Principal Investigator
PI Home Department
Source of Support
Total Cost
Patrick Romano, M.D.
General Medicine and Pediatrics
6/01/2002 -6/30/2004

Under a subcontract from the Evidence-based Practice center at Stanford University, CHSRPC is assisting the US Agency for Healthcare Research and Quality with refinement and support of the AHRQ Quality Indicators. These indicators use hospital administrative data to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time. They represent a refinement and further development of the Quality Indicators developed in the early 1990s as part of the Healthcare Cost and Utilization Project (HCUP). The Stanford-UC Davis group, including Dr. Romano, expanded the original quality indicators by: (1) identifying additional quality indicators reported in the literature and used by health care organizations; (2) evaluating both the HCUP QIs and other indicators using literature review and empirical methods; and (3) incorporating risk adjustment. The resulting AHRQ QIs are organized into three "modules," each of which measures quality associated with processes of care that occurred in an outpatient or an inpatient setting:

Prevention QIs—or ambulatory care sensitive conditions—identify hospital admissions that evidence suggests could have been avoided, at least in part, through high-quality outpatient care. The Prevention module is now available.
Inpatient Quality Indicators reflect quality of care inside hospitals and include:
Inpatient mortality for medical conditions
Inpatient mortality for procedures
Utilization of procedures for which there are questions of overuse, underuse, or misuse
Volume of procedures for which there is evidence that a higher volume of procedures is associated with lower mortality
Patient Safety Indicators also reflect quality of care inside hospitals, but focus on surgical complications and other iatrogenic events.

Our initial technical report has been released at In the past year, our work has focused on several updates and refinements to these indicators. A draft report has been written by Drs. Rainwater and Romano on the current status of public reporting systems in the U.S, and the potential usefulness of the AHRQ QIs and other related indicators for public reporting on hospital performance.

*Subcontracted through Stanford University.