The Agency for Healthcare Research and Quality is seeking public comment on plans to update and expand its quality indicators (QIs) toolkit to help hospitals document their quality and safety conditions, according to an August 4 Federal Register notice.

Three sets of QIs are currently in use at a number of hospitals throughout the country: Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs). The IQIs contain measures of volume, mortality, and utilization for common medical conditions and major surgical procedures. The PSIs are a set of measures to screen for potentially preventable adverse events that patients may experience during hospitalization, while the PDIs measure the quality of pediatric health care, mainly focusing on preventable complications that occur as a consequence of hospitalization among pediatric patients.

Nevertheless, “despite the availability of the QIs as tools to help hospitals assess their performance, many U.S. hospitals have limited experience with the use of such measurement tools, or in using quality improvement methods to improve their performance as assessed by these measures,” states the notice.

AHRQ contracted with RAND Corporation to develop a QIs toolkit to assist hospitals in both using the QIs and improving the quality and safety of the care they provide, as measured by those indicators. However, the toolkit—which was released in 2012—is in “critical need” of an update. As a result, AHRQ has funded RAND to update and expand the toolkit, and field test the updated toolkit with hospitals as they carry out initiatives designed to improve performance on the QIs.

To achieve the goals of the project, AHRQ will use three protocols to collect data:

*Pre/post-test interview protocol--The purpose of this data collection is to obtain data on the steps the hospitals took to implement actions to improve performance on the QIs; their plans for making process changes; and their experiences in achieving changes and perceptions regarding lessons learned that could be shared with other hospitals.

*Update protocol--The purpose of this data collection is to capture longitudinal data regarding hospitals' progress in implementing changes, successes and challenges, and plans for subsequent actions. These data will include descriptive information on changes over time in the hospitals' implementation actions and how they are using the toolkit, as well as experiential information on the perceptions of participants regarding the improvement implementation process and its effects. It also ensures the collection of information close to pertinent events, which avoids the recall bias associated with retrospective reporting of experiences.

*Usability testing protocol--The purpose of this data collection is to gather information from the hospitals on how they used each tool in the updated toolkit, the ease of use of each tool, which tools were most helpful, suggested changes to improve each tool, and suggestions for other tools to add to the updated toolkit. This information will be used in the revisions of the updated toolkit following the end of the field test.

“All the information obtained from the proposed data collection will be used to strengthen the updated toolkit before finalizing and disseminating it to hospitals for their use,” according to the agency’s notice. “First, information will be collected from the six hospitals participating in the toolkit field test about their experiences in implementing performance improvements related to the AHRQ QIs, which will be used to prepare experiential case examples for inclusion in the toolkit as a resource for other hospitals. Second, feedback will be elicited from them about the usability of the toolkit, which will be applied to modify and refine the toolkit so that it is as responsive as possible to the needs and priorities of the hospitals for which it is intended.”

Public comment on AHRQ's information collection plan must be received by September 3, 2014.

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