AHRQ Quality Indicators™ Toolkit for Hospitals

Improving Performance on the AHRQ Quality Indicators

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AHRQ Quality Indicators (QIs) are measures of hospital quality and safety drawn from readily available hospital inpatient administrative data. Hospitals across the country are using QIs to identify potential concerns about quality and safety and track their performance over time. This toolkit supports hospitals that want to improve performance on the IQIs and PSIs by guiding them through the process, from the first stage of self-assessment to the final stage of ongoing monitoring. The tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multistakeholder improvement teams.


This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ, and support your use of them to successfully improve quality and patient safety in your hospital. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs. For more information, select for the AHRQ Quality Indicators™ Toolkit for Hospitals: Fact Sheet ( PDF file PDF version - 291.3 KB ).

The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). More information on the QIs is available in the Fact Sheets on the IQIs and PSIs (Tools A.1a and A.1b).

A Sequence of Steps for Improvement. The complete improvement process includes the following sequence of steps, in which you will set priorities and plan for performance improvements on the QIs, implement improvement strategies, and sustain improvements achieved:

  • Determining Readiness To Change.
  • Applying QIs to the Hospital Data.
  • Identifying Priorities for Quality Improvement.
  • Implementing Improvements.
  • Monitoring Progress for Sustainable Improvement.
  • Analyzing Return on Investment.
  • Using Other Resources.

Implementing Improvements. Within the Implementation Methods step is a five-step implementation cycle (Tool D.1): 

  1. diagnose the problem; 
  2. plan and implement best practices; 
  3. measure results and analyze; 
  4. evaluate effectiveness of actions taken; and 
  5. evaluate, standardize, and communicate. 

This model is based on the well-known PDSA (plan, do, study, act) improvement cycle. For best results, it is advisable to have someone dedicated to serve as facilitator of the improvement process, which could be a staff person or an external resource.

Toolkit Roadmap. Tools are available to support work in each of the sequence of improvement steps. The Toolkit Roadmap will help you get started. For each key improvement step, it identifies the tools provided in the Toolkit to support your work. For each tool, the Roadmap gives a brief description of the tool and identifies additional relevant information.

Different Tools for Different Audiences. Successful improvement requires involvement by multiple positions in the hospital. Therefore, while your hospital's quality leaders are the primary audience, many tools are aimed at several audiences. The Roadmap shows the intended audiences for each tool. Your hospital may choose to use only those tools that you find helpful. View the toolkit as a "resource inventory" from which you can select the tools that are most useful, given your hospital's current quality improvement capabilities and efforts. The Toolkit Roadmap is the "shopping list" you can use to quickly identify which tools to use at any point in time.

This toolkit underwent a field test, evaluation, and revisions in response to feedback from six diverse hospitals. All information it contains is up to date as of November 2011.

Audio Interview Series

This series of interviews from May 2012 will orient users to the AHRQ Quality Improvement Toolkit for Hospitals. The topics provide an overview of the toolkit and information on how to use the tools and engage stakeholders and staff in quality improvement efforts.

Webinar on AHRQ Quality Indicators Toolkit for Hospitals

To orient users to the QI toolkit, AHRQ held a Web seminar on February 15, 2012. Select to access the slide presentations and an audio recording.

Current as of July 2012
Internet Citation: AHRQ Quality Indicators™ Toolkit for Hospitals: Improving Performance on the AHRQ Quality Indicators. July 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html