AHRQ Quality Indicators

Excerpt

The AHRQ QIs are one measure set, based on administrative data that can be used to evaluate the quality of clinical services. Most of the QIs focus on health care outcomes rather than rates of processes of care followed. The measures, their extensive documentation, and associated codes for SAS® and Windows® reside in the public domain and are available for download at no cost to the user. Furthermore, the QIs are maintained by AHRQ, which continues to refine and enhance them. Updates to the modules are done on a yearly basis and are routinely released in the first quarter of the year. AHRQ also provides technical support to users on a wide range of issues, including questions about the software package, clarifications of indicator definitions, theoretical questions on the indicators, and interpretation of performance results. The QI support team can be reached via e-mail at support@qualityindicators.ahrq.gov.

Future enhancements to the AHRQ QIs are underway and include the development of indicators specific to neonates, the development of additional indicators in areas such as hospital outpatient care, day surgery, diagnostic procedures, and emergency department care. Other planned improvements include incorporating additional clinical data elements such as lab values and do-not-resuscitate-order flag. Additional research is needed to develop evidence-based outcome measures that are sensitive to nursing practice.

“Quality of care is highly variable and delivered by a system that is too often poorly coordinated, driving up costs, and putting patients at risk.” (p. 1). Improving the access to and the performance of our health care system is a matter of national urgency. Yet, defining what quality is in health care is not easy. Quality is a complex, multidimensional concept that suggests different things to different people., Consequently, competing views of quality should be balanced among patients, purchasers, managers, and health care professionals. A widely used definition of quality in health care is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Regardless of how quality is defined, the only way to know whether the quality of health care is improving is to measure the performance of those that deliver it. Performance measures and performance measurement systems provide a tool to determine if quality exists. Currently there is a proliferation of performance measures, and development of these measures shows no sign of abating. While there is a plethora of measures in areas such as cardiac care, there is a dearth or complete lack of measures in other areas such as mental health and cancer care. Better coordination among measure developers is key to reducing the measurement burden of health care organizations. With the adoption of the electronic health record, performance measurement has the potential to become a by-product of care, instead of a distinct data-gathering activity.

The AHRQ QIs are one set of performance measures that cover a broad array of conditions and that use an inexpensive, readily available data source. While these measures do have certain limitations, these measures have been and are being used in a variety of initiatives that have contributed to improved quality of care within the United States.