Major Hospital Quality Measurement Sets

The list of valid and reliable indicators of inpatient quality of care continues to grow and evolve as measures are refined, introduced, and retired. The National Quality Forum has endorsed nearly 200 measures in the inpatient setting, many of which are used for public reporting. This page highlights a few of the measurement sets that are typically used in reports for consumers.

• Hospital Inpatient Quality Reporting Program Measures.
• AHRQ Quality Indicators.
• ORYX®.
• CAHPS Hospital Survey.
• The Leapfrog Group’s Measures.

Hospital Inpatient Quality Reporting Program Measures

The Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program uses a variety of measures for public reporting on its Care Compare website, for value-based purchasing, and to encourage improvements in the quality of inpatient care. These measures include indicators of patient safety, clinical process of care, patient experience of care (see “CAHPS Hospital Survey” below), maternal morbidity, mortality outcomes, coordination of care, and payment for specific diagnoses.

Data Source: The data for these measures is reported by individual hospitals to CMS. Scores from the Hospital Inpatient Quality Reporting Program are published on the CMS Care Compare website. 

AHRQ Quality Indicators

The AHRQ Quality Indicators (Qis) comprise four measure areas: inpatient, prevention, patient safety, and pediatric care. The measures were originally developed for quality improvement, pay-for-performance, and public health monitoring. The following indicator sets are considered appropriate and useful for public reports as well:

• The Inpatient Quality Indicators (IQIs) capture quality of care inside hospitals. They include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality.
• The Patient Safety Indicators (PSIs) identify adverse events occurring during hospitalization. They provide information on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.
• The Pediatric Quality Indicators (PedQIs) include measures of inpatient quality and patient safety specifically for the pediatric population.

Users of the AHRQ Qis can combine some of the individual indicators into composite measures to provide a more “global” assessment of hospital performance.

Data Source: The AHRQ Qis use inpatient administrative data that is available from individual hospitals, a statewide association or data organization, or a State agency. Another source of administrative data for populating the AHRQ Qis measures is the Healthcare Cost and Utilization Project (HCUP).

ORYX®

ORYX is a set of performance measures required by The Joint Commission. Hospitals seeking accreditation from The Joint Commission must submit some combination of ORYX measures to fulfill the requirements; the measures are also meant to support organizations in their quality improvement efforts.

Data Source: The Joint Commission's Quality Check®, a free public quality report, indicates whether the hospital is accredited and lists clinical services that have been awarded core or advanced certification based on the reported data.

CAHPS Hospital Survey—Adult Version

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey, commonly known as Hospital CAHPS or HCAHPS, is a standardized survey instrument for measuring adult patients' perspectives on care they experience during a hospital stay. HCAHPS addresses critical aspects of the hospital experience, including:

• Communication with doctors and with nurses.
• Responsiveness of hospital staff to patients' needs.
• Hospital cleanliness and quietness.
• Communication about medicines.
• Discharge information and patients' understanding of care when leaving the hospital.

Patients are also asked to rate the hospital overall and their willingness to recommend the hospital to others.

Download the CAHPS Hospital Survey and learn more about its implementation.

Data Source: Scores from the CAHPS Hospital Survey are available from the Care Compare website.

CAHPS Child Hospital Survey

The CAHPS Child Hospital Survey is a standardized survey instrument that asks about the experiences of pediatric patients and their parents or guardians with inpatient care. This survey asks about various aspects of patient experience that are important to children and their parents/guardians; the 16 measures cover the following four topics:

• Communication with the parent.
• Communication with the child.
• Attention to safety and comfort.
• Hospital environment.

Respondents also provide an overall rating and indicate their willingness to recommend the hospital.

Data Source: Survey scores are available from the hospitals administering this survey. The Agency for Healthcare Research and Quality publishes aggregated scores for hospitals participating in the CAHPS Child Hospital Survey Database.

The Leapfrog Group's Measures

The Leapfrog Group, an employer-based coalition, develops and maintains a measure set that focuses on hospital quality and safety practices. Hospitals voluntarily submit information on the extent to which they adhere to certain quality and safety practices using the Leapfrog Hospital Survey tool.

The Leapfrog measures address crucial areas, or “leaps,” such as:

• Do physicians enter prescriptions and other orders into computerized medication systems?
• How many high-risk surgeries are conducted at the hospital?
• How consistently does the hospital provide appropriate care to women giving birth and newborns?
• Are hospital intensive care units (ICUs) staffed by qualified specialists?
• Do hospitals have safety practices and policies advocated by the National Quality Forum to reduce harm and errors?

Data Source: The Leapfrog Group scores the hospital respondent's results and publicly reports the results for free on their website.

Also in "Measures of Hospital Quality"

• Examples of Hospital Quality Measures for Consumers
• Major Hospital Measurement Sets
• Databases Used for Hospital Quality Measures