210 lines
34 KiB
Text
210 lines
34 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK43831">
|
|
<meta name="ncbi_domain" content="techrev4">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK43831/?report=reader">
|
|
<meta name="ncbi_pagename" content="Refinement of the HCUP Quality Indicators - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Refinement of the HCUP Quality Indicators - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="jr-next-unit" content="/books/n/techrev4/toc/?report=reader">
|
|
<meta name="bk-toc-url" content="/books/n/techrev4/?report=toc">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="author" content="Sheryl M Davies, Jeffrey Geppert, Mark McClellan, Kathryn M McDonald, Patrick S Romano, Kaveh G Shojania">
|
|
<meta name="citation_title" content="Refinement of the HCUP Quality Indicators">
|
|
<meta name="citation_publisher" content="Agency for Healthcare Research and Quality (US)">
|
|
<meta name="citation_date" content="2001/05">
|
|
<meta name="citation_author" content="Sheryl M Davies">
|
|
<meta name="citation_author" content="Jeffrey Geppert">
|
|
<meta name="citation_author" content="Mark McClellan">
|
|
<meta name="citation_author" content="Kathryn M McDonald">
|
|
<meta name="citation_author" content="Patrick S Romano">
|
|
<meta name="citation_author" content="Kaveh G Shojania">
|
|
<meta name="citation_pmid" content="20734520">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK43831/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Refinement of the HCUP Quality Indicators">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="Agency for Healthcare Research and Quality (US)">
|
|
<meta name="DC.Contributor" content="Sheryl M Davies">
|
|
<meta name="DC.Contributor" content="Jeffrey Geppert">
|
|
<meta name="DC.Contributor" content="Mark McClellan">
|
|
<meta name="DC.Contributor" content="Kathryn M McDonald">
|
|
<meta name="DC.Contributor" content="Patrick S Romano">
|
|
<meta name="DC.Contributor" content="Kaveh G Shojania">
|
|
<meta name="DC.Date" content="2001/05">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK43831/">
|
|
<meta name="DC.Language" content="en">
|
|
<meta name="description" content="In 1994, the Agency for Healthcare Research and Quality (AHRQ) developed the Healthcare Cost and Utilization Project (HCUP) Quality Indicators (QIs), in response to the increasing demand for information regarding the quality of health care. These measures, based on discharge data, were intended to flag potential quality problems in hospitals or regions. The purpose of this project is to refine the original set of HCUP QIs (HCUP I) and recommend a revised indicator set (HCUP II). Specifically this project aims to 1) identify quality indicators reported in the literature and in use by health care organizations, 2) evaluate both HCUP I QIs and other indicators using literature review and novel empirical methods, and 3) make recommendations for the HCUP II QI set and further research. The project deferred evaluation of indicators of complications to a separate study and report.">
|
|
<meta name="og:title" content="Refinement of the HCUP Quality Indicators">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="In 1994, the Agency for Healthcare Research and Quality (AHRQ) developed the Healthcare Cost and Utilization Project (HCUP) Quality Indicators (QIs), in response to the increasing demand for information regarding the quality of health care. These measures, based on discharge data, were intended to flag potential quality problems in hospitals or regions. The purpose of this project is to refine the original set of HCUP QIs (HCUP I) and recommend a revised indicator set (HCUP II). Specifically this project aims to 1) identify quality indicators reported in the literature and in use by health care organizations, 2) evaluate both HCUP I QIs and other indicators using literature review and novel empirical methods, and 3) make recommendations for the HCUP II QI set and further research. The project deferred evaluation of indicators of complications to a separate study and report.">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK43831/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-techrev4-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/techrev4/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK43831/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8ED9A47D6A56710000000000530040.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK43831/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-rtoc-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK43831/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK43831/&text=Refinement%20of%20the%20HCUP%20Quality%20Indicators"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-rtoc-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Table of Content</div></div><div class="cnt lol f1"><a href="/books/n/hstechrevcollect/?report=reader">AHRQ Technical Reviews</a><a href="/books/n/hstatcollect/?report=reader">Health Services/Technology Assessment Text
|
|
(HSTAT)</a><a class="current">Title Information</a><a href="/books/n/techrev4/toc/?report=reader">Table of Contents Page</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK43831/?report=classic">Switch to classic view</a><a href="/books/n/techrev4/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK43831%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8ED9A47D6A56710000000000530040.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="http://www.ahrq.gov/" title="Agency for Healthcare Research and Quality (US)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-techrev4-lrg.png" alt="Cover of Refinement of the HCUP Quality Indicators" /></a></div><div class="bkr_bib"><h1 id="_NBK43831_"><span itemprop="name">Refinement of the HCUP Quality Indicators</span></h1><p><i>Technical Reviews, No. 4</i></p><p class="contrib-group"><h4>Authors</h4>Core Project Team: <span itemprop="author">Sheryl M Davies</span>, MA, <span itemprop="author">Jeffrey Geppert</span>, JD, <span itemprop="author">Mark McClellan</span>, MD, PhD, <span itemprop="author">Kathryn M McDonald</span>, MM, <span itemprop="author">Patrick S Romano</span>, MD, MPH, and <span itemprop="author">Kaveh G Shojania</span>, MD.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> UCSF-Stanford Evidence-based Practice Center</div><div class="half_rhythm">Rockville (MD): <a href="http://www.ahrq.gov/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">Agency for Healthcare Research and Quality (US)</span></a>; <span itemprop="datePublished">2001 May</span>.<div class="small">Report No.: 01-0035</div></div><div><a href="/books/about/copyright/">Copyright Notice</a></div><a class="btn wsprkl bkr_rd" href="/books/n/techrev4/A549/?report=reader">Read</a></div><div class="bkr_clear"></div></div><div class="bkr_bottom_sep bkr_bottom_margin body-content whole_rhythm"><div itemprop="description"><h2>Structured Abstract</h2><div id="A532"><h4 class="inline">Objectives:</h4><p>In 1994, the Agency for Healthcare Research and Quality (AHRQ) developed the
|
|
Healthcare Cost and Utilization Project (HCUP) Quality Indicators (QIs), in
|
|
response to the increasing demand for information regarding the quality of
|
|
health care. These measures, based on discharge data, were intended to flag
|
|
potential quality problems in hospitals or regions. The purpose of this project
|
|
is to refine the original set of HCUP QIs (HCUP I) and recommend a revised
|
|
indicator set (HCUP II). Specifically this project aims to 1) identify quality
|
|
indicators reported in the literature and in use by health care organizations,
|
|
2) evaluate both HCUP I QIs and other indicators using literature review and
|
|
novel empirical methods, and 3) make recommendations for the HCUP II QI set and
|
|
further research. The project deferred evaluation of indicators of complications
|
|
to a separate study and report.</p></div><div id="A533"><h4 class="inline">Evaluation framework:</h4><p>Potential and current QIs were evaluated according to six criteria:</p><p>Face validity. An adequate QI must have sound clinical and or
|
|
empirical rationale for its use, and measure an important aspect of
|
|
quality that is subject to provider or health care system
|
|
control.</p><p>Precision. An adequate QI should have relatively large variation
|
|
among providers that is not due to random variation or patient
|
|
characteristics.</p><p>Minimum bias. The indicator should not be affected by systematic
|
|
differences in patient case-mix. In instances where such systematic
|
|
differences exist, an adequate risk adjustment system should be
|
|
available based on HCUP discharge data.</p><p>Construct validity. The indicator should be supported by evidence of
|
|
a relationship to quality, and should be related to other indicators
|
|
intended to measure the same or related aspects of quality.</p><p>Fosters real quality improvement. The indicator should not create
|
|
incentives or rewards for providers to improve measured performance
|
|
without truly improving quality of care.</p><p>Application. The indicator should have been used effectively in the
|
|
past, and/or have high potential for working well with other
|
|
indicators currently in use.</p></div><div id="A540"><h4 class="inline">Literature review:</h4><p>Two separate literature reviews were performed using MEDLINE. The first search
|
|
(Phase 1) utilized a structured methodology, designed to locate quality
|
|
indicators developed since 1994 and reported in the literature. The search terms
|
|
used were "hospital, statistic and methods" and "quality indicator." Indicators
|
|
were also identified through web searches and contacts with quality measurement
|
|
experts.A second search (Phase 2) was used to evaluate each indicator according
|
|
to the evaluation framework above. MEDLINE (1990-2001) was searched for relevant
|
|
articles discussing one of the six evaluation framework criterion for selected
|
|
QIs.</p></div><div id="A541"><h4 class="inline">Empirical evaluation:</h4><p>Selected indicators were tested using a series of empirical analyses designed to
|
|
test precision (signal variance, provider- or area-level variance,
|
|
signal-to-noise ratio, and R-square), minimum bias (impact of risk adjustment
|
|
measured by Spearman's rank correlation, percentage remaining in extreme
|
|
deciles, absolute change in performance, and percent changing more than two
|
|
deciles), and construct validity (Pearson correlation and factor analysis). Each
|
|
indicator was assigned a summary score for empirical performance using results
|
|
from the precision, and to a lesser extent bias tests.</p></div><div id="A542"><h4 class="inline">Selection criteria:</h4><p>Due to resource constraints, only a portion of the over 200 identified indicators
|
|
were evaluated comprehensively (all empirical analyses tests and detailed
|
|
literature review). Indicators were selected for comprehensive evaluation based
|
|
on the following criteria: the indicator must have adequate clinical rationale; the measured event must be somewhat frequent and occur in an adequate number of providers or areas; the indicator must perform adequately well on preliminary tests of precision.</p></div><div id="A546"><h4 class="inline">Main results:</h4><p>Forty-five indicators were recommended for use in the HCUP II QI set, including
|
|
volume, mortality, utilization and ambulatory care sensitive condition measures.
|
|
Each indicator is appropriate for use as a "quality screen," meaning as an
|
|
initial tool to identify potential quality problems. These indicators would not
|
|
be expected to definitively distinguish low quality providers or areas from high
|
|
quality providers or areas. The empirical performance of each indicator was
|
|
evaluated; summary empirical scores ranged from 3 to 23 out of a possible 26.
|
|
All indicators are recommended with specific caveats of use, identified
|
|
primarily through literature review. Most volume and utilization indicators are
|
|
best used as proxy measures of quality. Some indicators carry substantial
|
|
selection bias due to the elective nature of some admissions and procedures.
|
|
Other indicators are subject to information bias, due to the inability to track
|
|
post-hospitalization mortality rates. Confounding bias, due to systematic
|
|
differences in case mix, was found to be a concern for some indicators. Further,
|
|
many indicators have limited evidence supporting their construct validity;
|
|
others are somewhat imprecise and require smoothing techniques. Finally, some
|
|
indicators may create perverse incentives for over- or under-utilization..
|
|
Specifics of the caveats of use can be found in the Executive Summary of this
|
|
report. Ten indicators are recommended for use only in conjunction with other
|
|
indicators.</p><p>Twenty-five of the indicators are provider level indicators, meaning that they
|
|
evaluate quality of care at the provider (in this case, hospital) level. These
|
|
indicators include seven procedure volume indicators (AAA repair, carotid
|
|
endarterectomy, CABG, esophageal resection, pancreatic resection, pediatric
|
|
heart surgery, and PTCA), five procedure utilization indicators (Cesarean
|
|
section rate, incidental appendectomy rate, bi-lateral heart catheterization
|
|
rate, VBAC rate, and laparoscopic cholecystectomy rate), six in-hospital medical
|
|
mortality indicators (AMI, CHF, GI hemorrhage, hip fracture, pneumonia and
|
|
stroke), and seven in-hospital provider mortality indicators (AAA repair, CABG,
|
|
craniotomy, esophageal resection, hip replacement, pancreatic resection, and
|
|
pediatric heart surgery).</p><p>Twenty of the recommended indicators are area-level indicators, meaning that they
|
|
have population denominators and likely measure quality of the health care
|
|
system in an area. These indicators include four procedure utilization
|
|
indicators (CABG, hysterectomy, laminectomy, and PTCA), and sixteen ambulatory
|
|
care sensitive condition indicators (dehydration, bacterial pneumonia, urinary
|
|
tract infection, perforated appendix, angina, asthma, COPD, CHF, diabetes short
|
|
term complications, uncontrolled diabetes, diabetes long term complications,
|
|
lower extremity amputation in diabetics, hypertension, low birth weight,
|
|
pediatric asthma and pediatric gastroenteritis).</p></div><div id="A547"><h4 class="inline">Conclusions and future research:</h4><p>This project identified 45 indicators that are promising for use as quality
|
|
screens, demonstrating through literature review and empirical analyses that
|
|
useful information regarding quality of health care can be gleaned from
|
|
routinely collected administrative data. However, these indicators have
|
|
important limitations and could benefit from further research. Techniques such
|
|
as risk adjustment and multivariate smoothing are currently available to reduce
|
|
the impact of some of these limitations, but other limitations remain.</p><p>There are two major recommendations for further action and research - (1) the
|
|
improvement of HCUP data and subsequently the HCUP QIs to address some of the
|
|
noted limitations, and (2) further research into quality measurement and the
|
|
reality of these limitations. The HCUP QIs could benefit from the inclusion of
|
|
additional data, some of which is now routinely available in some states.
|
|
Important additions to data include hospital outpatient; emergency room and
|
|
ambulatory surgery data; linkages to vital statistics such as death records to
|
|
track post-hospitalization deaths for mortality indicators or birth records for
|
|
better obstetric risk adjustment; and additional clinical data to improve the
|
|
risk adjustment available. In addition, research into quality measurement should
|
|
continue. The relationships underlying the validity of volume measures and
|
|
utilization measures needs to be revisited periodically to assure validity.
|
|
Further, research surrounding the construct validity of indicators is essential.
|
|
Finally, further research is needed regarding risk adjustment of indicators, and
|
|
how alternative risk adjustment methods affect indicators.</p></div></div></div></div><div class="fm-sec"><div><p>Contributors: Amber Barnato, MD, Paul Collins, BA, Bradford Duncan, MD, Michael Gould, MD, MS, Paul Heidenreich, MD, Corinna Haberland, MD, Paul Matz, MD, Courtney Maclean, BA, Susana Martins, MD, Kristine McCoy, MPH, Suzanne Olson, MA, L LaShawndra Pace, BA, Mark Schleinitz, MD, Herb Szeto, MD, Carol Vorhaus, MBA, Peter Weiss, MD, Meghan Wheat, BA. Consultant: Douglas Staiger, PhD. AHRQ Contributors: Anne Elixhauser, PhD, Margaret Coopey, RN, MGA, MPS.</p></div><div><p>Prepared for: Agency for Healthcare Research and
|
|
Quality, U.S. Department of Health and Human Services.<a href="#address"><sup>1</sup></a>
|
|
Contract No. 290-97-0013. Prepared by: UCSF-Stanford Evidence-based Practice Center.</p></div><div><h4 class="inline">Suggested citation:</h4><p>Davies SM, Geppert J, McClellan M, et al. Refinement of the HCUP Quality Indicators. Technical Review Number 4 (Prepared by UCSF-Stanford Evidence-based Practice Center under Contract No. 290-97-0013). AHRQ Publication No. 01-0035. Rockville, MD: Agency for Healthcare Research and Quality. May 2001.</p></div><div><p>The authors of this report are responsible for its content. Statements in the report
|
|
should not be construed as endorsement by the Agency for Healthcare Research and
|
|
Quality or the U.S. Department of Health and Human Services of a particular drug,
|
|
device, test, treatment, or other clinical service.</p><p>The Agency does not guarantee the accuracy of this report. Questions regarding the content of this report, including all tables, figures, copyrights, and reference citations must be directed to the Evidence-based Practice Center that developed the report.</p></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="address"><p class="no_top_margin">2101 East Jefferson Street, Rockville, MD 20852. <a href="http://www.ahrq.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.ahrq.gov</a>
|
|
</p></div></dd></dl></dl></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK43831</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/20734520" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">20734520</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|