Quality indicators using hospital discharge data: state and national applications

Demand for information about the quality of health care has escalated. Yet many organizations lack well-specified quality measures, statistical expertise, or the requisite data to produce such information. The Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs) represent one approach to measuring health care quality using readily available data on hospital inpatients.

The HCUP QIs, developed in 1994, address clinical performance rather than other dimensions of quality such as satisfaction or efficiency. The 33 indicators produce rates that represent measures of outcomes (mortality and complications), utilization, and access. In lieu of complex multivariate techniques, two methods were used: (1) restrictions in defining patient subgroups to isolate homogeneous at-risk populations and (2) standardization when populations are diverse. Stratified analyses are recommended when patient or hospital factors are believed to influence the outcome. A simple method for making statistical comparisons to national rates was developed. The HCUP QI software, available in both mainframe and microcomputer applications, have enabled organizations to use their own data to produce comparative statistics and examine trends over time. Results summarized at the individual hospital or aggregate level are being used to stimulate continuous quality improvement initiatives.

The HCUP QIs offer a low-cost alternative for organizations that have access to administrative data. Current users include hospital associations, state health departments, statewide data organizations, and individual hospitals. Although the HCUP QIs are intended to serve as indicators, not definitive measures, of quality, they were designed to highlight quality concerns and to target areas for more intensive study.