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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 recommendationRecommendation
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 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