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Tools/Toolkit > Measurement Tool/Indicator
AHRQ Quality Indicators. Rockville, MD: Agency for Healthcare Research and Quality; September 2005.
The Agency for Healthcare Research and Quality's (AHRQ) Quality Indicators (QIs) represent quality measures that make use of a hospital's available administrative data. The Inpatient Quality Indicators include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of underuse, overuse, and misuse; and volume of procedures for which evidence suggests that a higher volume is associated with lower mortality.
Journal Article > Commentary
The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality.
Chassin MR, Galvin RW. JAMA. 1998;280:1000-1005.
The National Roundtable on Health Care Quality was organized in 1996 by the Institute of Medicine and consisted of broad representation from business, education, government, the media, and health care. This 1998 consensus report articulates a definition of health care quality and indicts the US health care system for significant systematic failures to deliver high-quality care, giving several illustrative examples. The report offers a tripartite classification system—underuse, overuse, and misuse—for lapses in quality and discusses the impact of each on outcomes and health expenditures. The authors review existing efforts to improve quality, including regulation, "Continuous Quality Improvement," market forces, and payment incentives. Without prescribing a specific approach, the authors call on health care professionals to take the lead in a national health care quality improvement effort.
Tenner E. New York, NY: A.A. Knopf; 1996.
Tenner's discussions of medical and nonmedical examples provide an engaging introduction to the many ways in which new technologies can have unintended consequences. Side effects of any technology are well known and well studied. What interests Tenner, however, are ''revenge effects,'' which he defines as the exact opposite of the intended effects of a new technology. For instance, the widespread availability of computers in offices and homes was heralded as ushering in a new, paperless world. Instead, paper use sky-rocketed. From a safety perspective, numerous examples exist in which making something safer simply encouraged more reckless behavior. Health care examples often involve a safer version of a drug or procedure, which then becomes overused. At the population level, then, adverse events do not decrease and may even increase. For instance, laparoscopic cholecystectomy is a much less morbid procedure than open cholecystectomy. It is this feature of the laparoscopic procedure that resulted in a significant increase in the number of patients referred for removal of their gallbladder, to the point that morbidity and mortality at the population level did not improve as a result of this major advance in surgical technology.