The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators are standardized, evidence-based measures of health care quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes.  The Indicators highlight potential quality improvement areas, track changes over time and identify areas for further study.

Hospital-Level AHRQ Quality Indicators for California#

Hospital Inpatient Mortality Indicators for California#

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are a set of measures that provide a perspective on hospital quality of care using patient data routinely reported to OSHPD. The Inpatient Mortality Indicators (IMIs) are a subset of the AHRQ quality indicators that measure in-hospital mortality. They include medical conditions and procedures for which mortality rates may vary significantly across institutions. Evidence suggests that high mortality may be associated with deficiencies in the quality of hospital care provided.

These indicators are provided by OSHPD for use by California consumers, healthcare purchasers, and healthcare providers. OSHPD reports 12 of the 15 IMI measures, including 5 sub-measures (beginning with 2012 data).

2015 Report

2014 Report

2013 Report

2012 Report

2011 Report

2010 Report

Hospital Volume and Utilization Indicators for California#

The following is a brief description of 11 Hospital Inpatient Quality Indicators including 6 subcategories developed by the federal Agency for Healthcare Research and Quality (AHRQ) and provided by OSHPD for use by California consumers and health care providers.

The methods for calculating these indicators, along with detailed technical explanations are provided by AHRQ. AHRQ also provides valuable guidance regarding the validity of these indicators and important limitations on their use as quality measures. Details are available in documents found at the AHRQ website.

Volume and Utilization Reports#

Note that 2016 and 2017 data used Version 2018 of the AHRQ software, and 2013-2015 data used Version 5.0.

2017

2016

2015

2014

2013

2012

Volume Indicators#

Volume means the number of medical procedures of a given type that are done within one year. Medical research has linked higher hospital volumes for some complex surgical procedures with better patient outcomes (such as fewer deaths). Some research, however, has not found evidence for a “practice makes perfect” association, and the evidence base for this association varies by procedure. Also, other factors such as individual physician or surgical team experience may play an equal or even more important role. OSHPD does not endorse the use of the volume indicators as stand-alone measures of hospital quality. However, in the absence of other valid quality information, these indicators may prove useful to the public in making more informed healthcare decisions.

Details: The six volume indicators simply provide the number of procedures performed within each hospital. They are:

  • Esophageal Resection
    Research shows a link between higher numbers of cases and better outcomes.
  • Pancreatic Resection
    Research shows a link between higher numbers of cases and better outcomes.
    • Pancreatic Resection, Cancer
    • Pancreatic Resection, Other
  • Abdominal Aortic Aneurism Repairs (AAA Repair)
    Research shows a link between higher numbers of cases and better outcomes.
    • AAA Repair ruptured, Open
    • AAA Repair unruptured, Open
    • AAA Repair ruptured, Endovascular
    • AAA Repair unruptured, Endovascular
  • Carotid Endarterectomy
    Research shows a link between higher numbers of cases and better outcomes.
  • Coronary Artery Bypass Graft Surgery (CABG)
    Research findings are unclear about whether there is a link between higher numbers of cases and better outcomes.
  • Percutaneous Coronary Intervention (PCI)
    Most research shows a link between higher numbers of cases and better outcomes.

Utilization Indicators#

Utilization refers to the percent of times that a medical treatment is done using a particular type of procedure. These indicators are for procedures where evidence shows there is under-use or over-use, along with large variation in rates across hospitals. That is, procedures for some patients may be over-used (e.g., Cesarean section for child birth) and others may not be used enough (e.g., vaginal birth after previously having a baby by Cesarean section), given current medical care standards. A hospital with very high or very low utilization rates relative to other hospitals may be a reason for concern, though certain hospital characteristics (e.g., being a referral center where other hospitals send complex cases) may help explain extreme rates. These utilization rates represent the number of patients who are treated using a specific type of procedure per 100 patients admitted for the more general category of treatment.

For example: Hospital A has a Cesarean section rate of 20.3% (277). This means that Hospital A performed 277 Cesarean sections and these represented 20.3% of all the births ( 1365- number not included in table) at Hospital A that year.

Rate Explanations#

  • Cesarean Delivery Rate
    Number of Cesarean Section Deliveries per 100 deliveries (excludes abnormal presentation, preterm birth, fetal death, multiple gestations, and breech procedure). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Cesarean Delivery Rate – Primary
    Number of Cesarean Deliveries per 100 deliveries among women who have not previously had a Cesarean section (excludes abnormal presentation, preterm, fetal death, multiple gestation, and breech procedures). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Vaginal Birth After Cesarean (VBAC) Rate
    Number of vaginal births per 100 women with a previous Cesarean delivery. VBAC may be underused in some facilities, so higher rates may represent better care, though this rate includes some women who were probably not good candidates for vaginal birth.
  • Vaginal Birth After Cesarean (VBAC) Rate, Uncomplicated
    Number of vaginal births per 100 women with a previous Cesarean delivery (excludes abnormal presentation, preterm birth, fetal death, multiple gestation, and breech procedures). VBAC may be underused in some facilities, so higher rates may represent better care.
  • Laparoscopic Cholecystectomy
    Number of Cholecystectomies (surgical removal of gall bladder) performed with use of Laparoscope per 100 cholecystectomies. Laparoscopic Cholecystectomy is a new technology with lower risks than open cholecystectomy. Higher rates may represent better care.

Area-Level (Statewide, County) AHRQ Quality Indicators for California#

Prevention Quality Indicators (PQI) for California (Statewide, County)#

Prevention Quality Indicators (PQIs) identify hospital admissions (age 18 and over) that evidence suggests may have been avoided through access to high-quality outpatient care.  The PQIs measure preventable hospitalizations for “ambulatory care-sensitive conditions”, conditions for which hospital admission could be prevented by interventions in primary care.  They assess the quality of the healthcare system as a whole, especially ambulatory care, in preventing hospitalizations due to potentially-avoidable medical complications.

Data Download

Area-Level (Statewide, County) hospitalization rates are provided for the following PQI measures:

  • PQI #1 Diabetes Short-term Complications
  • PQI #2 Perforated Appendix (ruptured appendix)
  • PQI #3 Diabetes Long-term Complications
  • PQI #5 Chronic Obstructive Pulmonary Disease (COPD) (chronic bronchitis or emphysema) or Asthma in Older Adults (ages 40 and over)
  • PQI #7 Hypertension (high blood pressure)
  • PQI #8 Heart Failure
  • PQI #10 Dehydration
  • PQI #11 Community-Acquired Pneumonia
  • PQI #12 Urinary Tract Infection (UTI)
  • PQI #13 Angina Without Procedure (chest pain) – Retired, effective with 2016 data.
  • PQI #14 Uncontrolled Diabetes
  • PQI #15 Asthma in Younger Adults (ages 18-39)
  • PQI #16 Lower-Extremity Amputation among Patients with Diabetes (removal of leg or foot due to diabetes complications)
  • PQI #90 Prevention Quality Overall Composite (includes PQIs #1, 3, 5, 7, 8, 10, 11, 12, 14, 15, and 16) – PQI #13 has been removed from the composite, effective with 2016 data.
  • PQI #91 Prevention Quality Acute Composite (includes PQIs #10, 11, and 12)
  • PQI #92 Prevention Quality Chronic Composite (includes PQIs #1, 3, 5, 7, 8, 14, 15, and 16) – PQI #13 has been removed from the composite, effective with 2016 data.
  • PQI #93 Prevention Quality Diabetes Composite (includes PQIs #1, 3, 14, 16) – new, effective with 2016 data.

OSHPD views the area-level indicators as useful starting points for examining healthcare quality, but does not regard them as definitive measures of quality. For information about how the indicators are calculated, including technical details about each of the PQIs, visit the AHRQ Website.

Pediatric Quality Indicators (PDI) for California (Statewide, County)#

Pediatric Quality Indicators (PDIs) use indicators from other AHRQ Quality Indicator modules with adaptations for use among children. Similar to Prevention Quality Indicators, the PDIs identify hospital admissions that evidence suggests may have been avoided through access to high-quality outpatient care.

Data Download

Area-Level (Statewide, County) hospitalization rates are provided for the following PDI measures:

  • PDI #14 Asthma (Age 2 – 17)
  • PDI #15 Diabetes Short-Term Complications (Age 6 – 17)
  • PDI #16 Gastroenteritis (Age 3 months – 17 years)
  • PDI #17 Perforated Appendix (ruptured appendix; Age 1-17)
  • PDI #18 Urinary Tract Infection (Age 3 months – 17 years)
  • PQI #9 Low Birth Weight (< 2500 grams)
  • PDI #90 Pediatric Quality Overall Composite (includes PDIs #14, 15, 16 and 18; Age 6-17)
  • PDI #91 Pediatric Quality Acute Composite (includes PDIs #16 and 18; Age 6-17)
  • PDI #92 Pediatric Quality Chronic Composite (includes PDIs #14 and 15; Age 6-17)

OSHPD views the area-level indicators as useful starting points for examining healthcare quality, but does not regard them as definitive measures of quality. For information about how the indicators are calculated, including technical details about each of the PDIs, visit the AHRQ website.

Inpatient Quality Indicators (IQI) for California (Statewide, County)#

Inpatient Quality Indicators (IQIs) are measures that represent hospitalization rates for four medical procedures for which there could be possible over- or under-use and for which utilization varies across hospitals or geographic areas. High or low rates, by themselves, do not represent poor quality of care. Instead, the information is intended to inform consumers about local practice patterns or identify potential problem areas that might need further study.

Data Download

Area-Level (Statewide, County) hospitalization rates are provided for the following IQI measures:

  • IQI #26 Coronary Artery Bypass Graft (CABG) (heart bypass surgery)(Age 40 and over)
  • IQI #27 Percutaneous Coronary Intervention (PCI) (widening of a narrowed or blocked artery in the heart using a device inserted in the blood vessel) (Age 40 and over)
  • IQI #28 Hysterectomy (the surgical removal of the uterus or womb) (Age 18 and over)
  • IQI #29 Laminectomy (removal of part of a vertebrae) or Spinal Fusion (back surgery – joining together of two or more vertebrae) (Age 18 and over)

OSHPD views the area-level indicators as useful starting points for examining healthcare quality, but does not regard them as definitive measures of quality. For information about how the indicators are calculated, including technical details about each of the IQIs, visit the AHRQ Website.

Patient Safety Indicators (PSI) for California (Statewide, County)#

Patient Safety Indicators (PSIs) are measures that represent rates of potentially-preventable adverse events that occur during a hospital stay. They provide a perspective on potential complications and errors resulting from a hospital admission and help assess total incidence within a region.

Data Download

Area-Level (Statewide, County) hospitalization rates are provided for the following PSI measures:

  • PSI #21 Retained Surgical Item or Unretrieved Device Fragment
  • PSI #22 Iatrogenic Pneumothorax
  • PSI #23 Central Venous Catheter-Related Blood Stream Infection
  • PSI #24 Postoperative Wound Dehiscence
  • PSI #25 Accidental Puncture or Laceration
  • PSI #26 Transfusion Reaction
  • PSI #27 Perioperative Hemorrhage or Hematoma

OSHPD views the area-level indicators as useful starting points for examining healthcare quality, but does not regard them as definitive measures of quality. For information about how the indicators are calculated, including technical details about each of the PSIs, visit the AHRQ website