AHRQ Quality Indicators Guide to Inpatient Quality Indicators: Quality of Care in Hospitals – Volume, Mortality, and Utilization

ors recorded information about each article on a one-page abstraction form.Information coded included: Indicator type (i.e. mortality, readmission, potentially overused procedures)Clinical domain (i.e. medical, surgical, obstetric, pediatric, and psychiatric)Measure category (i.e. structure, process, proxy-outcome, and outcome)Clinical rationale for the indicators.Use of longitudinal data.Use of data beyond hospital discharge data.Strengths and weaknesses identified by the author.Strengths and weaknesses not identified by the author. Each abstraction form was reviewed by the research coordinator for quality of theabstraction and for accuracy of the coding. All data were then entered into a Microsoft Accessdatabase. Step 3: Full abstraction. The purpose of the full abstraction phase was to identifypotential indicators for the new QI set, and to assess the evidence for validity of existingindicators. To accomplish this, only articles that described an indicator in conjunction withspecific and comprehensive information on its validity were fully abstracted. Four of the originalabstractors participated in this phase of the abstraction. Three of these abstractors were medicaldoctors, the fourth a master’s level research coordinator. Each of the articles for preliminary abstraction and the corresponding abstraction formwas reviewed by both the research coordinator and the project manager independently. Toqualify for full abstraction, the articles needed to meet the previously noted criteria and thefollowing criteria: Define a quality indicator, as opposed to only a relationship that was not formulatedor explicitly proposed as a measurement tool. Discuss a novel indicator, as opposed to indicators defined elsewhere and used inthe article only to discuss its relationship with another variable (i.e., socioeconomicstatus, race, urbanization). Define an indicator based on administrative data only. Only 27 articles met these formal criteria. This highlights an important aspect of the literature onquality indicators: most indicators are based on published clinical literature to identify importantpatient and provider characteristics and processes of care for specific clinical conditions; there isalso a substantial literature on technical aspects such as severity adjustment, coding, and datacollection. It should be noted that, while only 27 articles qualified for formal abstraction, theseare not the only useful articles. Many articles provide important information about qualitymeasurement. However, few quality indicators are specifically defined, evaluated, and reportedin the literature besides descriptive information on the process of development. (TheComplication Screening Program is a noteworthy and laudable exception that has beenextensively validated in the published literature, mostly by the developers). This evidence reportwill be an important contribution to the paucity of literature on indicator validation.