AHRQ Quality Indicators Toolkit Offers Hospitals Implementation Guidance

The Agency for Healthcare Research and Quality (AHRQ) recently released the AHRQ Hospital Quality Indicators Toolkit (Toolkit), the latest measure to enhance public reporting on healthcare quality. The Toolkit is designed to allow hospitals to more easily understand quality indicators (QIs); increase their QI utilization; and, improve overall quality and patient safety. Guidance is provided through a seven-step process of QI tracking that allows hospitals and other healthcare organizations to self-assess their organizational infrastructure and show their level of readiness for QI implementation.1 These QIs will be incorporated into the Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing Program (VBP) beginning in fiscal year 2014, making the Toolkit a timely instrument for hospitals hoping to achieve maximum reimbursement.2

The AHRQ, an agency within the Department of Health and Human Services (HHS), focuses on improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans.3 To further this goal, AHRQ established QIs, organized into four categories: (1) Prevention Quality Indicators; (2) Inpatient Quality Indicators; (3) Patient Safety Indicators; and, (4) Pediatric Quality Indicators. The Toolkit focuses on 45 specific indicators: 17 Patient Safety Indicators (PSIs) and 28 Inpatient Quality Indicators (IQIs).4 In addition to the implementation of such QIs, the Toolkit offers selected best practices and suggestions for improvement.5

Established by the Patient Protection and Affordable Care Act, and in conjunction with its several new reporting requirements, CMS has created a Hospital Value-Based Purchasing Program (VBP). Through the VBP, CMS will reimburse acute care hospitals through value-based incentives based on either the hospitals’ performance on specific quality measures or their performance improvement on certain measures since a baseline period.6 The VBP is scheduled begin in fiscal year 2013 with payments for facility discharges that take place on or after October 1, 2012 also covered under this reimbursement scheme.7 Although the VBP will not incorporate the AHRQ PSI and IQI measures until fiscal year 2014, the release of the Toolkit in 2012 is a timely step for hospitals who wish to take advantage of higher incentive payments offered by the VBP, but still need to improve their performance on these quality measures.8

In a continuous effort to improve healthcare quality, multiple federal agencies have developed both guidelines and requirements to spur facilities’ improved performance on QIs.  Public reporting of healthcare facilities’ QIs is often proposed as not only a means of increasing transparency and accountability in healthcare organizations, but also a means of improving consumer information and involvement in healthcare decision making. The AHRQ Toolkit represents the latest effort in furtherance of this goal. In conjunction with CMS’s highly anticipated VBP, the Toolkit allows hospitals to meet their reporting requirements, assess their performance, and improve upon it in exchange for future financial incentives. For more information on CMS transparency initiatives see HC Topics Vol. 4, No. 4, Federal Efforts to Improve Healthcare Quality.

“AHRQ Quality Indicators Toolkit: Instructions – Getting Ready for Change Self-Assessment” Agency for Healthcare Research and Quality, Tool A.3, http://www.ahrq.gov /qual/qitoolkit/qitoolkit_allfiles.pdf (Accessed 03/01/12).

“Medicare Program; Hospital Inpatient Value-Based Purchasing Program” Vol. 76 Fed. Reg. Page 26510-26511 (May 6, 2011).

“AHRQ at a Glance” Agency for Healthcare Research and Quality, May 2011, http://www.ahrq.gov/about/ataglance.htm  (Accessed 03/01/12).

“AHRQ Quality Indicators Toolkit for Hospitals” Agency for Healthcare Research and Quality, January 2012, http://www.ahrq.gov/qual/qitoolkit/ (Accessed 03/02/12).

Agency for Healthcare Research and Quality “AHRQ Quality Indicators Toolkit: Instructions – Getting Ready for Change Self-Assessment.”

“Hospital Quality Initiatives: Overview” Centers for Medicare and Medicaid Services, November 14, 2011, https://www.cms.gov/HospitalQualityInits/01_Overview.asp#TopOfPage (Accessed 03/01/12).


76 FR 26510-11 (2011-05-06).

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