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Continuous Quality Improvement Tool Released by AHCPR

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Press Release Date: Tuesday, October 13, 1998

The federal Agency for Health Care Policy and Research (AHCPR) today released a free new computer software tool for routine self-assessments of inpatient care and/or evaluation of community access to primary care. AHCPR's Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) can help hospitals assess inpatient outcomes by screening discharge data and identifying clinical areas appropriate for follow-up, in-depth analysis.

"HCUP QIs are ideal for organizations that want to build a hospital quality and primary care access assessment program from the ground up, but lack the necessary resources," said AHCPR Administrator, John M. Eisenberg, M.D. Potential users include individual hospitals and hospital associations, managed care organizations and state and local health agencies.

The new tool was developed in partnership with state hospital associations, state agencies and quality experts. It can be run on microcomputers or mainframes, using SAS or SPSS programs, comes with user-friendly, easy-to-follow instructions, and is designed for use with available hospital discharge data.

The 33 clinical performance measures in HCUP QIs are designed to produce comparable statistics at the hospital, community or state levels along three dimensions of care:

  1. Potentially avoidable adverse outcomes—HCUP QIs calculate nine inpatient mortality rates among low-risk patients undergoing common surgical procedures, such as hip replacement and hysterectomy. Seven complication rates during hospitalization, such as urinary tract infection following major surgery, also are calculated.
  2. Potentially inappropriate utilization of hospital inpatient procedures—HCUP QIs calculate nine utilization rates for procedures for which there are concerns of over- or under-utilization, such as cesarean section deliveries.
  3. Potentially avoidable hospital admissions—HCUP QIs indirectly evaluate access to primary care by identifying eight conditions that may result in hospitalization, such as immunization-preventable pneumonia among the elderly. These are hospitalizations thought to be avoidable when there is adequate access to primary care in the community.

Users are able to compare rates across payer categories, and patient racial or ethnic groups. They also can compare data with groups of similar hospitals, with benchmarks such as Healthy People 2000 targets, or with the experience of a single hospital or group of hospitals tracked over time.

"The purpose of the tool," said Dr. Eisenberg, "is to help hospitals and other organizations take the first step in continuous quality improvement; it is not designed to identify particular hospitals or communities as 'good' or 'bad' performers."

HCUP QIs have been widely field tested and their measures adopted by a number of hospitals, hospital associations, state health departments and other organizations. Users include the Colorado Hospital Association, Maryland Hospital Association, Utah and Washington state health departments, and the Hawaii Health Information Corporation.

To access more detail on the QIs, select the HCUP QI fact sheet.

Version 1.1 software is available as part of a kit: "Outcome, Utilization, and Access Measures for Quality Improvement" (AHCPR 98-0048). Included in the kit are two software diskettes, a fact sheet, software user's guide, methods manual, and a reprint of an article (98-R041), "Quality Indicators Using Hospital Discharge Data: State and National Applications," that was published in the February 1998 issue of the Joint Commission Journal on Quality Improvement. The kit may be obtained by calling or writing the AHCPR Publications Clearinghouse (1-800-358-9295; P.O. Box 8547, Silver Spring, Md. 20907).

The Healthcare Cost and Utilization Project, from which HCUP QIs were developed, is a unique multi-state database of hospital inpatient information developed by AHCPR in partnership with state and private-sector organizations.

For additional information, contact AHCPR Public Affairs: Karen Migdail (301) 427-1855 (; Salina Prasad (301) 427-1864 (

The information on this page is archived and provided for reference purposes only.


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