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about modifications and enhancements to the AHRQ QIs and other information related to the QIs, such as the availability of new QIs, revisions to the software and related tools, and publications, reports, and other related news.

(AHRQ QIs) are standardized, evidence-based measures of healthcare quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes. AHRQ QIs provide healthcare decision makers, such as program managers, researchers, and others at the Federal, State, and local levels, with tools to assess their data, highlight potential quality concerns, identify areas for further study and investigation, and track changes over time. AHRQ QIs are available via free software distributed by AHRQ. The QIs are reported at two levels: Hospital and Area.

At the hospital level, the QIs are used to support internal quality improvement, monitoring, and assessment of adverse events related to patient safety. These indicators reflect quality of care inside hospitals, such as potentially avoidable complications and iatrogenic events; inpatient mortality for certain procedures and medical conditions; and procedures that may involve overuse, underuse, or misuse.

At the area level, the QIs are used to identify access to outpatient care, which includes appropriate postdischarge followup care. Although these indicators are based on hospital inpatient data, they provide insight into the health of the community and the community-based healthcare system. These indicators identify hospital admissions that evidence suggests might have been avoided through access to high-quality outpatient or preventive care.

Area-level QIs can be used as a "screening tool" to help flag potential healthcare access problems or concerns about population health. They can also help public health agencies, State data organizations, healthcare systems, and others interested in improving healthcare quality in their communities to identify and investigate communities that may need interventions.

These various tools support development of trend and benchmark information for comparing a given hospital’s current performance on the QI rates with its previous years (trending) and with national benchmarks.

Quality Indicator Modules

The AHRQ QIs include four modules: Prevention Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs).

Prevention Quality Indicators (PQIs) are population-based indicators that capture all cases of potentially preventable complications that occur in a given population either during a hospitalization or in a subsequent hospitalization. PQIs can be used to identify admissions that might have been avoided through access to high-quality outpatient care.

The PQIs use administrative data found in a typical hospital discharge abstract to flag potential healthcare quality problem areas that need further investigation. In addition, they provide a quick check on primary care access or outpatient services in a community and help organizations identify unmet needs in their communities.

Inpatient Quality Indicators (IQIs) help hospitals assess quality of care inside the hospital and identify areas that might need further study. The IQIs provide a perspective on quality of care inside hospitals, including inpatient mortality for surgical procedures and medical conditions and utilization of procedures for which there are questions of overuse, underuse, and misuse.

Patient Safety Indicators (PSIs) help hospitals assess the incidence of adverse events and in-hospital complications and identify issues that might need further study. PSIs provide information on potentially avoidable safety events that represent opportunities for improvement in care delivery. More specifically, they focus on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.

Pediatric Quality Indicators (PDIs) help detect issues in pediatric hospital care that may need further study. They can also be used to evaluate preventive care for children in outpatient settings by identifying potential quality and patient safety issues specific to the pediatric inpatient population. PDIs focus on potentially preventable complications and iatrogenic events for pediatric patients treated in hospitals and on preventable hospitalizations among pediatric patients, taking into account the special characteristics of the pediatric population.

Quality Indicator Products

AHRQ QI Software: AHRQ’s free software ( and ) can be used to calculate AHRQ QI rates and to help generate accurate and actionable results. Use of this software ensures a standard, trusted approach to quality measurement and means more resources are available to support patient care improvements.

QI Toolkit: The for Using the AHRQ Quality Indicators (QI Toolkit) is a free and easy-to-use resource for hospitals planning to use the AHRQ QIs to track and improve inpatient quality and patient safety. The QI Toolkit also may serve as a general guide to applying improvement methods in a hospital setting. Hospitals can select the most appropriate tools for their current quality improvement priorities and capabilities, and each tools can be adapted to an individual hospital’s needs.

The tools are organized by the six quality improvement process steps:

• Assessing Readiness To Change.
• Applying QIs to Your Hospital’s Data.
• Identifying Priorities for Quality Improvement.
• Implementing Evidence-Based Strategies To Improve Clinical Care.
• Monitoring Progress and Sustainability of Improvements.
• Analyzing Return on Investment.

ROI Tool: The Return on Investment Estimation (ROI) tool is for examining anticipated financial outcome data, thus supporting hospital and health system leadership in making more informed decisions when prioritizing resources for quality improvement initiatives. This tool provides a step-by-step method for calculating ROI for a new set of actions implemented to improve performance on one or more AHRQ QIs. Potential users of this tool include individuals who will contribute to ROI calculations, which may include hospital or health system financial, quality, or analytic staff, as well as statisticians, data analysts, and programmers.

Pediatric Toolkit: The Pediatric QI Toolkit is a standalone pediatric version of the QI Toolkit that meets the needs of hospitals that serve children. It includes a concise set of tools to facilitate efforts to improve clinical quality and can be used to improve performance on PDIs and other measures of inpatient pediatric quality. It contains the same six steps as the QI Toolkit, including materials that improvement teams can use to identify and catalog quality and patient safety concerns, educate clinical leaders and staff, and home in on priorities. It also includes 13 indicator-specific best practices for improving performance on the PDIs.

More Information

• AHRQ QI Technical Assistance: QISupport@ahrq.hhs.gov or (301) 427-1949.

AHRQ QI Publications

• AHRQ QI Quality Improvement .
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