 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Shulamit Bernard, PhD, Lucy A Savitz, PhD, MBA, and Erica R Brody, MPH. Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709
The Agency for Healthcare Research and Quality (AHRQ) developed and recently released a set of user-friendly Quality Indicators that were developed as part of a major AHRQ initiative to update and encourage the use of the Health Care Cost and Utilization Project (HCUP) indicators that were originally developed in the 1980s. The indicators are made available in three sets. This research focuses on the first set released—the Prevention Quality Indicators (PQI). RTI, in collaboration with clinicians and researchers at Intermountain Health Care, Providence Health System, and UPMC Health System, examined potential measurement issues associated with 16 PQIs, using information not available from administrative data. A cross-sectional analysis for the 3-year time period, 1998-2000 was completed using administrative data for all inpatient discharges in Utah, Oregon, and Pennsylvania. Comparative analyses involved descriptive statistics and spatial analyses whereby operational and case mix data were contrasted with PQIs generated by the AHRQ modules. Various graphical displays are used to support these analyses. Within the context of the RTI study, we provide: (1) A rationale for using the PQIs by specific types of users—health services researchers, state oversight agencies, and health care systems and plans; (2) discussion of four specific measurement issues identified; (3) an example application using iterative GIS analyses; and (4) a discussion of limitations. Specifically, we describe the following potential threats to the validity of the PQI indicator rates: the exclusion of observation stay and emergency department utilization in the calculation of the rates; regionalization of services that may compromise the validity of the population denominators used by the indicators (i.e., MSA), implications of alternative rate denominator choices, and discrepancies between coding requirements of the modules used to construct the indicators and the coding practices used by integrated delivery systems.
The AHRQ PQI Indicators are a valuable tool with multiple applications in regulatory oversight, public health, health services research, health care administration, and quality improvement. Care should be taken, nevertheless, to integrate knowledge of identified measurement issues associated with these indicators when developing and interpreting explanatory models and monitoring tools. The Prevention Quality Indicators (PQIs) use administrative data for inpatient care services and are intended to highlight patterns or trends in prevention and inpatient quality indicators. In doing so, they are available to assist health care decision makers in assessing the effects of program interventions and policy actions as well as accurately measuring access to, utilization of, and cost of care.
Learning Objectives:
Keywords: Quality Improvement, Medical Care
Related Web page: www.ahrq.gov/data/hcup/qinext.htm
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.