Evaluation of the Use of AHRQ and Other Quality Indicators

Table 6.2. Suggested Improvements to the Current AHRQ QIs

Number (percent) of interviewees making the recommendation Recommendation
27 (50%) Develop indicator specifications that rely on incorporating additional data elements with the administrative data (including present-on-admission flag, do not resuscitate order flag, clinical data elements, etc.)
13 (24%) Perform validation studies
12 (22%) Develop composite indices
12 (22%) Improve risk adjustment (alignment with other indicator system, non-proprietary system)
7 (13%) Add more analytic tools to the software, such as various levels of significance testing
5 (9%) Improve identification of "avoidable" admissions using secondary diagnoses or other methods
12 (22%) Develop composite indices
12 (22%) Improve risk adjustment (alignment with other indicator system, non-proprietary system)
7 (13%) Add more analytic tools to the software, such as various levels of significance testing
5 (9%) Improve identification of "avoidable" admissions using secondary diagnoses or other methods
5 (9%) Improve obstetric PSIs
5 (9%) Periodically assess the applicability of some of the IQIs to the inpatient setting, in particular for procedures that are now mostly done on an outpatient basis, like laparoscopic cholecystectomy
4 (7%) Provide guidance on how to perform trend analysis over time given changes in indicator definitions
3 (6%) Provide guidance on appropriate coding of source of admission
2 (4%) Adapt PQIs for hospital-level analyses
2 (4%) Calculate and disseminate cost-effectiveness of quality improvement using each indicator
1 (2%) Assume Poisson distribution for counts of infrequent events rather than normal distribution
1 (2%) Change smoothing procedure for PSIs so results are not over-smoothed
1 (2%) Develop a common minimum set of checks of data quality ("common minimum edits")
1 (2%) Develop open-source methods for probabilistic data linkages
1 (2%) Exclude cancer patients from failure to rescue indicator
1 (2%) Exclude patients transferred in from another hospital from all indicators
1 (2%) Improve handling of zero numerator events
1 (2%) Improve risk adjustment for IQI 33—it groups women 18 and younger and women 35 and older together despite the fact that the different groups have different risks
1 (2%) Provide PSIs for all ages—not split pediatric/adult
1 (2%) Study how coding practices vary across hospitals

Source: RAND analysis of interview responses.

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Page last reviewed October 2014
Internet Citation: Table 6.2. Suggested Improvements to the Current AHRQ QIs. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/qualityindicators/tab6-2.html