Overview
Agency for Healthcare Research and Quality (AHRQ) Indicators
The Deficit Reduction Act (DRA) of 2005 authorized the Secretary of Health and Human Services to expand the number and types of inpatient quality measures in the Hospital Inpatient Quality Reporting (IQR) Program. To improve the quality of our nation's hospitals and in response to the authority granted by the DRA, the Centers for Medicare & Medicaid Services (CMS) adopted Patient Safety and Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality (AHRQ) for the IQR Program.
The AHRQ Patient Safety Indicators (PSIs) reflect quality of care for adults inside hospitals and focus on potentially avoidable complications and iatrogenic events. The AHRQ Inpatient Quality Indicators (IQIs)* also reflect quality of care for adults inside hospitals and include inpatient mortality for selected medical conditions and procedures, measures of procedure volume, and measures of appropriate utilization.
The AHRQ measures were developed by a team of clinical and statistical experts from around the country, and most of the measures have also been endorsed by the National Quality Forum (NQF), a voluntary standard-setting, consensus-building organization representing providers, consumers, purchasers, and researchers.
2013 Public Reporting on Hospital Compare Update
The AHRQ measures are normally updated annually in July. However, in 2013, CMS anticipates updating the AHRQ measures in either the October or December release of its Hospital Compare consumer website. CMS is waiting to receive additional data needed for these calculations.
July 2012 Public Reporting on Hospital Compare
CMS publicly reported seven AHRQ measures on its Hospital Compare consumer website in July 2012. Calculations for 2012 public reporting are based on discharges from July 2009 through June 2011 and use Version 4.3 of the AHRQ software.
2012 Public Reporting Update
CMS identified an issue with the AHRQ Patient Safety Indicator (PSI) results in the preview reports released on May 1, 2012. For a small number of hospitals, due to an issue with the rounding of the confidence intervals surrounding AHRQ smoothed rates, one or more performance categories were assigned incorrectly. Hospitals affected by this issue did not receive a Hospital-Specific Report (HSR) during the first week of the preview period (May 1, 2012 – May 4, 2012). If your facility received an HSR during the first week of the preview period, you were not impacted by this issue. Hospitals that were impacted by this issue were contacted and received corrected HSRs by May 10, 2012, and corrected preview reports at a later date.
Additionally, AHRQ identified a difference between the SAS® and WinQI® implementation of the numerator inclusion and denominator exclusion logic that impacted cases flagged for PSI-11 Postoperative Respiratory Failure in version 4.3 of the Quality Indicator software. The issue affected the number of discharges, the rates, and the interval estimates for PSI-11. These data were suppressed (reported as N/A - ‘Not Available’) for all hospitals during July 2012 public reporting in the downloadable database on Hospital Compare. This issue, however, did not affect most hospitals’ performance categories. The performance categories included in the preview report and HSRs during the May 2012 preview period were publicly reported on Hospital Compare in July 2012 for most hospitals. This issue did, however, affect performance categories for PSI-11 for nine hospitals. These nine hospitals were contacted, and CMS suppressed the PSI-11 performance categories for these hospitals.
These issues also affected the national and state performance category counts for the AHRQ PSI measures provided in all hospitals’ preview reports and HSRs, and the PSI-11 national rate provided in all hospitals' HSRs and the mock HSR posted on QualityNet. Please disregard the U.S. national rate for PSI-11 provided in the HSRs and the mock HSR. Updated national and state performance category counts are provided in documents available at Hospital-Specific Reports.
For questions, contact AHRQmeasuresforIQR@mathematica-mpr.com.
* Updated IQI results were unavailable in July 2012 due to an error that AHRQ uncovered in the Limited License version of the 3M™ APR-DRG Grouper associated with its software, leading to inaccurate IQI results. As a result, CMS did not update AHRQ’s IQI measure results on Hospital Compare for the July 2012 public reporting period and reports that the results for these measures are “Not Available” for all hospitals.