Quality Indicators: Original CHSRA QIs

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Quality Indicators versus Quality Measures

The Center for Health Systems Research and Analysis (CHSRA) QIs are quality indicators. Therefore a high percentile ranking on a particular QI (e.g., 82nd percentile on the QI, Prevalence of Falls) on a quarterly QI report does not necessarily mean that there is a problem with the quality of care in the facility. It simply means that there is a flag that draws your attention to a potential problem that may need to be investigated. By the same token, having an average or low score on a particular QI (e.g., 21st percentile on the QI, Prevalence of Indwelling Catheters) does not mean that there is not a quality problem; there may be problems with quality of care that are not captured by the QIs. Careful investigation can help decide if a high QI percentile rank is really identifying a quality problem. Other sources of information (e.g., progress notes) may be helpful with the issue of identifying quality problems that are not covered by the QIs.

The CHSRA QIs can be used to identify concerns which will need further investigation; but on their own, they should not be used to make final judgments about the quality of care. The final decision of whether or not there is a quality problem requires careful and skilled investigation by clinical experts. This is an important consideration for how the information in the QI reports is used. For example, State surveyors are able to access QI reports. They are currently able to use the reports to focus their on-site survey to potential problem areas, however they also need to carefully investigate the potential problem areas in order to determine whether deficiencies should be issued. Likewise, facilities should be careful to not to use the information in their QI reports to draw specific comparisons to other facilities or portray the overall quality of their facility as compared to other facilities. The QI information in the QI reports is extremely useful in helping identify areas or systems in a facility that may be improved, but the QI reports should not be used as the single judge of the quality of care the facility delivers. A final determination of quality requires detailed clinical review and investigation.