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Measuring Quality of Care Using a Family of Scientific IndicatorsMeasuring the quality of healthcare is complex. Even with clearly defined goals and criteria often times the crux of the problem is the availability of the right data. Special purpose data collection is time consuming and expensive and requires a well designed research study. Administrative data are easily attainable but not always suited for answering the research questions at hand. The Agency for Healthcare Research and Quality[1] (AHRQ) has developed a suite of standardized measures to assess quality of care using administrative data sources. These measures are not flawless, but these types of measures afford researchers the ability to identify potential problem areas for more intensely designed research studies. The 2009 Quality Report presents an update on the AHRQ measures (first presented in last year’s Quality Report) by incorporating another year of data and providing an overview of important changes and trends.
AHRQ developed these measures to identify apparent variations in the quality of inpatient and outpatient care. These Quality Indicators (QIs) are organized into four modules: Prevention Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs). These indicators are rigorous, standardized measures with an assessment of the overall population and, where appropriate, regional and national comparisons.
General Findings
In general, findings are very similar to those presented in last year’s Quality Report. Trends in Vermont remain stable. Trending these QIs is particularly important in Vermont where measures based on small numbers can make performance appear erratic even though there is no statistical difference.
Rates of hospitalization, particularly for the Prevention Quality Indicators which report hospitalizations for ambulatory sensitive conditions are considerably lower than national rates. The Prevention Quality Indicators (preventable hospitalizations) illustrate some considerable county-level changes from those published last year. This is primarily explained by the fact that the 2007 hospital discharge data set captures hospitalizations for all Vermonters, including individuals receiving care in out-of-state hospitals. Out-of-state hospital stays for Vermonters were not available in earlier data sets.
Recommendations
These indicators are most suited to identify potential quality issues or patterns of excellence. Providers and/or communities with trends of less than favorable performance on these measures may direct future research of the provider community as well as external influential factors such as a patient’s support system, socio-economic and psycho-social factors.
Data and Methodology
The AHRQ indicators use administrative hospital discharge data as a window into the delivery of medical care. These data, which are collected as a routine step in the delivery of hospital services, provide information on diagnoses, procedures, age, gender, admission source, and discharge status. Although administrative data alone cannot provide a complete assessment of quality, they can be used to identify potential quality problems or “flag” areas of excellence which can then be further investigated and studied, either to address needed improvements or to assist adaption of excellence at other facilities or in other communities. In general, quality measures typically employ one of three lenses to view care: 1) missed opportunities or under-care; 2) excessive use of services or over-care; and 3) misuse or errors.
The 2009 Quality Report presents analyses of hospital discharge data from 2002 - 2007. This extends and updates the measures reported in last year’s Quality Report. Incorporating the additional year of data (2007) allows further examination of trends.
Chapter Outline
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