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Inpatient Quality IndicatorsInpatient Quality Indicators (IQIs) developed by the Agency for Healthcare Research and Quality[1] are measures that screen for potential problems with quality of care and identify the need for further investigation. The IQIs use a three-tiered approach to measuring quality:
1. Volume Indicators: Volume is an indirect measure of quality. Volume indicators simply count the number of admissions in which a certain procedure was 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.
3. Utilization Indicators: This 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 rate is desirable.
IQI measures for a single year provide 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). 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.
Rates of these complications for a single year at a hospital can provide a snapshot view of 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). This longitudinal perspective may identify models for excellence or areas that could benefit from quality improvement initiatives.
Last year’s Quality Report provided comparisons of Vermont IQI rates to the northeast and national statistics. The report also highlighted specific hospitals that were significantly above or below the state average rate. This year, the Quality Report incorporates another year of data (2007) to provide an update on these measures.
Click on the type of inpatient measure set below for detailed findings
Volume and Mortality Indicators
In-hospital Mortality Indicators
Utilization Indicators
General Findings
Little changed from previous analysis presented in last year’s Quality Report. None of the volume or utilization indictors showed a significant difference in 2007. Although none of the mortality indicators showed a significant change in 2007, it is interesting to note that the national rate of mortality decreased for seven of the nine mortality indicators, while the Vermont mortality rate remained unchanged.
Four of the utilization indicators are presented geographically, so comparisons can be made between Vermont counties. Three of these four indicators experienced a significant increase in 2007. This increase can likely be explained by the inclusion of out-of-state hospitalizations of Vermonters in the 2007 dataset. In previous years, Vermont residents hospitalized in New Hampshire, Massachusetts, or New York were not included in the data analysis. The 2007 data presents a more complete description of the IQIs in Vermont by including these out-of-state hospitalizations. The addition of these data points has a considerable impact on the county rates for hospitalization, particularly in counties adjacent to a large out-of-state hospital. Many of the differences between 2006 and 2007 results can be attributed to having a complete data set of hospitalizations for Vermont residents.
Recommendations
These indicators are most suited to “flag” or identify potential quality issues or patterns of excellence. For providers and/or communities with trends of less than favorable performance on these measures, they may provide direction for future research and examination of the provider community as well as external influential factors such as patient support system, socio-economic and psycho-social factors.
These measures should continue to be monitored. Hospitals experiencing trends of increasing rates should conduct further investigation for possible explanations and evaluation of the quality of care.
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 adoption of excellence at other facilities or in other communities.
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, and unlike previous years, the 2007 data includes Vermonters treated at out-of-state hospitals in New Hampshire, New York, and Massachusetts, as well as patients treated in-state. As such, provider-level indicators present services provided at Vermont hospitals (regardless of residence) and county-level indicators present services provided to Vermonters (regardless of hospital).
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