Toolkit for Using the AHRQ Quality Indicators™: Fact Sheet

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) to track and improve inpatient quality and patient safety. 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.

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

One critical factor driving hospitals’ growing interest in the PSIs—and the QI Toolkit—is CMS. The patient safety composite measure, PSI 90, is included in CMS’s Hospital Compare, Hospital Value-Based Purchasing program, and Hospital-Acquired Condition (HAC) Reduction program.

Overview of the AHRQ QIs

The AHRQ QIs consist of four modules, three of which measure hospital quality and safety performance1 which are the focus of the QI Toolkit

  • Patient Safety Indicators (PSIs)—The PSIs are a set of 18 hospital-level indicators of safety-related adverse events following operations, procedures, and childbirth. The PSIs include one composite measure of patient safety (PSI 90).
  • Inpatient Quality Indicators (IQIs)—The IQIs are a set of 28 hospital-level measures of quality for patients 18 years and over. These measures include procedure volume (for procedures for which there is evidence that higher volume is associated with lower mortality), procedure-specific inpatient mortality, condition-specific mortality, and utilization of procedures for which there are questions of overuse, underuse, and misuse. The IQIs include two composite measures of mortality (IQI 90 for selected procedures and IQI 91 for selected conditions).
  • Pediatric Quality Indicators (PDIs)—The PDIs are a set of 16 measures of the quality of pediatric health care. The hospital PDIs reflect the quality of care provided in hospitals and screen for problems that occur while patients are hospitalized as a result of exposure to the health care system. The PDIs include one composite measure of patient safety (PDI 19).

Many of the AHRQ QIs are endorsed by the National Quality Forum.

AHRQ provides free software in both SAS® and Windows that hospitals can use to apply the QIs to their own, readily available discharge data. Both versions of the software include modules for the PSIs, IQIs, and PDIs. A detailed list of indicator specifications, software for calculating the measures, and software documentation are available on the AHRQ Quality Indicators Web site.

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.

What's Available in the AHRQ QI Toolkit

Improving quality of care in the inpatient setting requires a solid foundation of skills to manage organizational change, communicate effectively within and across divisions, transform data into 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.

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 Hospital Data. Includes: software instructions to calculate the QI rates and coding and documentation practices.
  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 interventions to improve performance on an AHRQ QI, and an illustrative example of a return-on-investment calculation.
  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. For more information about each of the tools, visit the AHRQ QI Toolkit Web page.

New in 2016: Pediatric Toolkit for Using the AHRQ Quality Indicators™: How To Improve Hospital Quality and Safety

A standalone pediatric version of the QI Toolkit is available to meet the needs of hospitals that serve children. It includes a concise set of tools to facilitate efforts to improve clinical quality. The Pediatric QI Toolkit contains tools for the same six steps (A through F) noted above, including materials that improvement teams can use to identify and catalogue quality and patient safety concerns, educate clinical leaders and staff, and hone in on priorities. It also includes 13 indicator-specific best practices for improving performance on the AHRQ Pediatric Quality Indicators (PDIs) and a case study of a Toolkit user in a pediatric setting. This new Pediatric QI Toolkit can be used to improve performance on the PDIs as well as other measures of inpatient pediatric quality.

Select for more information about the tools in the Pediatric QI Toolkit.

Questions About the Quality Indicators?

Contact the QI Support Team:

Email: support@qualityindicators.ahrq.gov.
Voice mailbox (toll free): 888-512-6090.

AHRQ QI Email List

Learn about free resources to help users of the AHRQ QIs and Hospital QI Toolkit, including Webinars and podcasts, by registering for the AHRQ QI Email list. Instructions for registering are available.


1. A fourth module consists of the Prevention Quality Indicators, which assess quality of care for ambulatory care-sensitive conditions. Learn more.

Page last reviewed July 2016
Internet Citation: Toolkit for Using the AHRQ Quality Indicators™: Fact Sheet. Content last updated July 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/quality/qifactsheet/index.html