Toolkit for Using the AHRQ Quality Indicators

How To Improve Hospital Quality and Safety
The Toolkit for Using the AHRQ Quality Indicators (QI Toolkit) is a free and easy-to-use resource for hospitals planning to use the AHRQ Quality Indicators (QIs), including the Patient Safety Indicators (PSIs), to track and improve inpatient quality and patient safety.

More information is available in the AHRQ Quality Indicators™ Fact Sheet.

PSIs Are Key Indicators for Centers for Medicare & Medicaid Services (CMS)

One critical factor driving the emphasis on the PSIs is their use by the Centers for Medicare & Medicaid Services (CMS). The composite measure, PSI 90, is included in CMS’s Inpatient Quality Reporting program (and associated Hospital Compare report), Hospital Value-Based Purchasing program, and Hospital-Acquired Condition (HAC) Reduction program. The QI Toolkit serves as both a general guide to applying improvement methods in a hospital setting as well as guidance on improving performance specifically on the AHRQ QIs.

Improving quality of care in the inpatient setting requires a solid foundation of skills to manage organizational change, communicate effectively within and across divisions, generate usable information, and identify and implement appropriate changes in clinical care delivery.

The QI Toolkit is designed to help hospitals refine these skills and to serve as a how-to guide through the improvement process, from the first stage of self-assessment to the final stage of ongoing monitoring.

New in the 2016 Update of the AHRQ QI Toolkit

  • Updated content to partially address the transition from ICD-9 to ICD-10, including updated documentation and coding practices.
  • Guidance that can be used to improve pediatric quality in hospitals using the PDIs or other quality measures.
  • A new presentation template for engaging staff in improvement efforts.
  • Case studies of two hospitals that have successfully used the QI Toolkit.

The QI Toolkit supports improvement of the AHRQ QIs as well as other hospital quality measures.  The tools are practical and designed to meet the needs of hospital leadership and quality improvement teams. Individual tools are grouped into the following six steps A through F, followed by a general resources section:

  1. Assessing Readiness To Change. Includes: fact sheets on the QIs, a board presentation template, a survey to self-assess readiness to change, and case studies of QI Toolkit users.
  2. Applying QIs to Your Hospital’s Data. Includes: software instructions to calculate the QI rates and tips for coding and documentation.
  3. Identifying Priorities for Quality Improvement. Includes: a prioritization worksheet, an example of a completed worksheet, and a presentation template aimed at engaging staff in the improvement process.
  4. Implementing Evidence-Based Strategies To Improve Clinical Care. Includes: 25 indicator-specific best practices, a project charter, a gap analysis, and an implementation plan.
  5. Monitoring Progress and Sustainability of Improvements. Includes: a guide to support staff in tracking trends and monitoring progress for sustainable improvement.
  6. Analyzing Return on Investment. Includes: a step-by-step method for calculating the return on investment for an intervention implemented to improve performance on an AHRQ QI, and a case study of return on investment calculated by a hospital.
  7. Other Quality Improvement Resources. Includes: an annotated list of related quality improvement guides and tools.

The QI Toolkit serves as an "inventory" from which hospitals can select those tools that are most appropriate for their current quality improvement priorities and capabilities.  Each of the tools is—by design—adaptable to the needs of an individual hospital.

Download the QI Toolkit

The tables below list all of the resources available in the QI Toolkit. You can download the tools one at a time or altogether in a PDF or ZIP file.

  • To download the entire QI Toolkit, use this file [ PDF file PDF -11.35 MB]
  • To download sections of the toolkit, use this file [ compressed file archive Zipped - 17.11 MB]

Note: PDF files are accessible.

Section A: Assessing Readiness To Change

Tool Description Format
A.1. Introduction to the QI Toolkit Includes this introduction to toolkit (A.1) and fact sheets on AHRQ Quality Indicators (A.1a, A.1b, A.1c) Introduction PDF [PDF file - 67.33 KB]
IQI Fact Sheet PDF [PDF file - 61.98 KB]
PSI Fact Sheet PDF [PDF file - 230.74 KB]
PDI Fact Sheet PDF [PDF file - 217.67 KB]
A.2. Board PowerPoint Presentation on the AHRQ Quality Indicators Includes PowerPoint presentation to introduce project to the hospital board and/or senior leadership PDF [PDF file - 4 MB]
PPT [152.63 KB]
A.3. Getting Ready for Change Self-Assessment Includes survey to assess leaders' perspectives on organizational readiness PDF [PDF file - 320.25 KB]
Word [56.52 KB]
A.4. Case Studies of Improvement Implementation Includes two case studies of how hospitals used the QI Toolkit PSI Case Study PDF [PDF file - 40.28 KB]
PDI Case Study PDF [PDF file - 34.97 KB]

Section B: Applying QIs to Your Hospital's Data

Tool Description Format
B.1. Applying the AHRQ Quality Indicators to Hospital Data Includes instructions for performing calculations to identify current QI rates in your hospital PDF [PDF file - 528.36 KB]
B.2. IQI, PSI, and PDI Rates Generated by SAS QI (B.2a) and Windows QI (B.2b) Software Includes example output from both software packages SAS PDF [PDF file - 271.7 KB]
Windows PDF [PDF file - 344.66 KB]
B.3. Excel Worksheets for Charts on Data, Trends, and Rates To Populate the PowerPoint Presentation Instructions; PowerPoint Presentation: The AHRQ Quality Indicators, Results, and Discussion of Data Analysis Includes instructions on how to use Excel worksheets to produce charts based on your hospital's data and a PowerPoint presentation template Instructions PDF [PDF file - 194.43 KB]
Charts for Presentation Excel [81.45 KB]
Presentation PDF [PDF file - 643.44 KB]
PPT [140 KB]
B.4. Documentation and Coding for AHRQ Quality Indicators Includes strategies for addressing documentation and coding issues PDF [PDF file - 505.32 KB]
B.5. Assessing Indicator Rates Using Trends and Comparators Includes guidance for conducting trend and comparator analysis PDF [PDF file - 232.84 KB]

Section C: Identifying Priorities for Quality Improvement

Tool Description Format
C.1. Prioritization Worksheet and Instructions Includes Excel spreadsheet to assist in prioritizing selection of indicators Instructions PDF [PDF file - 247.49 KB]
Worksheet PDF [PDF file - 218.74 KB]
Excel [34.81 MB]
C.2. Prioritization Worksheet Example Includes an example of a completed prioritization worksheet PDF [PDF file - 391.44 KB]
Excel [208.32 KB]
C.3. Staff Engagement Presentation Includes a PowerPoint presentation template that can be used to engage frontline and other staff PDF [PDF file - 2.09 MB]
PPT [140.34 KB]

Section D: Implementing Evidence-Based Strategies To Improve Clinical Care

Tool Description Format
D.1. Improvement Methods Overview Includes an overview of the steps in a quality improvement process PDF [PDF file - 583.5 KB]
PPT [94.07 KB]
D.2. Project Charter Includes a charter to help you define the implementation team, goals, and measures of progress for your improvement project PDF [PDF file - 257.24 KB]
Word [41.61 KB]
D.4. Selected Best Practices and Suggestions for Improvements Includes introduction to the indicator-specific best practices and detailed information on best practices for selected indicators Introduction PDF [PDF file - 248.26 KB]
PSI03 Pressure Ulcer PDF [PDF file - 327.07 KB]
PSI05 Foreign Body PDF [PDF file - 133.68 KB]
PSI06 Pneumothorax PDF [PDF file - 130.62 KB]
PSI07 Central Venous Catheter-Related Bloodstream Infections PDF [PDF file - 150.03 KB]
PSI08 Postoperative Hip Fracture PDF [PDF file - 126.7 KB]
PSI09 Postoperative Hemorrhage PDF [PDF file - 76.1 KB]
PSI10 Postoperative Derangement PDF [PDF file - 85.99 KB]
PSI11 Postoperative Respiratory Failure PDF [PDF file - 55.55 KB]
PSI12 Perioperative Pulmonary Embolism or DVT PDF [PDF file - 136.84 KB]
PSI13 Postoperative Sepsis PDF [PDF file - 78.65 KB]
PSI14 Postoperative Wound Dehiscence PDF [PDF file - 137.17 KB]
PSI15 Accidental Puncture or Laceration PDF [PDF file - 115.46 KB]
PSI18-19 Obstetric Trauma Rate PDF [PDF file - 61.59 KB]
IQI: Mortality Review PDF [PDF file - 115.84 KB]
PDI01 Accidental Puncture PDF [PDF file - 61.67 KB]
PDI02 Pressure Ulcer PDF [PDF file - 109.89 KB]
PDI03 Foreign Body PDF [PDF file - 95.97 KB]
PDI05/NQI01 Iatrogenic Pneumothorax PDF [PDF file - 79.92 KB]
PDI06 Pediatric Heart Surgery PDF [PDF file - 74.18 KB]
PDI08 Perioperative Hemorrhage PDF [PDF file - 81.05 KB]
PDI09 Postoperative Respiratory Failure PDF [PDF file - 270.49 KB]
PDI10 Postoperative Sepsis PDF [PDF file - 286.81 KB]
PDI11 Postoperative Wound Dehiscence PDF [PDF file - 253.23 KB]
PSI12 Central Venous Catheter-Related Bloodstream Infections PDF [PDF file - 343.33 KB]
NQI03 Neonatal Blood Stream Infection PDF [PDF file - 331.63 KB]
D.5. Gap Analysis Includes a tool to help you understand how your organization's practices align with best practices to identify potential areas for improvement PDF [PDF file - 210.19 KB]
Word [45.73 KB]
D.6. Implementation Plan Includes a tool to help plan and monitor steps needed to begin implementation PDF [PDF file - 255.73 KB]
Word [48.81 KB]
D.7. Implementation Measurement Includes an example of how to monitor progress once implementation has begun PDF [PDF file - 254.66 KB]
Word [54.81 KB]
D.8. Project Evaluation and Debriefing Includes a tool to assist in evaluating the implementation process and identifying areas in need of further improvement PDF [PDF file- 205.42 KB]
Word [45.58 KB]

Please note that the D.3 tool no longer exists, but we have kept the existing numbering for the remaining tools.

Section E: Monitoring Progress and Sustainability of Improvements

Tool Description Format
E.1. Monitoring Progress for Sustainable Improvement Includes a tool to assist with planning for ongoing examination of processes and outcomes for continuous improvement PDF [PDF file - 231.96 KB]

Section F: Analyzing Return on Investment

Tool Description Format
F.1. Return on Investment Estimation Includes a step-by-step method for calculating return on investment (ROI) for an intervention aimed at improving performance on an AHRQ QI and an example ROI calculation PDF [PDF file - 464.46 KB]
Word [127.59 MB]

Section G: Other Quality Improvement Resources

Tool Description Format
G.1. Available Comprehensive Quality Improvement Guides Includes an annotated list of related comprehensive quality improvement guides PDF [PDF file - 208.23 KB]
G.2. Specific Tools To Support Change Includes an annotated list of other related quality improvement tools and resources PDF [PDF file - 320.31 KB]
Page last reviewed July 2016
Internet Citation: Toolkit for Using the AHRQ Quality Indicators. Content last reviewed July 2016. Agency for Healthcare Research and Quality, Rockville, MD.