Table 6.2. Suggested Improvements to the Current AHRQ QIs Evaluation of the Use of AHRQ and Other Quality Indicators Number (percent) of interviewees making the recommendationRecommendation27(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 studies12(22%)Develop composite indices12(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 testing5(9%)Improve identification of "avoidable" admissions using secondary diagnoses or other methods12(22%)Develop composite indices12(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 testing5(9%)Improve identification of "avoidable" admissions using secondary diagnoses or other methods5(9%)Improve obstetric PSIs5(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 cholecystectomy4(7%)Provide guidance on how to perform trend analysis over time given changes in indicator definitions3(6%)Provide guidance on appropriate coding of source of admission2(4%)Adapt PQIs for hospital-level analyses2(4%)Calculate and disseminate cost-effectiveness of quality improvement using each indicator1(2%)Assume Poisson distribution for counts of infrequent events rather than normal distribution1(2%)Change smoothing procedure for PSIs so results are not over-smoothed1(2%)Develop a common minimum set of checks of data quality ("common minimum edits")1(2%)Develop open-source methods for probabilistic data linkages1(2%)Exclude cancer patients from failure to rescue indicator1(2%)Exclude patients transferred in from another hospital from all indicators1(2%)Improve handling of zero numerator events1(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 risks1(2%)Provide PSIs for all ages—not split pediatric/adult1(2%)Study how coding practices vary across hospitalsSource: RAND analysis of interview responses.Return to Document Current as of December 2007 Internet Citation: Table 6.2. Suggested Improvements to the Current AHRQ QIs: Evaluation of the Use of AHRQ and Other Quality Indicators. December 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/qualityindicators/tab6-2.html
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