One of the offshoots of implementing the provisions of the Affordable Care Act is that all stakeholders, from health care providers to support staff and the patients themselves, have become keenly aware of quality indicators and cost containment issues.
Until recently, indicators of quality have not played a distinct role in health care decisions for the public aside from the public relations impact of positive audit reports. The Agency for Healthcare Research and Quality, under the auspices of the Department of Health and Human Services, developed a set of QIs, which are tools to measure the quality of health care delivery using inpatient administrative data combined with other resources.
The QIs can be utilized to identify potentially problematic quality issues, determine critical areas that should be prioritized for further studies and monitor changes over a given interval.
1. PQIs or Indicators for In-hospital Prevention Practices
PQIs are metrics that involve the use of hospital inpatient discharge data. The goal is to determine if there are any solutions that could have been introduced in an ambulatory care setting to prevent hospitalization. These conditions may include solutions such as early intervention to reduce complications or more aggressive interventions on an outpatient basis. PQIs may be based on hospital inpatient data, but they also reflect community health care processes. The example often cited is that of diabetes patients who may not have needed in-hospital services if they had been given adequate outpatient monitoring and educational support to manage their self-care treatment plans effectively.
2. IQIs or Indicators for Inpatient Quality of Care
IQIs measure in-hospital quality of care, accounting for factors such as mortality rates for specific conditions or procedures and the utilization rate for procedures that are prone to being overused, underused or misused. On the flip side, IQI measurements also analyze those procedures that are used at high volumes yet recorded mortality rate remains lower than expected.
3. Patient Safety Indicators
Patient Safety Indicators are metrics that help hospitals determine and address potentially adverse events occurring after surgeries and procedures, including those related to childbirth. PSIs are sets of measures generated from an exhaustive review of literature and an examination diagnosis codes most commonly associated with adverse events. The studies had to undergo clinician review, and the facility’s risk management strategies and inpatient safety data to develop the PSIs.
4. PQIs or Pediatric Quality Indicators
Pediatric QIs consist of a set of measures that can be combined with hospital inpatient discharge data to demonstrate the facility’s quality of pediatric healthcare. More specifically, PQIs look for challenges faced by pediatric patients due to their experiences with today’s health care environment. Some of these changes may be prevented or mitigated by positive action on the part of providers. In reviewing the quality of care provided to the entire demographic of very young patients, it is important to note that QIs used to evaluate quality of care for adults cannot be used in the same way for pediatric patients due to distinctively different health conditions and reactions along with children’s limited ability to self-report.
5. Rate of Readmissions
Hospital readmission is a cost center that may also indicate quality of care issues for health care providers and hospitals. To reduce acute care utilization and limit readmission, providers must collaborate to ensure that health and medical care issues are addressed thoroughly. Solutions include incorporating outpatient support such as transitional strategies in the post-discharge period.
The first four of these quality-of-care indicators form part of the AHRQ resources developed to create standardized sets of measures for hospitals. Free software is available for users to implement these measures and generate useful feedback to improve delivery of care, reduce costs and enhance the outcome of patient encounters. Rate of readmission as an indicator of health care quality has been studied at length as part of research to reduce health care costs. Other quality indicators may be used to assess the efficiency and effectiveness of hospitals in providing care for patients facing acute and chronic conditions.
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