Form #4 Form #4 AHRQ QI Data Collection Tool

Development and Evaluation of AHRQs Quality Indicators Improvement Toolkit

Attachment G -- AHRQ QI data collection tool

AHRQ QI Data Collection Tool

OMB: 0935-0164

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Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX


AHRQ QI Data Collection Tool for Improvement Toolkit

Hospital: _________________________

Table 1. Hospital Rates for the AHRQ Inpatient Quality Indicators

Inpatient Quality Indicator
Number and Name

Volume (numerator)

Patients at Risk (denominator)


Rate per 100 *

Volume Indicators




1 Esophageal resection


NA

NA

2 Pancreatic resection


NA

NA

4 Abdominal aortic aneurysm repair


NA

NA

5 CABG


NA

NA

6 PTCA


NA

NA

7 Carotid endarterectomy


NA

NA

Post-procedural Mortality Rates




8 Esophageal resection




9 Pancreatic resection




11 AAA repair




12 CABG




30 PTCA




31 Carotid endarterectomy




13 Craniotomy Hip replacement




14 Hip replacement




In-Hospital Mortality Rates




15 AMI




32 AMI, Without Transfer Cases




16 CHF




17 Acute stroke




18 GI hemorrhage




19 Hip fracture




20 Pneumonia




Utilization Rates




21 Cesarean-section delivery




33 Primary Cesarean delivery




22 VBAC (Vaginal Birth After Cesarean), Uncomplicated




34 VBAC, All




23 Laparoscopic Cholecystectomy




24 Incidental appendectomy among elderly




25 Bi-lateral cardiac catheterization




* Calculated as 100*numerator/denominator

Hospital: _________________________



Table 2. AHRQ Patient Safety Indicators

Patient Safety Indicator

Volume (numerator)

Patients at Risk (denominator)


Rate per 1000 *

1 Complications of Anesthesia




2 Death in Low-Mortality DRGs




3 Decubitus Ulcer




4 Failure to Rescue




5 Foreign Body Left During Procedure




6 Iatrogenic Pneumothorax




7 Selected Infections Due to Medical Care




8 Postoperative Hip Fracture




9 Postoperative Hemorrhage or Hematoma




10 Postoperative Physiologic and
Metabolic Derangements




11 Postoperative Respiratory Failure




12 Postoperative Pulmonary Embolism or Deep Vein Thrombosis




13 Postoperative Sepsis




14 Postoperative Wound Dehiscence




15 Accidental Puncture or Laceration




16 Transfusion Reaction




17 Birth Trauma – Injury to Neonate




18 Obstetric Trauma –
Vaginal with Instrument




19 Obstetric Trauma –
Vaginal without Instrument




20 Obstetric Trauma – Cesarean Delivery




* Calculated as 1000*numerator/denominator

Public reporting burden for this collection of information is estimated to average 12 hours per response, including time to program and run the computer programs necessary to produce the measures. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.





File Typeapplication/msword
File TitleHospital: _________________________
AuthorDonna Farley
Last Modified Bywcarroll
File Modified2009-12-28
File Created2009-12-28

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