Memo_COVID-19-Fix_v2021.pdf
- Previous Release Notes for v2021 below also apply to v2021.0.1

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2021
Release date: JULY 2021
-----------------------------------------
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This version of AHRQ's All-Payers version is named SAS QI v2021. 
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
- Added support for fiscal year 2021 code updates dictated by the Centers for Disease Control and Prevention (CDC) National
  Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services (CMS)
  These coding changes impact all software modules.
- Modified setnames, labels, and outputs in multiple modules. See log of changes for indicator-by-indicator changes.
- Updated risk-adjustment, signal variance, reference population rates, and composite weights for PSI, IQI, PDI, 
  and PQI modules using the 2018 HCUP state inpatient databases.
- Measures retired in v2021:
	IQI 32 Acute Myocardial Infarction (AMI) Mortality Rate, without Transfer Cases
	IQI 34 Vaginal Birth After Cesarean (VBAC) Rate
- AHRQ SAS QI v2021 includes new and updated risk factors in the risk-adjustment models. In the IQI module, 
	• Updated. All Patient Refined Diagnosis Related Groups (APR-DRGs) in the risk-adjustment models are based on the 
      patient's admission diagnoses and use present on admission (POA) information on the patient's discharge record.
	• New in v2021. A subset of the IQIs use Clinical Classifications Software Refined (CCSR) in the risk-adjustment 
      models are based on the patient's admission diagnoses and use present on admission (POA) information on the 
      patient's discharge record.
- Starting with AHRQ SAS QI v2021, the software will suppress expected rates, risk-adjusted rates, smoothed rates, and composites 
  for hospital-level indicators when MDC is missing or incomplete. Users should set the MDC_PROVIDED macro variable to ‘0' in the 
  CONTROL program when MDC is missing or incomplete on the input data.
- Users interested in calculating expected, risk-adjusted, smoothed, or composite values for hospital-level indicators must 
  have major diagnostic categories (MDCs) assigned for each discharge on their input file. MDCs are used in measure 
  specifications and risk adjustment, and although the QI software includes a macro to calculate MDC, it does not account 
  for assignments for pre-MDC DRGs or multiple trauma cases (MDC 24). Different versions of the MS-DRG grouper produce 
  slightly different results with respect to certain high resource intensity MS-DRGs. Specifically, MS-DRGs 001-017 
  and 981-989 are classified as "preMDC" MS-DRGs, which means that they are associated with such high length of stay and/or 
  cost that they supersede the usual assignment of MS-DRGs within body system or MDC categories. For records assigned to 
  these MS-DRGs, some versions of the grouper software retain the MDC that would be assigned based on the principal diagnosis 
  and procedure codes, whereas other versions of the grouper software overwrite the MDC assignment with a blank, missing, or 
  nonnumeric value such as "PRE." For those users who need to construct MDC, please view the documentation and software 
  available here: https://www.cms.gov/files/zip/icd-10-ms-drgs-v381-effective-january-1-2021.zip
- In AHRQ software v2021, the user has two options to calibrate smoothed rates and composite values using observed to expected ratio: 
	• Option 1: Set Calibration_OE_to_ref_pop to 1 in SAS QI control programs to calibrate using the 2018 HCUP reference population 
      observed-to-expected (O-E) ratio. This is recommended and is therefore the default choice.
	• Option 2: Set Calibration_OE_to_ref_pop to 0 in SAS QI control programs to calibrate to the O-E ratio of the user's input data. 
      This option is provided to large health care systems or states who want to calibrate the predicted QI rates within the system. 
      Starting with AHRQ SAS QI v2021, there is a new step in the software to rescale the predicted probabilities if the O/E calibration 
      pushes them above 1.0. The caveat is that the interpretation of the rates may be different since the software would still use 2018 
      HCUP reference population rate as multiplier for risk adjustment rates.
  For more details about the O-E ratio adjustment, please refer to the Empirical Methods document.
  https://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2021/Empirical_Methods_2021.pdf
- The AHRQ SAS QI v2021 now includes methodology to account for COVID-19 discharges for hospital-level indicators. Starting with 
  AHRQ SAS QI v2021 in modules that include hospital-level indicators (IQI, PDI, PSI), the user has the following options to specify 
  how to handle COVID discharges in the CONTROL program for each module: 
	• Option 1: The user can exclude COVID discharges. This is recommended and is therefore the default choice. The software will 
	  calculate risk-adjusted rates, smoothed rates, and composites.
	• Option 2: The user can include all discharges, with and without COVID. The software will only calculate numerators, denominators, 
	  and observed rates.
	• Option 3: The user can include only COVID discharges. The software will only calculate numerators, denominators, and observed rates.
- Because the 2018 HCUP reference population pre-dates the public health emergency, the software will suppress expected rates, risk-adjusted 
  rates, smoothed rates, and composites for hospital indicators when a user includes COVID-19 discharges. In other words, users can only 
  calculate expected, risk-adjusted, smoothed rates, or composites when they select the default to exclude COVID-19 discharges. This approach 
  is consistent with the previously published user guidance. We will continue to monitor the published evidence on COVID and update user 
  guidance as necessary.
  COVID-19 User Guidance is available here: https://qualityindicators.ahrq.gov/Downloads/Resources/User_note_COVID.pdf																	  
- AHRQ SAS QI software users continue to have the option to produce stratified rates. Starting in AHRQ SAS QI v2021, expected rates, 
  risk-adjusted rates, smoothed rates, and composites will be suppressed in certain situations. Because age, gender, age in days, and 
  birth weight are used in risk adjustment models, it is inappropriate to produce risk-adjusted rates for any stratum that includes 
  these variables.

Measure specific changes are outlined in the AHRQ SAS download page;
IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2021/ChangeLog_IQI_v2021.pdf

=============================================================================================
Inpatient Quality Indicators Software Version SAS v2020
Release date: JULY 2020
-----------------------------------------
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This version of AHRQ's All-Payers version is named SAS QI v2020. 
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
- Added support for fiscal year 2020 code updates dictated by the Centers for Disease Control and Prevention (CDC) National
  Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services (CMS) through March 31, 2020. 
  The SAS QI v2020 ICD-10-CM/PCS software does not reflect coding updates effective April 1, 2020. 
  These coding changes impact all software modules.
- Modified setnames, labels, and outputs in multiple modules. See log of changes for indicator-by-indicator changes.
- Updated risk-adjustment, signal variance, reference population rates, and composite weights 
  using the 2017 HCUP state inpatient databases.
- Users interested in calculating expected, risk-adjusted, smoothed, or composite values must have major diagnostic categories (MDCs)
  assigned for each discharge on their input file. MDCs are used in risk adjustment, and although the QI software includes a macro to 
  calculate MDC, it does not account for assignments for pre-MDC DRGs or multiple trauma cases (MDC 24). Different versions of the MS-DRG
  grouper produce slightly different results with respect to certain high resource intensity MS-DRGs. Specifically, MS-DRGs 001-017 
  and 981-989 are classified as "preMDC" MS-DRGs, which means that they are associated with such high length of stay and/or cost that
  they supersede the usual assignment of MS-DRGs within body system or MDC categories. For records assigned to these MS-DRGs, some
  versions of the grouper software retain the MDC that would be assigned based on the principal diagnosis and procedure codes, whereas
  other versions of the grouper software overwrite the MDC assignment with a blank, missing, or nonnumeric value such as "PRE." 
  For those users who need to construct MDC, please view the documentation and software available here:
    https://downloads.cms.gov/files/ms-drg-v37-0-r0-mce.zip
- In AHRQ software v2020, the user now has two options to calibrate smoothed rates and composite values using observed to expected ratio: 
  Option 1: Set Calibration_OE_to_ref_pop to 1 in SAS QI control programs to calibrate using the 2017 HCUP reference population 
  observed-to-expected (O-E) ratio. This is recommended and is therefore the default choice.
  Option 2: Set Calibration_OE_to_ref_pop to 0 in SAS QI control programs to calibrate to the O-E ratio of the user's input data. 
  This option is provided to large health care systems or states who want to calibrate the predicted QI rates within the system. 
  The caveat is that the interpretation of the rates may be different since the software would still use 2017 
  HCUP reference population rate as multiplier for risk adjustment rates.
  For more details about the O-E ratio adjustment, please refer to the Empirical Methods document.
  https://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2020/Empirical_Methods_2020.pdf
- In the IQI module of version 2020 of the SAS QI Software, the APR-DRGs in the risk-adjustment models are based on the patient's 
  admission diagnoses using POA information.
  
Measure specific changes are outlined in the AHRQ SAS download page;

IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2020/ChangeLog_IQI_v2020.pdf

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Version SAS v2019, ICD-10-CM/PCS
Release date: JULY 2019
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This version of AHRQ's All-Payers version is named SAS QI v2019 ICD-10-CM/PCS. 
 
Because of the transition to ICD-10-CM/PCS, 2018 SAS QI v2019 is the first software to support risk-adjustment using ICD-10-CMS/PCS.
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- Added support for fiscal year 2019 code updates dictated by the Centers for Disease Control and Prevention (CDC) National
  Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services (CMS).
- Introduces execution of all the supporting SAS programs from within the IQI_HOSP_CONTROL.sas program.
- SAS program and control file variables were renamed to align the naming with what the module is measuring - changing
  provider to hospital.
- Modified setnames, labels, and outputs in multiple modules. See log of changes for indicator-by-indicator changes.
- Added risk-adjustment, signal variance, reference population rates, and composite weights for the IQI module using
  the 2016 HCUP state inpatient databases. Risk adjustment output is limited to AGE_SEX models.
  
- Remove measures from version 2019:
	IQI 01 Esophageal Resection Volume
	IQI 02 Pancreatic Resection Volume
	IQI 04 Abdominal Aortic Aneurysm (AAA) Repair Volume
	IQI 05 Coronary Artery Bypass Graft (CABG)
	IQI 06 Percutaneous Coronary Intervention (PCI) Volume
	IQI 07 Carotid Endarterectomy Volume
	IQI 13 Craniotomy Mortality Rate
	IQI 14 Hip Replacement Mortality Rate

- Users interested in calculating expected, risk-adjusted, smoothed, or composite values must have major diagnostic categories (MDCs)
  assigned for each discharge on their input file. MDCs are used in risk adjustment, and although the QI software includes a macro to 
  calculate MDC, it does not account for assignments for pre-MDC DRGs or multiple trauma cases (MDC 24). Different versions of the MS-DRG
  grouper produce slightly different results with respect to certain high resource intensity MS-DRGs. Specifically, MS-DRGs 001-017 
  and 981-989 are classified as "preMDC" MS-DRGs, which means that they are associated with such high length of stay and/or cost that
  they supersede the usual assignment of MS-DRGs within body system or MDC categories. For records assigned to these MS-DRGs, some
  versions of the grouper software retain the MDC that would be assigned based on the principal diagnosis and procedure codes, whereas
  other versions of the grouper software overwrite the MDC assignment with a blank, missing, or nonnumeric value such as "PRE." 
  For those users who need to construct MDC, please view the documentation and software available here:
    https://downloads.cms.gov/files/MS-DRG-V36-0-R0-MSGMCE-V36-0-R0-MCE-V36-0-R0.zip
- In the IQI module of version 2019 of the SAS QI Software, the APR-DRGs in the risk-adjustment models are based on the patient's discharge
  diagnosis and does not consider POA information. 
- The naming convention for programs for measures focusing on care inside hospitals are referred to as hospital instead of provider. 

=====================================================================================================================

Measure specific changes are outlined in the AHRQ SAS download page;

IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2019/ChangeLog_IQI_v2019.pdf

=============================================================================================
Version SAS v2018, ICD-10-CM/PCS (Non-Risk Adjusted)
Release date: JUNE 2018
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This version of AHRQ's All-Payers version is named SAS QI v2018 ICD-10-CM/PCS (Non Risk Adjusted). AHRQ has revised the 
versioning approach with their software tools to better reflect the fiscal year the software tools are released, 
instead of an incremental version number. Hence, the next All-Payers release will not be called v8.0, but instead, will be 
called v2018.
 
Because of the transition to ICD-10-CM/PCS, risk adjustment is not supported in the 2018 SAS 
(or in v6.0 and v7.0 beta SAS software) for ICD-10-CM/PCS. 
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- Added support for fiscal year 2018 code updates dictated by the Centers for Disease Control and Prevention (CDC) National
  Center for Health Statistics (NCHS) and Centers for Medicare & Medicaid Services(CMS).
- Consolidated formats for DIAPHRP and LUNGBIP into THORAIP due to redundancy.
- Suppressed output of NQI 02, Neonatal Mortality rate, pending technical specification review.
- Updated AHRQ Population file to use US Census 'County Population by Characteristics: 2010-2017 Vintage' tables.
  The new population file uses Census estimates for singe year age population to create AHRQ 18+ age bands, This file includes estimates for the 1995 to 2017 period.
  Population data from years 1995-1999 uses a different method for the age group (18 – 24) compared to the population data starting with 2000.

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Version 7.0.1 Beta, ICD-10-CM/PCS
Release date: December 2017
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AHRQ has named this a "beta version" as a signal to users that there may be significant differences
between results obtained when using data and QI software based on ICD-9-CM coding vs. the results 
obtained when using data and QI software based on ICD-10-CM/PCS.
Users should interpret rates using the 7.0 beta version with caution. 
A brief introduction to the differences between ICD-9-CM and ICD-10-CM/PCS 
is available at: https://www.hcup-us.ahrq.gov/datainnovations/BriefIntrotoICD-10Codes041117.pdf
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The v7.0.1 Beta includes updates to the PDI, PQI, and PQI09 modules.
- Added support for the updated area population file for the years 2016 and 2017.
  The population data is used in calculating the denominator of area level indicators.
  The 1995 to 2017 population file is available for download on the AHRQ SAS Software website.
  http://www.qualityindicators.ahrq.gov/Software/SAS.aspx
- Except for the addition of 2016 and 2017 population data, this version is exactly same as SAS QI 7.0 Beta.

=============================================================================================
Version 7.0 Beta, ICD-10-CM/PCS
Release date: September 2017
-----------------------------------------

-  Adds PQI_AREA_CONDITION.sas to calculate diabetes rates for prevention quality indicators across stratifiers.  (PQI)
- Remove unused PDI variables DUALCAT, FIPST, CNTPRDAY, CONGCAT, TRNSFER, TRNSOUT, MAXPR, NOPOUB04, NOPRDAY, ARRY6, ARRY3, PAY2
- Remove unused IQI variables MORT30, DNR, FIPSTCO, FIPST, PSTCO, LOS, POPCAT, DUALCAT, PAY2, TRNSFER, MAXDX, MAXPR, NOPOUB04, NOPRDAY,
     TRNSOUT, CNTPRDAY, ARRY1, ARRY3, ARRY6
- Remove unused PSI variables ASOURCE, FIPSTCO, FIPST, and PSTCO, POPCAT, DUALCAT, MAXDX, MAXPR, NOPOUB04, NOPRDAY, TRNSOUT, TRANSFER
     PAY2, CNTPRDAY, ARRY1, ARRY3, ARRY4, ARRY6
- Remove unused PQI variables DUALCAT, PAY2, POVCAT1-POVCAT10, FEMALE, PVIDX, AGECAT1-AGECAT14, FAGECAT1-FAGECAT14, ARRY1, ARRY2, ARRY3
- Added support for ICD Version 34 and MS-DRG Version 34 codes through 09/30/2017
- Remove measures from version 7.0.
    IQI 23 Laparoscopic Cholecystectomy Rate
    IQI 24 Incidental Appendectomy in the Elderly Rate
    IQI 25 Bilateral Cardiac Catheterization Rate
    IQI 26 Coronary Artery Bypass Graft (CABG) Rate
    IQI 27 Percutaneous Coronary Intervention (PCI) Rate
    IQI 28 Hysterectomy Rate
    IQI 29 Laminectomy or Spinal Fusion Rate
    PSI 21 Retained Surgical Item or Unretrieved Device Fragment Rate 
    PSI 22 Iatrogenic Pneumothorax Rate 
    PSI 23 Central Venous Catheter-Related Blood Stream Infection Rate 
    PSI 24 Postoperative Wound Dehiscence Rate
    PSI 25 Unrecognized Abdominopelvic Accidental Puncture or Laceration Rate 
    PSI 26 Transfusion Reaction Rate 
    PSI 27 Postoperative Hemorrhage or Hematoma Rate

- Added exclusion for cases in hospice care at admission where POINTOFORIGINUB04 equal to 'F'.  (applicable to: IQI 15-20; PSI 04).
- Add support for present on admission exemption diagnosis codes based on date of discharge.

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Measure specific changes are outlined in the AHRQ SAS download page;

PQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/v2018/ChangeLog_PQI_v2018.pdf

IQI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/v2018/ChangeLog_IQI_v2018.pdf

PSI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V2018/ChangeLog_PSI_v2018.pdf 

PDI - https://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V2018/ChangeLog_PDI_v2018.pdf 
