In the previous practice question of the week, we discussed theories in Human Computer Interaction. This week, we’ll be moving back to clinical decision making by reviewing quality indicators.
Where Does this Fit Within the Core Content?
Quality Indicators fall under clinical decision making and care process improvement – particularly under CDS and “Quality and Safety Issues”.
2. Clinical Decision Making and Care Process Improvement
2.1. Clinical Decision Support
2.1.1. The nature and cognitive aspects of human decision making
2.1.2. Decision science
2.1.3. Application of clinical decision support
2.1.4. Transformation of knowledge into clinical decision support tools
2.1.5. Legal, ethical, and regulatory issues
2.1.6. Quality and safety issues
2.1.7. Supporting decisions for populations of patients
2.2. Evidence-based Patient Care
2.3 Clinical Workflow Analysis, Process Redesign,and Quality Improvement
What’s a Quality Indicator?
As you may already know, quality indicators measure health care quality using hospital inpatient administrative data so that hospitals can identify potential areas for concern or areas that need further investigation. Quality indicators also help hospitals track changes in the quality of health care they provide over time.
Who develops these quality indicators?
The Agency for Healthcare Research and Quality (AHRQ) is the government agency within the Department of Health and Human Services (HHS) responsible for developing and publishing these guidelines. Along with these quality indicators, AHRQ is also responsible for other programs such as National Guideline Clearinghouse (NGC), Comprehensive Unit-Based Safety Program (CUSP), and MONAHRQ (My Own Network – Powered by AHRQ), and Accelerating Change and Transformation in Organizations and Networks II (ACTION II), among others (man, these guys and their acronyms!).
Ok. That’s enough background. Let’s get into this week’s question.
Question
Which of the following is NOT an AHRQ Quality Indicator category?
A. Outpatient Quality Indicator (OQI)
B. Inpatient Quality Indicator (IQI)
C. Pediatric Quality Indicator (PDI)
D. Patient Safety Quality Indicator (PSI)
Answer and Explanation
There are four quality indicator categories.
- Prevention Quality Indicators
- Inpatient Quality Indicators
- Patient Safety Indicators
- Pediatric Quality Indicators
Below is an explanation and examples of each.
Prevention Quality Indicators (PQIs)
PQIs are a “set of measures that can be used with hospital inpatient discharge data to identify quality of care for “ambulatory care sensitive conditions.” These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates.”
Examples of PQIs include hypertension admission rate, dehydration admission rate, and lower extremity amputation among patients with diabetes rate.
Inpatient Quality Indicators (IQIs)
According to AHRQ, IQIs are a “set of measures that provide a perspective on hospital quality of care using hospital administrative data. These indicators reflect quality of care inside hospitals and include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality.”
Examples of IQIs include abdominal aortic aneurism repair volume, acute stroke mortality rate, and pancreatic resection mortality rate.
Patient Safety Indicators (PSIs)
PSIs are a “set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.”
Examples of PSIs include postoperative Sepsis Rate, retained surgical item or un-retrieved device fragment rate, and transfusion reaction rate.
Pediatric Quality Indicators (PDIs)
PDIs are a “set of measures that can be used with hospital inpatient discharge data to provide a perspective on the quality of pediatric healthcare. Specifically, PDIs screen for problems that pediatric patients experience as a result of exposure to the healthcare system and that may be amenable to prevention by changes at the system or provider level.”
Examples of PDIs include neonatal bloodstream infection rate, iatrogenic pneumothorax rate, and asthma admission rate.
Additional Resources
If you’re looking for more clinical informatics questions, check out our archive or come visit us every Thursday.
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You can also sign up for practice questions through learn.informaticspro.com if you’re looking to test your readiness for the exam. There’s a ten question quiz there for free if you want to test your knowledge. Plus, there is also a full-length practice exam available in beta mode.
References and Suggested Reading
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 45 AHRQ Quality Indicators. http://www.ncbi.nlm.nih.gov/books/NBK2664/