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 11 of the 15 IMI measures, including 5 sub-measures.

2018 Report

2017 Report

2016 Report

For reports from previous years, please use this link: Inpatient Mortality Indicators Archive.

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Hospital Utilization and Volume Indicators for California#

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.

Utilization Indicators#

2019

2018

2017

2016

Previous years utilization reports can be found at Utilization Rates for Selected Medical Procedures in California Hospitals. 2016-2019 data used Version 2020 of the AHRQ software, and 2012-2015 used Version 5.0.

Rate Explanations

  • Cesarean Delivery Rate, Uncomplicated
    Number of Cesarean Section Deliveries per 100 deliveries. Excludes deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, and breech procedure). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Primary Cesarean Delivery Rate, Uncomplicated
    First-time Cesarean Deliveries per 100 deliveries. Excludes deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, and breech procedure). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
  • Vaginal Birth After Cesarean (VBAC) Rate, All
    Number of vaginal births per 100 women with previous Cesarean deliveries. 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 previous Cesarean deliveries. Excludes deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnoses, and breech procedures). VBAC may be underused in some facilities, so higher rates may represent better care.
  • Laparoscopic Cholecystectomy (Retired 2016)
    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.

Volume Indicators#

AHRQ has retired these indicators and OSHPD will no longer produce them. Please view 2005-2017 Volume reports at Number of Selected Inpatient Medical Procedures in California Hospitals.

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) (Retired, effective 2016)
  • 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 (Retired, effective 2016)
  • PQI #11 Community-Acquired Pneumonia
  • PQI #12 Urinary Tract Infection (UTI)
  • PQI #13 Angina Without Procedure (chest pain) (Retired, effective 2016)
  • 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, 11, 12, 14, 15, and 16) (Removed PQIs #10 and 13, effective 2016).
  • PQI #91 Prevention Quality Acute Composite (includes PQIs #11, and 12) (Removed PQI #10, effective 2016).
  • PQI #92 Prevention Quality Chronic Composite (includes PQIs #1, 3, 5, 7, 8, 14, 15, and 16) (Removed PQI #13, effective 2016).
  • PQI #93 Prevention Quality Diabetes Composite (includes PQIs #1, 3, 14, 16) (New, effective 2016).

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); Retired, effective 2016
  • PDI #18 Urinary Tract Infection (Age 3 months – 17 years)
  • PQI #9 Low Birth Weight (< 2500 grams); Retired, effective 2016
  • 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.

AHRQ has retired these indicators and OSHPD will no longer produce them. Please view 2005-2015 IQI reports at Rates of Selected Hospital Procedures Examined for Over or Under-Use by County.

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.

AHRQ has retired these indicators and OSHPD will no longer produce them. Please view 2005-2015 PSI reports at Hospitalization Counts and Rates of Selected Adverse Hospital Events by California County.