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Data Collection Methods
Agency for Healthcare Research and Quality (AHRQ) Quality Indicators
Executive Summary
The AHRQ Quality Indicator tools
represent the current state-of-the-art in
measuring the safety of hospital care
through the analysis of inpatient discharge
data (administrative claims data). Though
initially constructed to track healthcare
trends, recent efforts have been made to
use the tools to examine clinical outcomes.
AHRQ and IHC advise using this
information as a screening tool to identify
potential issues that may require deeper
investigation, and strongly advise against
using this information alone to draw
clinical conclusions. With this advice on
approaching the data, IHC has constructed
a mechanism to identify outliers in clinical
performance.
In 2005, IHC reviewed an initial set
of 55 AHRQ Quality Indicators in quality
and safety, the IHC Data Committee
selected 11 measures to present in the
Iowa Report. This set of 11 measures was
presented as state aggregated information
in the Iowa Report. Since 2005, each year
the IHC Data Committee has engaged
in a process of reviewing the Quality
Indicators with the purpose of adding
appropriate new Quality Indicators to the
Iowa Report, and to consider the graduation
of previous state-aggregated measures
to hospital-specific measures. A primary
selection criterion was an adequate number
of hospitals with significant number of cases
(at least 30) to minimize variability due
to small numbers in reporting. Variability
in coding procedures that may confound
reporting was also considered. In the 2006
Iowa Report the original 11 measures were
graduated to hospital-specific measures,
and 7 new AHRQ Quality Indicators were
added as state-aggregated measures. In
this report 6 measures were graduated to
hospital-specific measures, 1 measure was
retained as a state-aggregate measure, and 9
new AHRQ Quality Indicators were added
as state-aggregated measures.
Introduction
The Agency for Healthcare Research
and Quality (AHRQ) is the health services
research arm of the U.S. Department of
Health and Human Services. AHRQ's
mission is to improve the quality, safety,
efficiency, and effectiveness of health care
for all Americans.
In the early 1990s, several organizations
requested assistance from AHRQ in
providing a set of quality measures using the
information that exists in routine hospital
administrative data. AHRQ responded
by creating the Healthcare Cost and
Utilization Project (HCUP)-a federal,
state, and private sector collaborative
effort-to build healthcare databases from
U.S. hospitals' administrative data and
develop the original 33 HCUP Quality
Indicators (QIs). These examine in-hospital
mortality, complications of medical
procedures, inappropriate uses of services,
and ambulatory care sensitive conditions.
As nationwide interest grew in the use of the
QIs as effective quality measurement tools,
AHRQ funded a project with the University
of California-San Francisco and Stanford
University to adapt, expand, and refine the
33 original Quality Indicators. There are
now 91 state-of-the-art QIs organized into
Patient Safety Indicators, Inpatient Quality
Indicators, Pediatric Quality Indicators, and
Prevention Quality Indicators.
As a public reporting tool, the QI
measures are being used to compare
variations in quality between geographical
regions and/or providers, monitor the
incidence of new events and to detect trends
over time. Overall, the QIs allow healthcare
researchers, stakeholders, providers, and the
public to assess health care issues that affect
our health.
Although the AHRQ QIs are easy to use
and inexpensive quality measures, AHRQ
strongly cautions users regarding their use
and interpretation. Due to the inherent
limitations in using administrative data,
AHRQ suggests that QIs be used as simple
screening tools to identify potential issues
that may require deeper investigation and
not as definitive measures of the quality of
care. IHC feels that the data has usefulness
as a "signal," alerting the institution that a
careful clinical study of a potential problem
may be warranted.
Description of Iowa and National Data
Iowa's 2002-2006 State Inpatient
Database (SID) datasets were used to
compute AHRQ performance measures
for each year individually, and for all five
years combined. Each dataset was limited
to include only acute inpatient cases. The
Mercy Medical Center - Dyersville, Iowa,
was new to the Iowa SID in 2006, therefore
this hospital does not have reported
measures for the years 2002 through 2005.
All Iowa's hospitals were allowed to provide
comments regarding their performance
on each AHRQ Quality Indicator. Where comments were provided, they appear
following the hospital's name in each table.
The 2004 and 2005 Healthcare
Cost and Utilization Project (HCUP)
Nationwide Inpatient Samples (NIS) were
used to compute nationally representative
performance measures for the years 2004
and 2005. Both datasets include all
inpatient discharges from a 20% stratified
sample of U.S. community hospitals in
37 participating states. In the 2005 NIS
dataset, HCUP added data from the state
of Oklahoma and Virginia's data were not
available. Both the 2004 and 2005 NIS
datasets include Iowa.
AHRQ Qua lity Indica tors Inc luded in this Report
AHRQ Quality Indicator Measures - Hospital Specific Information
Inpatient Quality Indicators
- Coronary Artery Bypass Graft (CABG) Mortality Rate Comparisons - (IQI 12)
- Hip Replacement Mortality Rate Comparisons - (IQI 14)
- Percutaneous Transluminal Coronary Angioplasty (PTCA) Mortality Rate
Comparisons - (IQI 30)
- Carotid Endarterectomy Angioplasty (CEA) Mortality Rate Comparisons - (IQI 31)
Patient Safety Indicators
- Complications of Anesthesia Rate Comparisons – (PSI 1)
- Low Mortality DRG Mortality Rate Comparisons - (PSI 2)
- Decubitus Ulcer Rate Comparisons - (PSI 3)
- Foreign Body Left in During Procedure Rate Comparisons - (PSI 5)
- Iatrogenic Pneumothorax Rate Comparisons – (PSI 6)
- Postoperative Hip Fracture Rate Comparisons - (PSI 8)
- Postoperative Hemorrhage or Hematoma Rate Comparisons – (PSI 9)
- Postoperative Respiratory Failure Rate Comparisons – (PSI 11)
- Postoperative Pulmonary Embolism/Deep Vein Thrombosis Rate Comparisons - (PSI 12)
- Postoperative Sepsis Rate Comparisons – (PSI 13)
- Postoperative Wound Dehiscence Rate Comparisons - (PSI 14)
- Accidental Puncture or Laceration Rate Comparisons - (PSI 15)
- Birth Trauma – Injury to Neonate Rate Comparisons - (PSI 17)
New/Retained 2007 IHC Reported AHRQ Quality Indicator Measures -
Statewide Aggregate Information
Patient Safety Indicators
- Selected Medical Infections Due to Medical Care Rate Comparisons - (PSI 7)
- Postoperative Physiologic/Metabolic Derangement Rate Comparisons – (PSI 10)
- Obstetric Trauma – Vaginal with Instrument-Assisted Delivery
Rate Comparisons – (PSI 18)
- Obstetric Trauma – Vaginal without Instrument-Assisted Delivery
Rate Comparisons – (PSI 19)
- Obstetric Trauma – Cesarean Section Delivery – (PSI 20)
Inpatient Quality Indicators
- Inhospital Hip Fracture Mortality Rate Comparisons – (IQI 19)
Pediatric Safety Indicators
- Accidental Puncture or Laceration Rate Comparisons – (PDI 1)
- Foreign Body Left in During Procedure Rate Comparisons – (PDI 3)
- Iatrogenic Pneumothorax Rate Comparisons – (PDI 5)
- Selected Infections Due to Medical Care Rate Comparisons – (PDI 12)
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