**Agency for Healthcare Research and Quality**

**Inpatient Quality Indicators (IQIs)**

**Log of Revisions to IQI Documentation and Software**

**Updated March 16, 2007**

The following table summarizes the revisions made to the IQI software,
software documentation and the Guide to Inpatient Quality Indicators
(Guide) document since the original release of the software and
documents in June 2002. The table lists the version and revision number,
the date the revision was made, the component(s) affected by the change
and a short summary of the changes that were made. For convenience and
ease of use, the changes are listed in reverse chronological order with
the most recent changes appearing first in the table. This log of
revisions is current as of the date noted above.

+--------+----------+------------+------------------------------------+
| ***Ver | #        | ***Co      | ##### Changes                      |
| sion/\ | ### Date | mponent*** |                                    |
| Re     |          |            |                                    |
| vision |          |            |                                    |
| Num    |          |            |                                    |
| ber*** |          |            |                                    |
+========+==========+============+====================================+
| V3.1a  | March    | SAS        | Added program to calculate the IQI |
|        | 16, 2007 | Software   | composite measures. The new files  |
|        |          | and        | are IQI_COMPOSITE.SAS and          |
|        |          | Doc        | MSXIQC31.TXT.                      |
|        |          | umentation |                                    |
+--------+----------+------------+------------------------------------+
| V3.1a  | March    | SAS        | Amended the aggregation algorithm  |
|        | 16, 2007 | Software   | to correctly sum the numerator and |
|        |          | (IQSASA2)  | denominator counts across          |
|        |          |            | stratifiers.                       |
+--------+----------+------------+------------------------------------+
| V3.1   | March    | Software   | 1.  Implemented changes associated |
|        | 12, 2007 | (SAS and   |     with ICD-9-CM coding updates   |
|        |          | Windows),  |     for Fiscal Year (FY) 2007      |
|        |          | Software   |     (effective 10-1-2006). See     |
|        |          | Docu       |     separate documentation on      |
|        |          | mentation, |     ICD-9 coding updates for       |
|        |          | Guide, and |     specific details.[^1]          |
|        |          | Technical  |                                    |
|        |          | Spec       | 2.  The years for which the        |
|        |          | ifications |     ICD-9-CM and DRG codes         |
|        |          |            |     defining IQIs are valid was    |
|        |          |            |     amended to be through FY 2007  |
|        |          |            |     instead of FY 2006, that is,   |
|        |          |            |     the codes in the software are  |
|        |          |            |     effective through September    |
|        |          |            |     30, 2007.                      |
|        |          |            |                                    |
|        |          |            | 3.  Pneumonia mortality (IQI #20)  |
|        |          |            |     added code 487.0 and dropped   |
|        |          |            |     codes 507.0, 510.0, 510.9,     |
|        |          |            |     511.0 and 513.0 from the       |
|        |          |            |     inclusion criteria for         |
|        |          |            |     denominator in order to align  |
|        |          |            |     indicator with CMS 30-day      |
|        |          |            |     mortality indicator.\          |
|        |          |            |     \                              |
|        |          |            |     Impact: The rate increases by  |
|        |          |            |     about 25%                      |
+--------+----------+------------+------------------------------------+
| V3.1   | March    | Guide      | Moved average volume, provider     |
|        | 12, 2007 |            | rates, and population rates into   |
|        |          |            | separate document, *Inpatient      |
|        |          |            | Quality Indicators Comparative     |
|        |          |            | Data*.                             |
+--------+----------+------------+------------------------------------+
| V3.1   | March    | Software   | 1.  Age-, race-, gender- and       |
|        | 12, 2007 | (SAS and   |     county-specific population     |
|        |          | Windows)   |     estimates used for AHRQ QI     |
|        |          |            |     area rates were updated to use |
|        |          |            |     revised post-censal estimates  |
|        |          |            |     for years 2001 through 2005    |
|        |          |            |     and projections for the years  |
|        |          |            |     2006 and 2007.                 |
|        |          |            |                                    |
|        |          |            | 2.  The syntax will compute        |
|        |          |            |     risk-adjusted rates and        |
|        |          |            |     observed-to-expected ratios    |
|        |          |            |     for the pre-defined set of     |
|        |          |            |     stratification variables       |
|        |          |            |     (e.g., age, gender, payer,     |
|        |          |            |     race). When stratifications    |
|        |          |            |     other than hospital or area    |
|        |          |            |     are selected, the RPIQxx       |
|        |          |            |     variables and their confidence |
|        |          |            |     intervals are                  |
|        |          |            |     observed/expected ratios to    |
|        |          |            |     avoid confounding with risk    |
|        |          |            |     adjustment variables           |
+--------+----------+------------+------------------------------------+
| V 3.1  | March    | Software   | 1.  Added capability to apply      |
|        | 12, 2007 | (SAS and   |     weight value to each           |
|        |          | Windows)   |     discharge.                     |
|        |          | and        |                                    |
|        |          | Doc        | 2.  Added data element DISCWT to   |
|        |          | umentation |     hold weight to assign to       |
|        |          |            |     discharge.                     |
|        |          |            |                                    |
|        |          |            | 3.  Added an option to incorporate |
|        |          |            |     the Present on Admission (POA) |
|        |          |            |     indicator into risk adjustment |
|        |          |            |     and                            |
|        |          |            |                                    |
|        |          |            | 4.  Added Data Elements            |
|        |          |            |     DXATADMIT1 - DXATADMIT30 to    |
|        |          |            |     indicate whether the           |
|        |          |            |     corresponding diagnosis (i.e., |
|        |          |            |     DX1 - DX30) was Present on     |
|        |          |            |     Admission.                     |
+--------+----------+------------+------------------------------------+
| V 3.1  | March    | SAS        | Added alternative POA parameter    |
|        | 12, 2007 | Software   | files of risk-adjustment           |
|        |          | and        | covariates and population rates    |
|        |          | Doc        | using 2002-2004 SID data from      |
|        |          | umentation | California and New York.           |
+--------+----------+------------+------------------------------------+
| V3.1   | March    | Software   | 1.  Based on recommendations of    |
|        | 12, 2007 | (SAS and   |     the Risk Adjustment and        |
|        |          | Windows),  |     Hierarchical Modeling (RAHM)   |
|        |          | and        |     Workgroup, computed covariates |
|        |          | Covariates |     using logistic regression      |
|        |          | document   |     model with a hospital random   |
|        |          |            |     effect instead of the existing |
|        |          |            |     simple logistic model. Because |
|        |          |            |     the AHRQ QI use a large        |
|        |          |            |     sample, the impact on the      |
|        |          |            |     covariates of using the        |
|        |          |            |     hierarchical model (and hence  |
|        |          |            |     the impact on the              |
|        |          |            |     risk-adjusted rates) is minor. |
|        |          |            |                                    |
|        |          |            | 2.  Updated the coefficients used  |
|        |          |            |     in the calculation of expected |
|        |          |            |     and risk-adjusted rates to the |
|        |          |            |     reference population, based on |
|        |          |            |     the 2002-2004 State Inpatient  |
|        |          |            |     Data (SID).                    |
|        |          |            |                                    |
|        |          |            | 3.  Updated Covariates document to |
|        |          |            |     include the POA coefficients.  |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Guide      | 1.  Moved Appendix A into new      |
|        | 20, 2006 |            |     document *Inpatient Quality    |
|        |          |            |     Indicators Technical           |
|        |          |            |     Specifications*.               |
|        |          |            |                                    |
|        |          |            | 2.  Removed Appendix B.            |
|        |          |            |                                    |
|        |          |            | 3.  Added new section \"Using      |
|        |          |            |     Different Types of QI Rates.\" |
|        |          |            |                                    |
|        |          |            | 4.  Added explanation of changes   |
|        |          |            |     to area definitions and new    |
|        |          |            |     stratification options.        |
|        |          |            |                                    |
|        |          |            | 5.  Changed \"MSA\" to \"Metro     |
|        |          |            |     Area\" throughout the          |
|        |          |            |     document.                      |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Guide,     | 1.  Removed Appendices that were   |
|        | 20, 2006 | Software   |     copies of Change Log and       |
|        |          | Docu       |     Indicator Changes documents.   |
|        |          | mentation, |                                    |
|        |          | and        | 2.  Added Appendix of Links to all |
|        |          | Technical  |     IQI documents and additional   |
|        |          | Spe        |     resources.                     |
|        |          | cification |                                    |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Software   | 1.  Implemented changes associated |
|        | 20, 2006 | (SAS and   |     with ICD-9-CM coding updates   |
|        |          | SPSS),     |     for Fiscal Year (FY) 2006      |
|        |          | Software   |     (effective 10-1-2005). See     |
|        |          | Docu       |     separate documentation on      |
|        |          | mentation, |     ICD-9 coding updates for       |
|        |          | Guide, and |     specific details.              |
|        |          | Technical  |                                    |
|        |          | Spec       | 2.  The years for which the        |
|        |          | ifications |     ICD-9-CM and DRG codes         |
|        |          |            |     defining IQIs are valid was    |
|        |          |            |     amended to be through FY 2006  |
|        |          |            |     instead of FY 2005, that is,   |
|        |          |            |     the codes in the software are  |
|        |          |            |     effective through September    |
|        |          |            |     30, 2006.                      |
|        |          |            |                                    |
|        |          |            | 3.  Dropped pediatric heart        |
|        |          |            |     surgery indicators IQI #3      |
|        |          |            |     (volume) and IQI #10           |
|        |          |            |     (mortality), which are being   |
|        |          |            |     moved into the new Pediatric   |
|        |          |            |     Quality Indicators module.     |
|        |          |            |                                    |
|        |          |            | ```{=html}                         |
|        |          |            | <!-- -->                           |
|        |          |            | ```                                |
|        |          |            | 3.  Revised multiple indicators to |
|        |          |            |     exclude pediatric populations  |
|        |          |            |     (age less than 18).            |
|        |          |            |     Specifically, IQIs #1-2, 4-9,  |
|        |          |            |     11, 14, 23, 25-27, and 31.     |
|        |          |            |                                    |
|        |          |            | 4.  Added procedure codes 42.4,    |
|        |          |            |     42.5, 42.5x, 42.6, 42.6x to    |
|        |          |            |     inclusion criteria for IQI #1  |
|        |          |            |     (Esophageal Resection Volume)  |
|        |          |            |     and IQI #8 (Esophageal         |
|        |          |            |     Resection Mortality).          |
|        |          |            |                                    |
|        |          |            | 5.  Dropped esophageal cancer      |
|        |          |            |     diagnosis codes from the       |
|        |          |            |     inclusion criteria for IQI #1  |
|        |          |            |     (Esophageal Resection Volume). |
|        |          |            |                                    |
|        |          |            | 6.  Dropped pancreatic cancer      |
|        |          |            |     diagnosis codes from the       |
|        |          |            |     inclusion criteria IQI #2      |
|        |          |            |     (Pancreatic Resection Volume). |
|        |          |            |                                    |
|        |          |            | 7.  Added procedure code 39.71     |
|        |          |            |     (Endovascular implantation of  |
|        |          |            |     graft in abdominal aorta) to   |
|        |          |            |     inclusion criteria for IQI #4  |
|        |          |            |     (AAA Repair Volume) and IQI    |
|        |          |            |     #11 (AAA Repair Mortality).    |
|        |          |            |                                    |
|        |          |            | 8.  Dropped procedure code 36.06   |
|        |          |            |     from inclusion criteria for    |
|        |          |            |     IQI #6 (PTCA Volume), IQI #27  |
|        |          |            |     (PTCA Utilization) and IQI #30 |
|        |          |            |     (PTCA Mortality).              |
|        |          |            |                                    |
|        |          |            | 9.  Changed references from 3M     |
|        |          |            |     APR-DRG Version 15.0 to        |
|        |          |            |     Version 20.0.                  |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Software   | 1.  Amended Table 2 to add         |
|        | 20, 2006 | Doc        |     variables for expected, lower  |
|        |          | umentation |     and upper CI levels, and       |
|        |          | (SAS and   |     standard error of smoothed     |
|        |          | SPSS)      |     rate.                          |
|        |          |            |                                    |
|        |          |            | 2.  Amended Table 3 to include the |
|        |          |            |     new 1995-2006 census data      |
|        |          |            |     (POP95TO06.TXT).               |
|        |          |            |                                    |
|        |          |            | 3.  Removed section \"Interpreting |
|        |          |            |     the Results\".                 |
|        |          |            |                                    |
|        |          |            | 4.  Replaced example printouts     |
|        |          |            |     with tables explaining         |
|        |          |            |     contents of columns in         |
|        |          |            |     printouts.                     |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Software   | 1.  Added the 1995-2006 Census     |
|        | 20, 2006 | (SAS and   |     data (e.g., POP95TO06.TXT).    |
|        |          | SPSS)      |                                    |
|        |          |            | 2.  Updated the covariates to 3M   |
|        |          |            |     APR-DRG Version 20.0 (i.e.,    |
|        |          |            |     COVIQP30.TXT).                 |
|        |          |            |                                    |
|        |          |            | 3.  Changed the computation of the |
|        |          |            |     risk-adjusted rate to use a    |
|        |          |            |     proportional formula for       |
|        |          |            |     indirect standardization.      |
|        |          |            |                                    |
|        |          |            | 4.  Added a computation of exact   |
|        |          |            |     confidence limits.             |
|        |          |            |                                    |
|        |          |            | 5.  Changed name of data element   |
|        |          |            |     HOSPSTCO to PSTCO.             |
|        |          |            |                                    |
|        |          |            | 6.  Added parameter POPYEAR to     |
|        |          |            |     specify year for Census data.  |
+--------+----------+------------+------------------------------------+
| V3.0   | February | Software   | Updated the coefficients used in   |
|        | 20, 2006 | (SAS and   | the calculation of expected and    |
|        |          | SPSS),     | risk-adjusted rates to the 2003    |
|        |          | Software   | reference population.              |
|        |          | Doc        |                                    |
|        |          | umentation |                                    |
|        |          | and        |                                    |
|        |          | Covariates |                                    |
|        |          | document   |                                    |
+--------+----------+------------+------------------------------------+
| V2.1   | May 18,  | Software   | Updated the 2002 reference         |
| R4a    | 2005     | (SAS and   | population coefficients used in    |
|        |          | SPSS) and  | the calculation of expected and    |
|        |          | Covariate  | risk-adjusted rates.               |
|        |          | Table      |                                    |
+--------+----------+------------+------------------------------------+
| V2.1   | May 18,  | Software   | Corrected Pediatric Heart Surgery  |
| R4a    | 2005     | (SPSS)     | (IQI #3 and #10) exclusion for     |
|        |          |            | single procedure of vessel repair  |
|        |          |            | or occlusion (impacts less than    |
|        |          |            | 0.5% of cases)                     |
+--------+----------+------------+------------------------------------+
| V2.1   | December | Software   | Modified documentation to reflect  |
| R4     | 22, 2004 | (SAS and   | changes in indicators associated   |
|        |          | SPSS) and  | with ICD-9-CM coding updates for   |
|        |          | Guide      | FY 2005 (effective 10-1-2004). See |
|        |          |            | separate documentation on ICD-9    |
|        |          |            | coding updates for specific        |
|        |          |            | details.                           |
+--------+----------+------------+------------------------------------+
| V2.1   | December | Guide      | 1.  Corrected the low volume       |
| R4     | 22, 2004 |            |     threshold (10) for AAA         |
|        |          |            |     mortality (IQI #4) in Table 2. |
|        |          |            |                                    |
|        |          |            | 2.  Updated the provider, area and |
|        |          |            |     population rates in Table 2    |
|        |          |            |     and the detailed evidence      |
|        |          |            |     section using data from the    |
|        |          |            |     2002 HCUP SID files.           |
|        |          |            |                                    |
|        |          |            | 3.  In the detailed evidence       |
|        |          |            |     section, added a cross         |
|        |          |            |     reference from each indicator  |
|        |          |            |     description to the             |
|        |          |            |     indicator\'s detailed          |
|        |          |            |     definition in Appendix A.      |
|        |          |            |                                    |
|        |          |            | 4.  Included Appendix A titles of  |
|        |          |            |     detailed definitions in the    |
|        |          |            |     Table of Contents.             |
+--------+----------+------------+------------------------------------+
| V2.1   | December | Software   | 1.  Added an explicit age          |
| R4     | 22, 2004 | (SAS and   |     inclusion (age \>=18) to       |
|        |          | SPSS)      |     Craniotomy mortality (IQI      |
|        |          |            |     #13). The age inclusion had    |
|        |          |            |     been implicit in the DRGs 1,2, |
|        |          |            |     but not new DRGs 528, 529, 530 |
|        |          |            |     (FY 2004) and 543 (FY 2005).   |
|        |          |            |                                    |
|        |          |            | 2.  Added optional data elements   |
|        |          |            |     YEAR (year of patient          |
|        |          |            |     discharge) and DQTR (calendar  |
|        |          |            |     quarter of patient discharge). |
|        |          |            |     If available, these data       |
|        |          |            |     elements are used to implement |
|        |          |            |     a coding change to Stroke      |
|        |          |            |     mortality (IQI #17) that drops |
|        |          |            |     ICD-9-CM code 436 from the     |
|        |          |            |     denominator for discharges     |
|        |          |            |     occurring on or after          |
|        |          |            |     10/1/2004. However, ICD-9 code |
|        |          |            |     436 will be retained in the    |
|        |          |            |     denominator if the data        |
|        |          |            |     elements year and quarter of   |
|        |          |            |     discharge are not available or |
|        |          |            |     if the user selects the option |
|        |          |            |     to retain code 436 for         |
|        |          |            |     purposes of trending over      |
|        |          |            |     time.                          |
|        |          |            |                                    |
|        |          |            | 3.  Added the calculation and      |
|        |          |            |     reporting of the expected rate |
|        |          |            |     at the stratification level    |
|        |          |            |     selected by the user. The SAS  |
|        |          |            |     (IQSASP3.SAS) and SPSS         |
|        |          |            |     (IQSPSP3.SPS) software now     |
|        |          |            |     calculates the risk-adjusted   |
|        |          |            |     rate, the expected rate and    |
|        |          |            |     the smoothed rate. The rates   |
|        |          |            |     are saved in the output file.  |
|        |          |            |     The user also has the option   |
|        |          |            |     to print the rates or save the |
|        |          |            |     rates in a comma-delimited     |
|        |          |            |     ASCII file. (Note: the         |
|        |          |            |     parameter file MNSIQP00.TXT is |
|        |          |            |     no longer required).           |
+--------+----------+------------+------------------------------------+
| V2.1   | December | Software   | 1.  Added new user control         |
| R4     | 22, 2004 | Doc        |     parameter YEARQTR to           |
|        |          | umentation |     CONTROL_IQI.SAS and            |
|        |          | (SAS and   |     IQSPS1.SPS. This parameter is  |
|        |          | SPSS)      |     set to 1 if the data elements  |
|        |          |            |     YEAR and DQTR are available on |
|        |          |            |     the input data file. Otherwise |
|        |          |            |     the parameter is set to 0.     |
|        |          |            |                                    |
|        |          |            | 2.  Added optional data elements   |
|        |          |            |     YEAR (year of patient          |
|        |          |            |     discharge) and DQTR (calendar  |
|        |          |            |     quarter of patient discharge)  |
|        |          |            |     to Table 4.                    |
|        |          |            |                                    |
|        |          |            | 3.  Revised text to reflect that   |
|        |          |            |     calculation of expected rates  |
|        |          |            |     is now incorporated.           |
|        |          |            |                                    |
|        |          |            | 4.  Updated flowchart (Figure 1)   |
|        |          |            |     to eliminate the parameter     |
|        |          |            |     file MNSIQP00.TXT and include  |
|        |          |            |     \"expected\" in the            |
|        |          |            |     description of the rates       |
|        |          |            |     calculated.                    |
+--------+----------+------------+------------------------------------+
| V2.1   | July 21, | Guide      | 1.  Modified documentation to      |
| R3     | 2004     |            |     reflect changes in indicators  |
|        |          |            |     associated with ICD-9-CM       |
|        |          |            |     coding updates for FY 2004     |
|        |          |            |     (effective 10-1-2003). See     |
|        |          |            |     separate documentation on      |
|        |          |            |     ICD-9 coding updates for       |
|        |          |            |     specific details.[^2]          |
|        |          |            |                                    |
|        |          |            | 2.  Implemented changes to IQI #3, |
|        |          |            |     Pediatric Heart Surgery Volume |
|        |          |            |     Indicator, both in its         |
|        |          |            |     inclusion criteria and its     |
|        |          |            |     exclusion criteria. Inclusion  |
|        |          |            |     is now defined to be           |
|        |          |            |     discharges with ICD-9-CM       |
|        |          |            |     procedure codes for congenital |
|        |          |            |     heart disease (1P) in any      |
|        |          |            |     field or non-specific heart    |
|        |          |            |     surgery (2P) in any field with |
|        |          |            |     ICD-9-CM diagnosis of          |
|        |          |            |     congenital heart disease (2D)  |
|        |          |            |     in any field. Exclusions now   |
|        |          |            |     include MDC 14 (pregnancy,     |
|        |          |            |     childbirth and pueperium);     |
|        |          |            |     patients with transcatheter    |
|        |          |            |     interventions (either 3AP,     |
|        |          |            |     3BP, 3CP, 3DP, 3EP with 3D, or |
|        |          |            |     3FP) as single cardiac         |
|        |          |            |     procedures, performed without  |
|        |          |            |     bypass (5P) but with           |
|        |          |            |     catheterization (6P); patients |
|        |          |            |     with septal defects (4P) as    |
|        |          |            |     single cardiac procedures      |
|        |          |            |     without bypass (5P); heart     |
|        |          |            |     transplant (7P); premature     |
|        |          |            |     infants (4D) with PDA closure  |
|        |          |            |     (3D and 3EP) as only cardiac   |
|        |          |            |     procedure; age less than 30    |
|        |          |            |     days with PDA closure as only  |
|        |          |            |     cardiac procedure; missing     |
|        |          |            |     discharge disposition          |
|        |          |            |     (DISP=missing); and            |
|        |          |            |     transferring to another        |
|        |          |            |     short-term hospital (DISP=2).  |
|        |          |            |     These changes were the result  |
|        |          |            |     of research by the original    |
|        |          |            |     developers of this             |
|        |          |            |     indicator[^3], and are         |
|        |          |            |     designed to increase the       |
|        |          |            |     sensitivity and specificity of |
|        |          |            |     the indicator.                 |
|        |          |            |                                    |
|        |          |            | **Note:** Due to the large number  |
|        |          |            | of changes to the pediatric heart  |
|        |          |            | surgery indicators, comparing      |
|        |          |            | results with past versions is      |
|        |          |            | cautioned.                         |
|        |          |            |                                    |
|        |          |            | 3.  Implemented changes to IQI     |
|        |          |            |     #10, Pediatric Heart Surgery   |
|        |          |            |     Mortality Indicator, both in   |
|        |          |            |     its inclusion criteria and its |
|        |          |            |     exclusion criteria. Inclusion  |
|        |          |            |     is now defined to be           |
|        |          |            |     discharges with ICD-9-CM       |
|        |          |            |     procedure codes for congenital |
|        |          |            |     heart disease (1P) in any      |
|        |          |            |     field or non-specific heart    |
|        |          |            |     surgery (2P) in any field with |
|        |          |            |     ICD-9-CM diagnosis of          |
|        |          |            |     congenital heart disease (2D)  |
|        |          |            |     in any field. Exclusions now   |
|        |          |            |     include MDC 14 (pregnancy,     |
|        |          |            |     childbirth and pueperium);     |
|        |          |            |     patients with transcatheter    |
|        |          |            |     interventions (either 3AP,     |
|        |          |            |     3BP, 3CP, 3DP, 3EP with 3D, or |
|        |          |            |     3FP) as single cardiac         |
|        |          |            |     procedures, performed without  |
|        |          |            |     bypass (5P) but with           |
|        |          |            |     catheterization (6P); patients |
|        |          |            |     with septal defects (4P) as    |
|        |          |            |     single cardiac procedures      |
|        |          |            |     without bypass (5P); heart     |
|        |          |            |     transplant (7P); premature     |
|        |          |            |     infants (4D) with PDA closure  |
|        |          |            |     (3D and 3EP) as only cardiac   |
|        |          |            |     procedure; age less than 30    |
|        |          |            |     days with PDA closure as only  |
|        |          |            |     cardiac procedure; missing     |
|        |          |            |     discharge disposition          |
|        |          |            |     (DISP=missing); and            |
|        |          |            |     transferring to another        |
|        |          |            |     short-term hospital (DISP=2).  |
|        |          |            |     These changes were the result  |
|        |          |            |     of research by the original    |
|        |          |            |     developers of this indicator   |
|        |          |            |     (see footnote Error: Reference |
|        |          |            |     source not found), and are     |
|        |          |            |     designed to increase the       |
|        |          |            |     sensitivity and specificity of |
|        |          |            |     the indicator.                 |
|        |          |            |                                    |
|        |          |            | 4.  Eliminated MDC 14 (pregnancy,  |
|        |          |            |     childbirth, and pueperium) and |
|        |          |            |     MDC 15 (newborns and other     |
|        |          |            |     neonates) from exclusion       |
|        |          |            |     criteria for IQI #15, Acute    |
|        |          |            |     Myocardial Infarction (AMI)    |
|        |          |            |     Mortality Indicator. This      |
|        |          |            |     change was made since these    |
|        |          |            |     patients are at low risk for   |
|        |          |            |     AMI and removing these         |
|        |          |            |     patients brings the indicator  |
|        |          |            |     into alignment with other      |
|        |          |            |     national efforts. The          |
|        |          |            |     estimated impact is low.       |
|        |          |            |                                    |
|        |          |            | 5.  Established a new indicator    |
|        |          |            |     (IQI #32), AMI Mortality       |
|        |          |            |     Indicator -- Without Transfer  |
|        |          |            |     Cases. Unlike the existing     |
|        |          |            |     indicator for AMI mortality    |
|        |          |            |     (IQI #15), it excludes         |
|        |          |            |     patients transferring from     |
|        |          |            |     another short-term hospital    |
|        |          |            |     and patients with missing      |
|        |          |            |     admission source. This         |
|        |          |            |     indicator is closely related   |
|        |          |            |     to the JCAHO indicator for AMI |
|        |          |            |     mortality[^4] however it is    |
|        |          |            |     NOT risk adjusted in the same  |
|        |          |            |     manner as the JCAHO indicator  |
|        |          |            |     and does not exclude hospice   |
|        |          |            |     patients (due to inability to  |
|        |          |            |     identify hospice patients in   |
|        |          |            |     hospital discharge data).      |
|        |          |            |                                    |
|        |          |            | 6.  Implemented a change to IQI    |
|        |          |            |     #21, Cesarean Section Delivery |
|        |          |            |     Rate to exclude patients with  |
|        |          |            |     abnormal presentation, preterm |
|        |          |            |     delivery, fetal death, or      |
|        |          |            |     multiple gestation. These      |
|        |          |            |     changes create an indicator    |
|        |          |            |     that closely mirrors           |
|        |          |            |     indicators used by Healthy     |
|        |          |            |     People 2010[^5] .              |
|        |          |            |                                    |
|        |          |            | 7.  Created a new indicator (IQI   |
|        |          |            |     #33), Primary Cesarean         |
|        |          |            |     Delivery Rate which closely    |
|        |          |            |     mirrors the JCAHO measure for  |
|        |          |            |     Cesarean Delivery[^6]. This    |
|        |          |            |     indicator excludes patients    |
|        |          |            |     with abnormal presentation,    |
|        |          |            |     preterm delivery, fetal death, |
|        |          |            |     multiple gestation, and        |
|        |          |            |     patients with a prior Cesarean |
|        |          |            |     Section.                       |
|        |          |            |                                    |
|        |          |            | 8.  Implemented a change to IQI    |
|        |          |            |     #22, Vaginal Birth After       |
|        |          |            |     Cesarean Section (VBAC),       |
|        |          |            |     Uncomplicated to exclude       |
|        |          |            |     patients with diagnoses        |
|        |          |            |     describing abnormal            |
|        |          |            |     presentation, preterm          |
|        |          |            |     delivery, fetal death or       |
|        |          |            |     multiple gestation.            |
|        |          |            |                                    |
|        |          |            | 9.  Created new indicator (IQI     |
|        |          |            |     #34), Vaginal Birth After      |
|        |          |            |     Cesarean Section (VBAC) All,   |
|        |          |            |     which does not exclude         |
|        |          |            |     patients with diagnoses of     |
|        |          |            |     abnormal presentation, preterm |
|        |          |            |     delivery, fetal death, or      |
|        |          |            |     multiple gestation.            |
|        |          |            |                                    |
|        |          |            | 10. Implemented a change to IQI    |
|        |          |            |     #13, Craniotomy Mortality      |
|        |          |            |     Rate. Restructuring of the     |
|        |          |            |     DRGs for craniotomy occurred   |
|        |          |            |     in FY 2003. As a result, the   |
|        |          |            |     including definition of        |
|        |          |            |     craniotomy was revised to      |
|        |          |            |     include both DRG 001 and DRG   |
|        |          |            |     002 (Craniotomy with and       |
|        |          |            |     without comorbidities and      |
|        |          |            |     complications, \>17 years),    |
|        |          |            |     DRG 528 (Intracranial vascular |
|        |          |            |     procedure with principal       |
|        |          |            |     diagnosis of hemorrhage), and  |
|        |          |            |     DRG 529 and 530 (Ventricular   |
|        |          |            |     shunt procedures with and      |
|        |          |            |     without comorbidities and      |
|        |          |            |     complications). To maintain    |
|        |          |            |     comparability with previous    |
|        |          |            |     years of data, patients with a |
|        |          |            |     principle diagnosis of head    |
|        |          |            |     trauma are now excluded from   |
|        |          |            |     this indicator. Empirical      |
|        |          |            |     analyses demonstrate minimal   |
|        |          |            |     impact of these changes for    |
|        |          |            |     this indicator.                |
+--------+----------+------------+------------------------------------+
| V2.1   | July 21, | Software   | 1.  Implemented syntax changes     |
| R3     | 2004     | (SAS and   |     associated with ICD-9-CM       |
|        |          | SPSS)      |     coding updates from FY 2004    |
|        |          |            |     (effective 10-1-2003). See     |
|        |          |            |     separate documentation on      |
|        |          |            |     ICD-9 coding updates for       |
|        |          |            |     specific details.              |
|        |          |            |                                    |
|        |          |            | 2.  Implemented the option to      |
|        |          |            |     aggregate all area-based       |
|        |          |            |     indicators by Metropolitan     |
|        |          |            |     Statistical Area (MSA) and     |
|        |          |            |     County or just by County.      |
|        |          |            |                                    |
|        |          |            | 3.  Implemented all syntax changes |
|        |          |            |     required to implement the      |
|        |          |            |     indicator modifications (noted |
|        |          |            |     above under Guide) and         |
|        |          |            |     incorporated the related       |
|        |          |            |     documentation in the Software  |
|        |          |            |     manuals.                       |
|        |          |            |                                    |
|        |          |            | 4.  County-based population files  |
|        |          |            |     are now distributed with the   |
|        |          |            |     SAS and SPSS software, and the |
|        |          |            |     names of the population files  |
|        |          |            |     now have the letters "cty" in  |
|        |          |            |     their third, fourth and fifth  |
|        |          |            |     positions instead of the       |
|        |          |            |     letters "pop".                 |
|        |          |            |                                    |
|        |          |            | 5.  Converted mean-centering       |
|        |          |            |     routine for risk-adjustment to |
|        |          |            |     use population case-mix of     |
|        |          |            |     APR-DRG as reference           |
|        |          |            |     population for Age-Sex only    |
|        |          |            |     risk-adjustment. This change   |
|        |          |            |     resulting in the age-sex only  |
|        |          |            |     risk adjustment scaling closer |
|        |          |            |     to the mean.                   |
+--------+----------+------------+------------------------------------+
| V2.1   | July 21, | Software   | 1.  Implemented changes to all     |
| R3     | 2004     | (SAS)      |     mortality indicators excluding |
|        |          |            |     cases for which the value for  |
|        |          |            |     the variable "disposition of   |
|        |          |            |     patient" (DISP) is missing,    |
|        |          |            |     unknown or invalid. The SAS    |
|        |          |            |     software is now consistent     |
|        |          |            |     with the SPSS versions that    |
|        |          |            |     have always excluded cases     |
|        |          |            |     with missing, unknown, or      |
|        |          |            |     invalid disposition.           |
|        |          |            |                                    |
|        |          |            | 2.  Inserted "IQ" in format names  |
|        |          |            |     for age, sex and APR-DRG       |
|        |          |            |     aggregations in SAS programs   |
|        |          |            |     to distinguish these formats   |
|        |          |            |     from similarly named formats   |
|        |          |            |     used by other indicator        |
|        |          |            |     software.                      |
+--------+----------+------------+------------------------------------+
| V2.1   | Sept. 4, | Software   | 1.  Congestive Heart Failure (CHF) |
| R3     | 2003     | (SAS and   |     Mortality Rate: The            |
|        |          | SPSS) and  |     denominator exclusion of       |
|        |          | Guide      |     patients undergoing a cardiac  |
|        |          |            |     procedure was removed from CHF |
|        |          |            |     Mortality Rate. This exclusion |
|        |          |            |     was unnecessary due to the use |
|        |          |            |     of APR-DRGs for risk           |
|        |          |            |     adjustment and to provide      |
|        |          |            |     consistency across indicators  |
|        |          |            |     (e.g. AMI patients with these  |
|        |          |            |     procedures are not excluded).  |
|        |          |            |                                    |
|        |          |            | 2.  Bilateral Heart                |
|        |          |            |     Catheterization Rate: Codes    |
|        |          |            |     404.xx for hypertensive heart  |
|        |          |            |     disease were added to the      |
|        |          |            |     denominator exclusion.         |
|        |          |            |                                    |
|        |          |            | 3.  Pediatric Heart Surgery Volume |
|        |          |            |     and Mortality Rate: The code   |
|        |          |            |     36.3 was added to numerator    |
|        |          |            |     including definition of        |
|        |          |            |     pediatric heart surgery (#2P)  |
|        |          |            |     to reflect coding before       |
|        |          |            |     October 1, 1998.               |
|        |          |            |                                    |
|        |          |            | 4.  Mortality after Hip            |
|        |          |            |     Replacement: The code 716.69   |
|        |          |            |     was deleted from the including |
|        |          |            |     definition of osteoarthritis   |
|        |          |            |     (the fifth digit "9"           |
|        |          |            |     indicating "multiple sites" is |
|        |          |            |     not valid for 716.6x).         |
+--------+----------+------------+------------------------------------+
| V2.1   | Sept. 4, | Software   | 1.  All parameter text files were  |
| R2     | 2003     | (SAS and   |     renamed to refer specifically  |
|        |          | SPSS)      |     to the IQI module (e.g., use   |
|        |          |            |     of IQ in file name). These     |
|        |          |            |     changes are also reflected in  |
|        |          |            |     the software documentation.    |
|        |          |            |                                    |
|        |          |            | 2.  All parameter files were rerun |
|        |          |            |     using the updated software and |
|        |          |            |     Year 2000 HCUP SID data.       |
|        |          |            |                                    |
|        |          |            | 3.  Population files for 2000, and |
|        |          |            |     2001 were re-estimated using   |
|        |          |            |     the latest available census    |
|        |          |            |     files.                         |
+--------+----------+------------+------------------------------------+
| V2.1   | Sept. 4, | Software   | The treatment of missing data by   |
| R2     | 2003     | (SPSS)     | SPSS was changed to mirror the     |
|        |          |            | treatment of missing data by SAS,  |
|        |          |            | specifically the software requires |
|        |          |            | confirmation for the assignment of |
|        |          |            | a poor outcome or negative event.  |
|        |          |            | For instance, in order to be       |
|        |          |            | assigned as a death, each case     |
|        |          |            | must actually be coded as a death. |
|        |          |            | Missing data is considered         |
|        |          |            | neutral. Missing data for some     |
|        |          |            | elements results in the exclusion  |
|        |          |            | of that case from the denominator. |
|        |          |            | For a few other elements, the case |
|        |          |            | is retained. Table 5 of the        |
|        |          |            | Software Documentation lists the   |
|        |          |            | impact of missing data for each    |
|        |          |            | data element.                      |
+--------+----------+------------+------------------------------------+

[^1]: *Fiscal Year 2007 Coding Changes, (Effectiver October 1, 2006)*,
    available at
    <http://www.qualityindicators.ahrq.gov/iqi_download.htm>.

[^2]: *IQI ICD-9-CM Coding Chages, September 2003 - July 2004*,
    available at
    <http://www.qualityindicators.ahrq.gov/iqi_archive.htm>.

[^3]: Kathy Jenkins et al., Boston Children's Hospital and Harvard
    University. See Center-specific differences in mortality:
    preliminary analyses using the Risk Adjustment in Congenital Heart
    Surgery (RACHS-1) method. J Thorac Cardiovasc Surg. 2002
    Jul;124(1):97-104

[^4]: <http://www.jcaho.org/pms/core+measures/information+on+final+specifications.htm>.
    See AMI-9 and Appendix A

[^5]: <http://www.healthypeople.gov/Document/html/tracking/od16.htm#obstetcare>.
    See 16-9

[^6]: <http://www.jcaho.org/pms/core+measures/information+on+final+specifications.htm>.
    See PR-1 and Appendix A