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


This page provides information on how organizations, including hospitals and health systems, use the AHRQ QIs to improve the quality of care.


  • CHRISTUS Health
    • Organization At a Glance:
      • An international Catholic, faith-based, not-for-profit health system comprising more than 60 hospitals and long-term care facilities, 175 clinics and outpatient centers.

    • Improvement Opportunity: CHRISTUS created a composite Harm Index using the AHRQ PSIs, and used this Index to motivate the organization’s leaders and clinical staff to achieve significant reductions in system-wide harm events.

    • Results: Since late 2015, CHRISTUS Health has achieved a 22 percent reduction in overall harm events after the system began to use 14 AHRQ Patient Safety Indicators (PSIs). CHRISTUS Health achieved significant improvements in its results for Central Venous Catheter-related Blood Stream Infections (PSIs 07) with a 53.8 percent improvement, and for Postoperative Respiratory Failure (PSI 011) with a 41.3 percent reduction for 2016 through 2017.

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  • Missouri Hospital Association
    • Organization At a Glance:
      • A not-for-profit membership association that represents every acute care hospital in Missouri, as well as most federal (VA, military) facilities, state psychiatric care and private rehabilitation facilities.

      • Since its creation in 1922 with 50 hospital members, MHA has grown to 145 members representing hospitals from across Missouri.
    • Improvement Opportunity: In support of the Missouri Hospital Association’s (MHA’s) statewide Triple Aim quality agenda—better health, better care, and lower costs—MHA and its members have reported on AHRQ Quality Indicators (QIs) since 2000.

    • Results: MHA launched a public reporting website that uses a range of AHRQ QIs to support greater statewide transparency on hospital quality and cost. Initially a voluntary effort, the state legislature now mandates that all Missouri hospitals report pricing data for the 100 most common Diagnostic-Related Groups.

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  • Vanderbilt University Medical Center
    • Organization At a Glance:
      • VUMC is a 1,000-bed medical center with more than 2,000 medical staff, 60,000 admissions and 120,000 emergency room visits annually.

      • The organization has hospitals, clinics, physician practices and affiliates covering nine hospital systems and 48 hospital locations.
    • Improvement Opportunity: VUMC’s focus on its PSI performance spurred several quality initiatives, including efforts to reduce the incidence of pressure ulcers (PSI 03) and postoperative respiratory failure (PSI 11).

    • Results: Achieved a 28 percent improvement in performance on AHRQ’s Patient Safety Indicators (PSIs), largely as a result of improved collaboration across departments and increased attention to documentation.

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  • University of Pittsburgh Medical Center
    • Organization At a Glance:
      • UPMC operates more than 25 academic, community, and specialty hospitals, with 600 doctors’ offices and outpatient sites, and employs 3,600 physicians, and offers an array of rehabilitation, retirement, and long-term care facilities.

      • The two largest hospitals are Presbyterian and Shadyside – with more than 1,000 beds across these two facilities.
    • Improvement Opportunity: Beginning in 2010, UPMC bolstered its commitment to patient safety by using the AHRQ Patient Safety Indicators (PSIs) for tracking its performance on a range of safety issues.

    • Results: UPMC's rate of Unrecognized Abdominopelvic Accidental Puncture/Laceration Rate (PSI 15) fell from 8.26 per 1,000 patient discharges in FY 2010 to 1.56 per 1,000 patients in FY 2016. .

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  • SUNY Upstate University Hospital
    • Organization At a Glance:
      • The only academic medical center in central New York, serving 1.8 million people

      • Has 735 licensed beds and 77 hospital-based specialty clinics

      • Has 10,000 staff members, 1,400 of whom are credentialed

    • Improvement Opportunity: In 2014, SUNY Upstate began a major patient safety initiative that included implementation of the full set of AHRQ Patient Safety Indicators (PSIs). At the same time, the medical center also began tracking its performance across 22 of the AHRQ Inpatient Quality Indicators (IQIs).

    • Solution: The hospital assigned a physician lead or ‘champion’ to each PSI. This person led a team that worked closely with clinical staff, providing feedback to providers on a daily basis. The hospital also dedicated staffing and resources to improve the clinical documentation and coding for each PSI.

    • Results: SUNY Upstate improved its performance on several PSIs, including PSI 11 (Postoperative Respiratory Failure) and PSI 13 (Postoperative Sepsis), between the first quarter of 2015 and the second quarter of 2016. The hospital also avoided any financial penalty in 2016 for Healthcare-Acquired Conditions (HACs), eliminating what had been a $1 million penalty just two years prior.

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  • Keck Medical Center of the University of Southern California
    • Organization At a Glance:
      • Fully owned by the University of Southern California (USC)

      • Includes Keck Hospital of USC, USC Norris Cancer Center, and Verdugo Hills Hospital – with more than 1,100 medical staff across these three facilities

    • Improvement Opportunity: Following a focus on patient safety as part of a new strategic plan, quality improvement and clinical documentation staff at Keck Medical Center worked together to improve performance on the Patient Safety Indicators (PSIs).

    • Solution: Keck Medical Center decided to tackle one PSI at a time. They started by reviewing documentation of safety events, and then focused on finding opportunities for increasing safety for patients.

    • Results: Between 2014 and 2016, Keck Medical Center cut its rate in half or more for seven PSIs, including an 88 percent reduction in the occurrence of PSI 11(Postoperative Respiratory Failure).

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  • Cleveland Clinic
    • Organization At a Glance:
      • Nearly 54,000 discharges in 2014, generating more than $13 billion in patient revenues.

      • 1,400 beds on Cleveland Clinic’s main campus and 4,450 beds systemwide.

      • 43,000 employees, including 3,200 professional staff and 1,700 residents and fellows.
    • Improvement Opportunity: Cleveland Clinic began working with the Patient Safety Indicators (PSIs) in 2010 because patient safety is the “right thing to do” and because Federal payment programs and private payers use these quality indicators in their reimbursement programs.

    • Solution: By using the PSIs, Cleveland Clinic detected some clear opportunities to improve quality of care and used those opportunities to allocate resources. For example, for PSI 15 (Accidental Puncture or Laceration), Cleveland Clinic’s rate was worse than its peer institutions—both for documentation and clinical reasons. Using the PSI specifications and partnering with its providers, the Clinic made dramatic improvements and now its PSI 15 results are in the best quartile.

    • Results: Cleveland Clinic improved its performance on the PSIs from the lowest quartile in 2010 to the best quartile as of June 2015.

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  • Essentia Health
    • Organization At a Glance:
      • A private, non-profit integrated health care system with facilities in Minnesota, Wisconsin, North Dakota and Idaho

      • A $1.7 billion enterprise with more than 14,000 employees including 1,500 physicians and advanced practitioners.

      • Includes 16 hospitals, 69 clinics, eight long term care facilities, two assisted living facilities, four independent living facilities, and one research institute
    • Improvement Opportunity: Essentia Health analyzed a benchmark report and found that select Patient Safety Indicators (PSIs) were higher than national benchmarks, suggesting opportunities for making improvements in the delivery of care.

    • Solution: Begining in 2013, Essentia Health tracked 10 of the PSIs, ultimately focusing on performance improvement for three of them—PSI 03 (Pressure Ulcer Rate), PSI 09 (Perioperative Hemorrhage or Hematoma Rate), and PSI 15 (Accidental Puncture or Laceration Rate).

    • Results: Essentia Health-Fargo reduced PSI 15 from a rate of 1.2 events per 1000 eligible procedures in 2013 to 0.07 in the first half of 2015. Essentia Health has also improved the quality of care for treatment of pressure ulcers (PSI 03) and has experienced a decline in perioperative hemorrhage or hematoma incidences (PSI 09).

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  • Yale New Haven Health System
    • Organization At a Glance:
      • YNHHS' flagship facility is the Yale-New Haven Hospital (YNHH), a non-profit, 1,541-bed tertiary medical center.

      • YNHHS also includes Bridgeport Hospital, Greenwich Hospital and Northeast Medical Group

      • With more than 20,000 employees and a medical staff of 6,491, Yale New Haven Health System (YNHHS) had more than 109,000 discharges in 2014, generating about $3.3 billion in revenue.
    • Improvement Opportunity: Yale New Haven Health System (YNHHS) wanted to identify variations in quality of care so that patients consistently receive better care at lower cost. YNHHS tackled this issue as part of a multiyear effort to improve the overall value of care.

    • Solution: Beginning in 2012, YNHHS developed a set of tailored indicators—Quality Variation Indicators (QVIs)—that identify variations in the quality of care provided at YNHHS. The purpose of the QVIs is to target areas for potential improvement. The QVIs include selected AHRQ Patient Safety Indicators (PSIs), as well as hospital acquired infections (HAI) indicators, among others.

    • Results: Between 2012 and 2014, while most hospitals experienced rising costs, the expense to YNHHS per equivalent discharge was reduced by 4.6 percent, decreasing from $16,390 to $15,635.

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    • How does your organization use the AHRQ QIs to improve quality of care?
      Share your story by contacting the AHRQ QI Support Team at