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| The Vermont Health Care Quality Report 2008 |
Ch2: Measuring Quality of Care Ch3: Chronic Illness in Vermont
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Inpatient Quality Indicators
(click for printable PDF) The Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are a tool that takes advantage of hospital administrative data to identify potential quality problems and identify the need for further investigation. The IQIs use three separate approaches to measuring quality: 1. Volume Indicators. Volume is an indirect measure of quality. Volume indicators simply count the number of admissions in which certain procedures were performed. These indicators are based on evidence suggesting that hospitals performing more of certain intensive, high-technology, or highly complex procedures may have better outcomes for those procedures; 2. In-Hospital Mortality Indicators. These measures examine outcomes following procedures and for common medical conditions; and 3. Utilization Indicators. This third approach examines procedures for which questions have been raised about overuse, underuse, and misuse. High or low rates may likely represent inappropriate or inefficient delivery of care. The reader is advised whether a high or low rates is desirable. Examining rates for a single year provides a snapshot view into hospital performance. Trending these indicators over time, affords the ability to assess whether observed differences are likely the result of normal variation (i.e., rates differ from average in a single year) or if observed differences reflect a pattern (i.e., rates differ from average for longer periods of time). Subsequently this longitudinal perspective may lead to the identification of hospitals as a model of excellence or quality of care areas that may benefit from quality improvement initiatives. Volume and Mortality Indicators for Inpatient Procedures For some complex procedures there is evidence to suggest that better outcomes may be associated with hospitals where doctors perform procedures regularly. Where possible, volume indicators should be evaluated with the mortality indicator for the same procedure. Better quality may be associated with higher volume and lower mortality rates.
The above six volume and mortality indicators are also presented as part of Vermont’s Hospital Report Card (www.vthospitalreportcards.info) maintained by the Health Care Adminstration. Mortality Indicators for Inpatient Conditions Rates are the percentage of patients who died at a hospital while being treated for each condition. Better quality of care may be associated with lower mortality rates. While these indicators present risk-adjusted rates, not all relevant factors are included in the risk-adjustment. Patient preference, for example, cannot be taken into account. Hospitals providing more hospice care or end of life care, may appear to have higher mortality. Results should be interpreted cautiously.
Utilization Indicators These indicators examine procedures for which questions have been raised about overuse, under use, or misuse. While there is no “correct” volume for performing these procedures, high or low rates may raise questions about the use of these procedures. The reader is directed whether a high or low rate is desirable for each indicator.
Laparoscopic Cholecystectomy is a procedure routinely performed on an outpatient basis. These outpatient procedures are not captured using the data currently available. The following indicator is not presented because results are misleading without the ability to include outpatient procedures. For the following inpatient procedures, rates are presented using a population-based denominator. While there is no “correct” volume for performing these procedures, high or low rates may raise questions about the use of these procedures.
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