Toolkit for Using the AHRQ Quality Indicators

More information is available in the AHRQ Quality Indicators™ Fact Sheet.

PSIs Are Key Indicators for Centers for Medicare & Medicaid Services (CMS)

One critical factor driving the emphasis on the PSIs is their use by the Centers for Medicare & Medicaid Services (CMS). The composite measure, PSI 90, is included in CMS’s Inpatient Quality Reporting program (and associated Hospital Compare report), Hospital Value-Based Purchasing program, and Hospital-Acquired Condition (HAC) Reduction program. The QI Toolkit serves as both a general guide to applying improvement methods in a hospital setting as well as guidance on improving performance specifically on the AHRQ QIs.

Improving quality of care in the inpatient setting requires a solid foundation of skills to manage organizational change, communicate effectively within and across divisions, generate usable information, and identify and implement appropriate changes in clinical care delivery.

The QI Toolkit is designed to help hospitals refine these skills and to serve as a how-to guide through the improvement process, from the first stage of self-assessment to the final stage of ongoing monitoring.

New in the 2016 Update of the AHRQ QI Toolkit

• Updated content to partially address the transition from ICD-9 to ICD-10, including updated documentation and coding practices.
• Guidance that can be used to improve pediatric quality in hospitals using the PDIs or other quality measures.
• A new presentation template for engaging staff in improvement efforts.
• Case studies of two hospitals that have successfully used the QI Toolkit.

The QI Toolkit supports improvement of the AHRQ QIs as well as other hospital quality measures.  The tools are practical and designed to meet the needs of hospital leadership and quality improvement teams. Individual tools are grouped into the following six steps A through F, followed by a general resources section:

1. Assessing Readiness To Change. Includes: fact sheets on the QIs, a board presentation template, a survey to self-assess readiness to change, and case studies of QI Toolkit users.
2. Applying QIs to Your Hospital’s Data. Includes: software instructions to calculate the QI rates and tips for coding and documentation.
3. Identifying Priorities for Quality Improvement. Includes: a prioritization worksheet, an example of a completed worksheet, and a presentation template aimed at engaging staff in the improvement process.
4. Implementing Evidence-Based Strategies To Improve Clinical Care. Includes: 25 indicator-specific best practices, a project charter, a gap analysis, and an implementation plan.
5. Monitoring Progress and Sustainability of Improvements. Includes: a guide to support staff in tracking trends and monitoring progress for sustainable improvement.
6. Analyzing Return on Investment. Includes: a step-by-step method for calculating the return on investment for an intervention implemented to improve performance on an AHRQ QI, and a case study of return on investment calculated by a hospital.
7. Other Quality Improvement Resources. Includes: an annotated list of related quality improvement guides and tools.

The QI Toolkit serves as an "inventory" from which hospitals can select those tools that are most appropriate for their current quality improvement priorities and capabilities.  Each of the tools is—by design—adaptable to the needs of an individual hospital.

Download the QI Toolkit

The tables below list all of the resources available in the QI Toolkit. You can download the tools one at a time or altogether in a PDF or ZIP file.

• To download the entire QI Toolkit, use this file [ PDF -11.35 MB]
• To download sections of the toolkit, use this file [ Zipped - 17.11 MB]

Note: PDF files are accessible.

Section A: Assessing Readiness To Change

Tool	Description	Format
A.1. Introduction to the QI Toolkit	Includes this introduction to toolkit (A.1) and fact sheets on AHRQ Quality Indicators (A.1a, A.1b, A.1c)	Introduction PDF [ - 67.33 KB] IQI Fact Sheet PDF [ - 61.98 KB] PSI Fact Sheet PDF [ - 230.74 KB] PDI Fact Sheet PDF [ - 217.67 KB]
A.2. Board PowerPoint Presentation on the AHRQ Quality Indicators	Includes PowerPoint presentation to introduce project to the hospital board and/or senior leadership	PDF [ - 4 MB] PPT [152.63 KB]
A.3. Getting Ready for Change Self-Assessment	Includes survey to assess leaders' perspectives on organizational readiness	PDF [ - 320.25 KB] Word [56.52 KB]
A.4. Case Studies of Improvement Implementation	Includes two case studies of how hospitals used the QI Toolkit	PSI Case Study PDF [ - 40.28 KB] PDI Case Study PDF [ - 34.97 KB]

Section B: Applying QIs to Your Hospital's Data

Tool	Description	Format
B.1. Applying the AHRQ Quality Indicators to Hospital Data	Includes instructions for performing calculations to identify current QI rates in your hospital	PDF [ - 528.36 KB]
B.2. IQI, PSI, and PDI Rates Generated by SAS QI (B.2a) and Windows QI (B.2b) Software	Includes example output from both software packages	SAS PDF [ - 271.7 KB] Windows PDF [ - 344.66 KB]
B.3. Excel Worksheets for Charts on Data, Trends, and Rates To Populate the PowerPoint Presentation Instructions; PowerPoint Presentation: The AHRQ Quality Indicators, Results, and Discussion of Data Analysis	Includes instructions on how to use Excel worksheets to produce charts based on your hospital's data and a PowerPoint presentation template	Instructions PDF [ - 194.43 KB] Charts for Presentation Excel [81.45 KB] Presentation PDF [ - 643.44 KB] PPT [140 KB]
B.4. Documentation and Coding for AHRQ Quality Indicators	Includes strategies for addressing documentation and coding issues	PDF [ - 505.32 KB]
B.5. Assessing Indicator Rates Using Trends and Comparators	Includes guidance for conducting trend and comparator analysis	PDF [ - 232.84 KB]

Section C: Identifying Priorities for Quality Improvement

Tool	Description	Format
C.1. Prioritization Worksheet and Instructions	Includes Excel spreadsheet to assist in prioritizing selection of indicators	Instructions PDF [ - 247.49 KB] Worksheet PDF [ - 218.74 KB] Excel [34.81 MB]
C.2. Prioritization Worksheet Example	Includes an example of a completed prioritization worksheet	PDF [ - 391.44 KB] Excel [208.32 KB]
C.3. Staff Engagement Presentation	Includes a PowerPoint presentation template that can be used to engage frontline and other staff	PDF [ - 2.09 MB] PPT [140.34 KB]

Section D: Implementing Evidence-Based Strategies To Improve Clinical Care

Tool	Description	Format
D.1. Improvement Methods Overview	Includes an overview of the steps in a quality improvement process	PDF [ - 583.5 KB] PPT [94.07 KB]
D.2. Project Charter	Includes a charter to help you define the implementation team, goals, and measures of progress for your improvement project	PDF [ - 257.24 KB] Word [41.61 KB]
D.4. Selected Best Practices and Suggestions for Improvements	Includes introduction to the indicator-specific best practices and detailed information on best practices for selected indicators	Introduction PDF [ - 248.26 KB] PSI03 Pressure Ulcer PDF [ - 327.07 KB] PSI05 Foreign Body PDF [ - 133.68 KB] PSI06 Pneumothorax PDF [ - 130.62 KB] PSI07 Central Venous Catheter-Related Bloodstream Infections PDF [ - 150.03 KB] PSI08 Postoperative Hip Fracture PDF [ - 126.7 KB] PSI09 Postoperative Hemorrhage PDF [ - 76.1 KB] PSI10 Postoperative Derangement PDF [ - 85.99 KB] PSI11 Postoperative Respiratory Failure PDF [ - 55.55 KB] PSI12 Perioperative Pulmonary Embolism or DVT PDF [ - 136.84 KB] PSI13 Postoperative Sepsis PDF [ - 78.65 KB] PSI14 Postoperative Wound Dehiscence PDF [ - 137.17 KB] PSI15 Accidental Puncture or Laceration PDF [ - 115.46 KB] PSI18-19 Obstetric Trauma Rate PDF [ - 61.59 KB] IQI: Mortality Review PDF [ - 115.84 KB] PDI01 Accidental Puncture PDF [ - 61.67 KB] PDI02 Pressure Ulcer PDF [ - 109.89 KB] PDI03 Foreign Body PDF [ - 95.97 KB] PDI05/NQI01 Iatrogenic Pneumothorax PDF [ - 79.92 KB] PDI06 Pediatric Heart Surgery PDF [ - 74.18 KB] PDI08 Perioperative Hemorrhage PDF [ - 81.05 KB] PDI09 Postoperative Respiratory Failure PDF [ - 270.49 KB] PDI10 Postoperative Sepsis PDF [ - 286.81 KB] PDI11 Postoperative Wound Dehiscence PDF [ - 253.23 KB] PSI12 Central Venous Catheter-Related Bloodstream Infections PDF [ - 343.33 KB] NQI03 Neonatal Blood Stream Infection PDF [ - 331.63 KB]
D.5. Gap Analysis	Includes a tool to help you understand how your organization's practices align with best practices to identify potential areas for improvement	PDF [ - 210.19 KB] Word [45.73 KB]
D.6. Implementation Plan	Includes a tool to help plan and monitor steps needed to begin implementation	PDF [ - 255.73 KB] Word [48.81 KB]
D.7. Implementation Measurement	Includes an example of how to monitor progress once implementation has begun	PDF [ - 254.66 KB] Word [54.81 KB]
D.8. Project Evaluation and Debriefing	Includes a tool to assist in evaluating the implementation process and identifying areas in need of further improvement	PDF [- 205.42 KB] Word [45.58 KB]

Please note that the D.3 tool no longer exists, but we have kept the existing numbering for the remaining tools.

Section E: Monitoring Progress and Sustainability of Improvements

Tool	Description	Format
E.1. Monitoring Progress for Sustainable Improvement	Includes a tool to assist with planning for ongoing examination of processes and outcomes for continuous improvement	PDF [ - 231.96 KB]

Section F: Analyzing Return on Investment

Tool	Description	Format
F.1. Return on Investment Estimation	Includes a step-by-step method for calculating return on investment (ROI) for an intervention aimed at improving performance on an AHRQ QI and an example ROI calculation	PDF [ - 464.46 KB] Word [127.59 MB]

Section G: Other Quality Improvement Resources

Tool	Description	Format
G.1. Available Comprehensive Quality Improvement Guides	Includes an annotated list of related comprehensive quality improvement guides	PDF [ - 208.23 KB]
G.2. Specific Tools To Support Change	Includes an annotated list of other related quality improvement tools and resources	PDF [ - 320.31 KB]