Introduction

Health policymakers, health care administrators, employers

who purchase health insurance, and clinicians want highquality, safe health care that is accessible and affordable for

Americans. They need current information to develop

policies and programs that improve access to health care,

help guide consumer choices, ensure accountability,

measure the quality of care patients are receiving, help

track the costs of health care, and guide clinical

decisionmaking. Recognizing these needs, the Agency for

Healthcare Research and Quality (AHRQ) has devoted

significant funding to the creation of tools and resources

that will help meet the needs of the U.S. health care system. 

This report briefly describes the tools and resources that

AHRQ has made available, such as data sets, assessment

and performance measures, clinical care guidelines, and

quality measurement indicators. Examples of how these

tools and resources are being used by Federal, State, and

local governments; private industry; health service

providers; hospital associations; and health maintenance

organizations to improve health care quality and help

consumers make more informed choices are also provided. 

Background

Health care decisionmakers require accurate and timely

information to be able to identify problems in health care

delivery and develop a strategy to overcome them. State

legislators, legislative staff members, and State health

agency managers have indicated that reading all of the

available health research is challenging simply because of

its volume.1 These policymakers further said that when

they need information, they turn to experts and simple,

easily understood materials to find their answers.1 To

assess availability of health insurance, access to care, and

costs as well as to prevent overuse, underuse, and misuse of

health care services, tools must be available to measure

patient outcomes and the quality of health care that patients

receive.2 The tools and resources that AHRQ has developed

AHRQ Tools and Resources for Better Health Care

Making a Difference

Data resources and tools: information and software to

analyze health insurance, health services, hospitalization

access, and cost...Page 3

Assessment tools: patients’ experiences with their health

care services and health system response capability to

bioterrorism...Page 7

Clinical care tools: preventive care and clinical

guidelines...Page 8

Quality measurement tools: assessment of clinical

performance and the quality of services...Page 10

RESEARCH IN ACTION

Agency for Healthcare Research and Quality • www.ahrq.gov

Issue #10 December 2002

Author: Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S.

Managing Editor: Margaret K. Rutherford

Design and Production: Joel Boches

Suggested citation: Kass-Bartelmes BL, Rutherford MK. AHRQ tools and resources for better health care. Rockville (MD): Agency for Healthcare Research and

Quality; 2002. Research in Action Issue 10. AHRQ Pub No. 03-0008.
can help decisionmakers by providing information they can

use for comparison and as quality indicators to assess their

own performance. 

Data resources provide survey information to help track and

identify trends in health insurance, health services,

hospitalizations, cost, access, and quality of care. AHRQ

data resources include:

• The Medical Expenditure Panel Survey (MEPS)—A

nationwide survey of families and individuals that

collects information and helps produce reports

containing annual estimates of health status, health

insurance coverage, health care use and expenses, and

sources of payment for health care services.3 MEPSnet

is an online tool that provides instant statistics.4

• The Healthcare Cost and Utilization Project

(HCUP)—A data system consisting of inpatient

information collected from over 1,000 hospitals

nationwide, State community hospitals, and hospitalaffiliated ambulatory surgical care sites.5 HCUPnet is

an online tool that analyzes statistics on hospital care.6

Clinical Classifications Software, created for HCUP, can

be used to analyze diagnoses and procedures.7,8

• HIVnet—An online tool for service providers, program

planners, policymakers, and health services researchers

that calculates selected statistics on health services use

for HIV-related care.9

Assessment tools capture patients’ experiences with their

health care services. They also evaluate the ability of the

Nation’s health system to meet the public’s health needs.

Assessment tools provided by AHRQ include:

• CAHPS® (formerly known as the Consumer

Assessment of Health Plans)—A set of rigorously

tested and standardized questionnaires and reporting

formats that can be used to collect and report

meaningful and reliable information about the

experiences of consumers enrolled in health plans in

many health care settings.10

• Hospital Bioterrorism Preparedness Tool—A

questionnaire for hospitals developed to assess the

capacity of hospitals and health systems to respond to

bioterrorism.11

Clinical care tools assist providers in delivering needed

health services. AHRQ clinical care tools include:

• Put Prevention into Practice (PPIP)—A national

program to help improve delivery of appropriate clinical

preventive services.12

• The National Guideline Clearinghouse (NGC)—An

online public resource for clinicians, providers, and

others that includes detailed information on evidencebased clinical practice guidelines.13

Quality measurement tools can be used to assess clinical

performance. AHRQ provides access to the following

quality measurement tools:

• Child Health Toolbox—An online collection of

performance measures for child health programs.14

• AHRQ Quality Indicators (QIs)—Online software

programs to help hospitals, State and local health

agencies, and others screen hospital discharge data for

potential problems with the quality of inpatient and

ambulatory care.15,16

Links to AHRQ tools and resources on the Internet are

shown in Box 1.

2 www.ahrq.gov

Box 1. Links to AHRQ tools on the internet

Data resources—

MEPS: http://www.meps.ahrq.gov/

HCUP: http://www.ahrq.gov/data/hcup/

HIVnet: http://www.ahrq.gov/data/hivnet.htm

Assessment tools—

CAHPS®: http://www.ahrq.gov/qual/cahpsix.htm

Hospital bioterrorism preparedness tool: 

http://www.ahrq.gov/about/cpcr/bioterrorism.htm

Clinical care tools—

PPIP: http://www.ahrq.gov/clinic/ppipix.htm

NGC: http://www.guideline.gov

Quality measurement tools—

Child Health Toolbox: http://www.ahrq.gov/chtoolbx/

Prevention Quality Indicators: 

http://www.ahrq.gov/data/hcup/prevqi.htm

Inpatient Quality Indicators: 

http://www.ahrq.gov/data/hcup/inpatqi.htm
AHRQ data resources and tools

MEPS has information on use of health services 

MEPS is designed to provide policymakers, health care

administrators, business executives, and others with timely,

comprehensive information about health care use and costs

in the United States.3 Information is collected either by

talking directly with people in households, nursing homes,

and hospitals, and with businesses, physicians, and home

care providers, or by gathering data from databases. MEPS

data provide answers about the specific health services that

Americans use, how frequently they use them, the cost of

these services, and how they are paid for, as well as data on

the cost, scope, and breadth of private health insurance held

by and available to the U.S. population. The information

collected is organized into three components: 

• The Household Component (HC) collects data from a

sample of families and individuals across the Nation. 

• The Medical Provider Component (MPC) supplements

information received from respondents to the MEPS HC

with data from hospitals, physicians, and home health

care providers. 

• The Insurance Component (IC) consists of detailed

information on the health insurance held by and offered

to those surveyed in the MEPS HC and a representative

sample of business establishments and governments

throughout the United States.

Decisionmakers can compare their experience with national

trends using these findings. For example, MEPS HC data

show that during the first half of 2001, 23.1 percent of

children under age 18 were covered by public health

insurance, primarily Medicaid (Figure 1). However, 14.5

percent of children remained uninsured during this time.17

Data on expenses from the 1998 MEPS HC indicate that

most medical expenses were paid for by either private or

public insurance (Figure 2).18

MEPS HC data are very detailed, so data on health services

spending and health insurance can be linked to the

demographic, employment, economic, health status, and

other characteristics of the people who are surveyed.3 It is

www.ahrq.gov 3

Children under age 18

0

10

20

30

40

50

60

70

Private Public only Uninsured

62.4%

23.1%

14.5%

Percent

Figure 1. Health insurance coverage of children under

age 18: United States, first half of 2001

Source: Agency for Healthcare Research and Quality. Statistical Brief #4. 

The uninsured in America – 2001. Rockville (MD); 2002. AHRQ Web site:

<http://www.meps.ahrq.gov/papers/st4/stat04.htm>. Accessed Sept. 25, 2002.

Private Insurance Medicare Medicaid

Out-of-pocket Other

38.7%

24.1%

8.6%

19.3%

9.4%

Figure 2. Medical expenses by source of payment:

United States, 1998

Source: Agency for Healthcare Research and Quality. Health care expenses in the U.S.

civilian noninstitutionalized population, 1998. Rockville (MD); June 2002. AHRQ Web

site: <http://www.meps.ahrq.gov/compendiumtables/98ch1/compendiumtables.htm>.
the only national survey whose findings can be used to help

estimate how changes in sources of payment and insurance

coverage impact different people, such as the poor, elderly,

families, veterans, the uninsured, and racial and ethnic

minorities.3 While the MEPS HC can provide this

information only on a national level, not at the State level,

decisionmakers can use national estimates to evaluate how

local communities compare with the Nation as a whole and

identify areas that are doing well, along with those areas

that need improvement. 

MEPS can also help evaluate Americans’ experiences with

health care based on questions taken from CAHPS®. For

instance, MEPS respondents were asked CAHPS®-based

questions about the timeliness of the urgent and routine

medical care they received. People without insurance were

more likely than those with coverage to report that they

sometimes or never received urgent care as soon as they

wanted (Figure 3).

The MEPS Insurance Component uses the health insurance

information gathered from people in the Household

Component and interviews their employers and union

officials about that health insurance, and it also interviews

a sample of employers nationwide.3 Specifically, the

MEPS IC collects information on the amount, types, and

costs of health insurance available to Americans at their

work places.3 This information is available at the State

level for all 50 States. For example, MEPS IC data for

2000 show that nearly 60 percent of private-sector

establishments in the United States offer health insurance

(Figure 4). However, the percent of private employers

varies widely among States, from Connecticut at 69.4

percent to South Dakota at 42.4 percent.19

MEPSnet is an online tool that allows anyone to get MEPS

statistics immediately. MEPSnet/HC currently provides

access to 1997 and 1998 information on family

composition, geographic and demographic variables,

income and tax filing, employment, health insurance,

health status, health care use, expenditures, and sources of

payment. MEPSnet/IC provides easy access to national

statistics and trends about health insurance offered by

private employers and State and local governments for 1996

through 2000.3

MEPS data have been used by government, private,

and public organizations

• MEPS 1996 data on medical conditions were used to

help formulate recommendations of the 2001

Institute of Medicine Report, Crossing the Quality

Chasm: A New Health System for the 21st Century.20

• In 2001, the Heritage Foundation in Washington,

DC, sought MEPS data on employer-based health

insurance relevant to the Patients’ Bill of Rights

legislation being debated on Capitol Hill. 

• Since the second quarter of 2000, the U.S.

Commerce Department’s Bureau of Economic

Analysis has used the MEPS IC in its estimate of the

Gross Domestic Product (GDP). The Commerce

Department also used the MEPS IC in its revisions

of GDP estimates from 1997 through the first

quarter of 2000. 

• From March to June 2001, AHRQ’s Center for Cost

and Financing Studies responded to requests from

the Council of Economic Advisors, the Treasury

Department, and the Congressional Budget Office

regarding information from the 1996 MEPS on

individual premiums. These requests stemmed from

proposals in the 107th Congress intended to reduce

the number of uninsured people by offering tax

credits to subsidize health insurance premiums. 

4 www.ahrq.gov Percent

Private Public only Uninsured

0

5

10

15

20

25

30

35

16.1%

19.1%

28.6%

Figure 3. Percent of Americans ages 18-64 who did

not receive urgent care as soon as they wanted, by

insurance coverage: United States, 2000

Source: Agency for Healthcare Research and Quality. Statistical Brief #2. Access and

experiences regarding medical care, fall 2000. Rockville (MD). Mar. 2002. AHRQ Web

site: <http://www.meps.ahrq.gov/papers/st2/stat02.htm>.
www.ahrq.gov 5

South Dakota

New Mexico

Texas

Oregon

Maryland

Alabama

New York

Michigan

Connecticut

United States

0 10 20 30 40 50 60 70 80

42.4%

52.6%

52.8%

55.3%

57.7%

62.1%

62.5%

63.9%

69.4%

59.3%

Percent

Figure 4. Percent of private-sector establishments that offer health insurance by selected States: 

United States, 2000

Source: Agency for Healthcare Research and Quality. 2000 Medical Expenditure Panel Survey—Insurance Component. Table II.A.2(2000) Percent of private-sector establishments that offer

health insurance by firm size and State: United States, 2000. Rockville (MD). AHRQ Web site: <http://www.meps.ahrq.gov/mepsdata/ic/2000/index200.htm>. Accessed Sept. 25, 2002.

• In October 2000, 19 State government agencies

joined together to place a special data request for

employer data from the MEPS IC. The request was

part of an Institute for Health Policy Solutions

project to work with States interested in coordinating

public subsidies with private coverage on behalf of

low-income children, workers, and families (for

example, under State Children’s Health Insurance

Programs, or SCHIP).

HCUP provides data about hospitalizations

HCUP can be used to examine hospital use, access to care,

charges, quality, and outcomes for diseases and hospital

procedures, and to study the care furnished to population

subgroups such as minorities, children, women, and the

uninsured. HCUP data come from AHRQ-funded

databases: the Nationwide Inpatient Sample (NIS), the

State Inpatient Databases (SID), the State Ambulatory

Surgery Databases (SASD), and the Kids’ Inpatient

Database (KID). Researchers and policymakers use HCUP

data to identify, track, analyze, and compare hospital

statistics at the national, regional, and State levels.5 For

example, for some common conditions, hospitalization

charges increased between 1993 and 2000 but the average

length of stay decreased (Figures 5 and 6).21

HCUPnet is an online interactive tool that can be used to

identify, track, analyze, and compare statistics on hospital

care at the national level as well as for selected States.

Users can conduct analyses on outcomes and measures of

specific conditions, including length of stay, total hospital
6 www.ahrq.gov

1993 2000

$28,663

$24,365

$19,956

$15,104 $15,293

$12,491

$20,578

$17,909

$15,365

$12,860 $11,995 $11,263

Heart attack Blood poisoning Stroke Pneumonia Congestive heart

failure

Chronic obstructive

pulmonary disease

0

$10,000

$20,000

$30,000

Figure 5. Average hospital charge per patient: United States

Source: Agency for Healthcare Research and Quality. AHRQ data show rising hospital charges, falling hospital stays. Press release. Sept. 18, 2002. AHRQ Web site:

<http://www.ahrq.gov/news/press/pr2002/rishospr.htm>.

charges, in-hospital deaths, and discharge status. These can

then be compared with data on patients by age, sex,

primary payer and income, and on types of hospitals.6

Clinical Classifications Software (CCS) is a tool developed

for HCUP data that clusters patient diagnoses and

procedures into a manageable number of clinically

meaningful categories. CCS collapses diagnosis and

procedure codes from the International Classification of

Diseases, 9th Revision, Clinical Modification (ICD-9-CM),

and the International Statistical Classification of Diseases

and Related Health Problems, 10th Revision (ICD-10).

CCS is used for grouping conditions and procedures

without having to wade through thousands of codes. This

“clinical grouper” makes it easier to quickly understand

patterns of diagnoses and procedures so that health plans,

policymakers, and researchers can analyze costs, utilization,

and outcomes associated with particular illnesses and

procedures. 7,8

HCUP and CCS measure the quality of health care

delivered by providers

• The Oklahoma Department of Health’s Healthcare

Information Division used the Nationwide Inpatient

Sample and the Clinical Classifications Software to

develop a comprehensive annual report of hospital

admissions in the State and to make comparisons

with national figures. The data have prompted the

development of several prevention campaigns aimed

at encouraging seniors to get their flu and pneumonia

vaccines. 

• Insurers use CCS to develop clinically based

utilization profiles. For example, one insurer

integrated CCS into inhouse software that develops

profiles of patient populations and purchasers.

• Researchers use CCS in risk-adjustment models and

as a way to predict future health resource use.

Investigators in one study found that categorizing

patients using CCS predicted over 40 percent of the

subsequent year’s medical expenses.

HIVnet has statistics on HIV-related medical care

HIVnet is an online tool that provides information on

inpatient and outpatient use by people with HIV disease.

HIVnet provides easy access to selected statistics on

patterns of HIV-related care based on data collected by the

HIV Research Network. The HIV Research Network

obtains, analyzes, and disseminates current information on
www.ahrq.gov 7

the delivery of services to people with HIV infection. It

presently includes 18 medical practices located across the

United States that treat more than 14,000 patients. Each

practice collects information on clinical and demographic

characteristics, medications prescribed, frequency of

outpatient clinic visits, and number of inpatient admissions

for each patient with HIV infection.9

AHRQ cosponsors the HIV Research Network with other

Federal agencies: the Center for Substance Abuse

Treatment in the Substance Abuse and Mental Health

Services Administration, the HIV/AIDS Bureau in the

Health Resources and Services Administration, and the

Office of AIDS Research in the Office of the Director of

the National Institutes of Health.9

AHRQ assessment tools

CAHPS® assesses consumers’ experiences with

health services

CAHPS® is a family of rigorously tested and standardized

questionnaires and reporting formats that can be used to

collect and report meaningful and reliable information

about the experiences of consumers with a variety of health

services. The goal of CAHPS® is for consumers to use its

data to make informed decisions about their health care

services. Supplemental questions have been added to a

core set of items to address specific populations such as

Medicaid recipients, Medicare beneficiaries, people with

chronic conditions, and children with special health care

needs, as well as particular health care services such as

prescriptions and transportation. The latest version, the

CAHPS® 3.0 Survey and Reporting Kit, contains a set of

questions that ask consumers about their experiences with

their health plans, sample formats for reporting results to

consumers, software to assist in data analysis, and guidance

and instructions. The questionnaires are in both English

and Spanish.10

Examples of questions include:

• Since you joined your health plan, how much of a

problem, if any, was it to get a personal doctor or nurse

you are happy with?

• In the last 12 months, how much of a problem, if any,

was it to see a specialist that you needed to see?

• In the last 12 months, when you called during regular

office hours, how often did you get the help or advice

you needed?

5.5

8.2

6.7

6.0 5.6 5.3

7.4

10.0

9.5

7.8 7.4 7.2

Heart attack Blood poisoning Stroke Pneumonia Congestive heart

failure

Chronic obstructive

pulmonary disease

0

2

4

6

8

10

12

1993 2000

Days

Figure 6. Average hospital stay: United States

Source: Agency for Healthcare Research and Quality. AHRQ data show rising hospital charges, falling hospital stays. Press release. Sept. 18, 2002. AHRQ Web site:

<http://www.ahrq.gov/news/press/pr2002/rishospr.htm>.
To receive copies of the survey instruments and reporting

tools or for guidance in implementation, please contact the

CAHPS® Helpline at 1-800-492-9261 or e-mail

cahps1@westat.com.

CAHPS® is used to monitor the quality of health

plans

• In 1999, the U.S. Office of Personnel Management

adopted CAHPS® for use by the Federal Employees

Health Benefits Program to survey Federal

employees. The results are reported to 9 million

Federal employees and their dependents in an annual

guide to help them choose health plans. 

• CAHPS® also was adopted into the Health Plan

Employer Data and Information Set (HEDIS®),

which is used to evaluate and accredit managed care

plans. HEDIS® is sponsored by the National

Committee for Quality Assurance, and measures

clinical services and use such as preventive care,

cancer screening, prenatal care, mental health, and

access to care.22

• The Centers for Medicare & Medicaid Services

(CMS) (formerly the Health Care Financing

Administration) has used a specially developed

version of CAHPS® to survey 130,000 Medicare

enrollees in managed care plans. The results of the

Medicare survey were released in February 1999 to

help CMS’s 39 million beneficiaries select a health

plan. 

• State health departments in 34 States have used

CAHPS® to assess member satisfaction with their

health care.

Bioterrorism preparedness tool gauges health system

capabilities

The hospital bioterrorism preparedness tool helps assess the

current capacity of hospitals and health systems to respond

to a bioterrorist attack, in particular the capacity of existing

hospital and public health systems to communicate and to

develop an effective medical response to a bioterrorist

threat. The methodology for assessing regional medical

capacity and plans involves use of the data collection tool,

model criteria, and a simulation and analysis model. The

Bioterrorism Emergency Planning and Preparedness

Questionnaire for Healthcare Facilities is available in both

PDF and text format. Examples of questions asked

include:

• Does your hospital’s emergency preparedness plan

address mass casualty incidents involving biological

agents?

• Does your hospital have a coordinator designated to

oversee all preparedness efforts as they relate to your

hospital’s bioterrorism preparedness efforts?

• Does your hospital experience problems staffing your

emergency department, general medical, pediatrics, and

surgical floors with nurses employed by the hospital?11

The methodology could be further refined in a larger study

and pilot tested in a region to identify additional needs and

requirements. Once completed, this methodology could be

used by city and State planners to assess medical capacity

and the adequacy of emergency medical response plans.

Developing this standardized approach would help State

planners better communicate medical resource needs for a

bioterrorist event or other mass casualty event.11

AHRQ clinical care tools

PPIP helps clinicians and patients practice prevention

Put Prevention Into Practice (PPIP) is a program sponsored

by AHRQ to increase the appropriate use of clinical

preventive services, such as screening tests, immunizations,

chemoprevention, and counseling.23 PPIP is derived from

the evidence-based recommendations of the U.S. Preventive

Services Task Force. New and updated Task Force

recommendations and important evidence reviews are

available in two convenient three-ring binders and on the

AHRQ Web site. PPIP tools enable health care providers to

determine which services their patients should receive and

provide guidance on setting up a system to facilitate their

delivery. PPIP patient materials make it easier for patients

to understand and keep track of their preventive care.12,23

PPIP materials include:

• The Clinician’s Handbook of Preventive Services,

second edition. This is both a reference tool and a

practical guide to delivering clinical preventive services

in a variety of settings.23

• A Step-by-Step Guide to Delivering Clinical Preventive

Services: A Systems Approach. This new Guide

describes steps to help office staff and clinicians

8 www.ahrq.gov
implement a formal system for delivering clinical

preventive services. Chapters explain how to establish a

process, assess current practice and readiness, develop a

protocol, and evaluate the system. The Guide provides

easy-to-follow steps, encourages teamwork, and is

adaptable to all practice settings.24

• The Guide also includes health risk profiles, preventive

care flow sheets, and waiting room and prevention

timeline posters.23

• Pocket-sized guides for patients and the general public,

including the Personal and Child Health Guides and

Staying Healthy at 50+ (all available in English and

Spanish).23

• Other prevention products include reminder postcards

and brief, easy-to-read summaries of recent Task Force

recommendations entitled What’s New from the U.S.

Preventive Services Task Force.23

PPIP has been used by clinicians and health systems

• In 1994, the Texas Department of Health (TDH)

established support systems throughout the State to

encourage the implementation of PPIP. TDH also

provided startup funds to primary care sites

statewide. Specially trained registered nurses are

stationed around the State to provide one-on-one

instruction in the use of materials and PPIP

implementation. In addition, TDH developed

companion pieces, including a 20-item

comprehensive health risk assessment, a 10-item

targeted risk assessment, and a self-administered risk

assessment.

• PPIP tools are part of the STEP-UP (Study To

Enhance Prevention by Understanding Practice)

clinical trial. STEP-UP, launched in 1997, involves

80 family practices and clinics across Northeast Ohio

in urban, rural, and suburban areas. This study

evaluates a preventive service delivery intervention

that is tailored to the unique characteristics of each

practice. PPIP materials included in the STEP-UP

manual include adult and child preventive care flow

sheets, child immunization flow sheets, posters, and

patient reminder postcards.

• The U.S. Air Force adopted the PPIP materials in

1995 and continues active use of the Clinician’s

Handbook, Personal Health Guide, Child Health

Guide, and posters to help stimulate discussions

between clients and providers about preventive care.

The timeline posters are displayed in the examining

rooms of 84 family practice clinics. The Air Force

also uses the adult and child health guides as

teaching tools and as vehicles to encourage patients

to be active participants in their own preventive care

by keeping track of services received and future

preventive care needs.25

The NGC provides access to clinical guidelines

The National Guideline ClearinghouseTM, sponsored by

AHRQ in partnership with the American Medical

Association and the American Association of Health Plans,

is an online database of evidence-based clinical practice

guidelines. The NGC contained 200 guidelines when it was

launched in December 1998. Since then, the content of the

NGC has grown to over 1,000 clinical practice guidelines

submitted by more than 165 health care organizations and

other entities in the United States and other countries. Its

key components include:

• Summaries of guideline recommendations and

development.

• Side-by-side comparison of two or more guidelines.

• Syntheses of guidelines covering similar topics.

• Links to full-text guidelines.

• E-mail notification of new and updated guidelines.

• Annotated bibliographies on guideline development

methodology, evaluation, implementation, and

structure.13

Clinical practice guidelines included in the NGC meet the

following criteria:

• The clinical practice guideline meets the Institute of

Medicine’s definition of a clinical practice guideline:

systematically developed statements to assist

practitioner and patient decisions about appropriate

health care for specific clinical circumstances.26,27

• It was produced under the auspices of medical specialty

associations; relevant professional societies; public or

private organizations; government agencies at the

Federal, State, or local level; or health care organizations

or plans.26

www.ahrq.gov 9
• A systematic literature search and review of existing

scientific evidence published in peer-reviewed journals

was performed during guideline development.26

• The guideline is current and the most recent version

produced. The guideline was developed, reviewed, or

revised within the last 5 years.26

The NGC has been used by clinicians, medical

schools, and health systems

• Georgetown University’s Department of Family

Medicine uses the NGC and the U.S. Preventive

Services Task Force materials as part of the training

students receive in family medicine. The Web-based

reference (http://www.family.georgetown.edu/

webref/) is used in conjunction with live classroom

instruction and also used by students before, during,

and after class to prepare or follow up on discussion. 

• The University of Michigan Health System (UMHS)

in Ann Arbor has developed a program entitled

Guidelines Utilization, Implementation,

Development and Evaluation Studies (GUIDES).

Now in its sixth year, UMHS has 10 of its guidelines

in the NGC. The NGC is especially valuable in

disseminating UMHS work to other institutions and

is used by medical librarians, students, and

physicians to search for existing guidelines on new

topics. 

AHRQ quality measurement tools

The Child Health Toolbox helps measure quality

Because children’s health care needs are different from

those of adults, AHRQ has collected various measurement

sets to assess the performance of child health programs and

has made them accessible in its Child Health Toolbox. This

online resource can help State and local policymakers,

program directors, and staff develop plans that reliably

measure the performance of child health programs, such as

whether children are receiving quality health care and

whether a health program is functioning effectively.

Specifically, this Web site has access to tools and

information on how to measure performance, access,

quality, and health service delivery, as well as concepts,

tips, and tools for evaluating Medicaid, the State Children’s

Health Insurance Program (SCHIP), Title V, and other

health care service programs for children. Information

about how to develop performance guidelines can also be

found at this site.14

The NQMC will expand access to quality measures

AHRQ is sponsoring the development of the Internet-based

National Quality Measures ClearinghouseTM (NQMC) to

promote widespread access to quality measures. This

resource of health quality measures significantly enhances,

updates, and essentially replaces AHRQ’s COmputerized

Needs-oriented QUality Measurement Evaluation SysTem

(CONQUEST), an earlier database of performance

measures. The NQMC will use the Internet to effectively

and efficiently reach a broad audience within the health

care community. The database will help practitioners and

organizations quickly identify and access quality measures.

The NQMC Web site is expected to be available by winter

2002. Summaries of quality measures will be retrievable

by many parameters, including topic, target population, and

setting of care. NQMC users will be able to search the

NQMC and the NGC simultaneously.28

AHRQ Quality Indicators will improve hospital care

AHRQ is developing three sets of Quality Indicators (QIs)

to identify specific areas where problems may exist in a

hospital: prevention, inpatient care, and patient safety.

These indicators use hospital inpatient administrative data

to measure health care quality. Program managers,

researchers, and other health care decisionmakers can use

the AHRQ QI software and user’s guide to help them apply

the QIs to their own data. The QIs can identify areas that

need further study and investigation and can track changes

over time.15

The Prevention QIs are a set of measures that can identify

ambulatory-care-sensitive conditions. These are conditions

for which good outpatient care might prevent the need for

hospitalization or for which early intervention can prevent

complications or more severe disease. Such conditions

include bacterial pneumonia, urinary tract infections,

congestive heart failure, and asthma.16

Inpatient QIs reflect the quality of care inside hospitals and

include: 

• Inpatient mortality for 13 medical conditions. 

• Inpatient mortality for 9 procedures. 

• Utilization rates of procedures for which there are

questions of overuse, underuse, or misuse.

10 www.ahrq.gov
• Volume of procedures for which there is evidence that a

higher volume of procedures is associated with lower

mortality.15

The Inpatient QI software contains information at the

hospital and area levels. Hospitals can use these data to

identify questionable use of procedures to investigate

quality problems and make improvements.29

Patient Safety QIs also reflect quality of care inside

hospitals but focus on surgical complications, adverse

events, infections acquired in the hospital, and other

problems that may result from medical treatment. This

module is currently under development by the University of

California at San Francisco-Stanford Evidence-based

Practice Center and will become available in winter 2002.15

Conclusion

AHRQ has supported the development of a wide variety of

tools and resources to provide accurate, timely, and relevant

information on the status of health services. Federal and

State agencies, legislators, clinicians, health plan

administrators, employers, and universities use these tools

and resources to make decisions, inform the public, educate

health care professionals, and identify areas where health

care services can be improved. By providing these tools,

AHRQ has helped enhance the quality of health care and

contributed to efforts to improve patient safety.

For more information

For further information on AHRQ tools and resources,

contact:

• MEPS, Center for Cost and Financing Studies, 

(301) 594-1400, e-mail: mepspd@ahrq.gov 

• HCUP, Center for Organization and Delivery Studies,

(301) 594-1410, e-mail: hcup@ahrq.gov 

• HIVnet, John Fleishman, Ph.D., (301) 594-2007, 

e-mail: jfleishm@ahrq.gov 

• CAHPS®, Christine Crofton, Ph.D., (301) 594-2003, or

Charles Darby, M.A., (301) 594-2050, 

e-mail: cahps@ahrq.gov 

• Bioterrorism, Center for Primary Care Research, 

(301) 594-1357, e-mail: info@ahrq.gov 

• PPIP, Hazel Keimowitz, M.A., (301) 594-6393, 

e-mail: hkeimowi@ahrq.gov

• NGC, Jean R. Slutsky, P.A., M.S.P.H., (301) 594-4042,

e-mail: info@guideline.gov 

• Child Health Toolbox, Denise M. Dougherty, Ph.D.,

(301) 594-2051, e-mail: ddougher@ahrq.gov 

• Quality Indicators, e-mail:

support@qualityindicators.ahrq.gov

www.ahrq.gov 11
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*6. Agency for Healthcare Research and Quality. Welcome

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26, 2002.

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Medical Expenditure Panel Survey—Insurance

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12 www.ahrq.gov
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*AHRQ-funded/sponsored research

www.ahrq.gov 13

www.ahrq.gov 15

Previous issues of Research in Action are available for free from the AHRQ Publications Clearinghouse: 1-800-358-9295.

Please specify the AHRQ publication number when you call.

Issue Title Publication Number

9 Reducing Costs in the Health Care System: Learning From AHRQ 02-0046

What Has Been Done

8 Prescription Drug Therapies: Reducing Costs and Improving AHRQ 02-0045

Outcomes

7 Improving Treatment Decisions for Patients with Community- AHRQ 02-0033

Acquired Pneumonia

6 Medical Informatics for Better and Safer Health Care AHRQ 02-0031

5 Expanding Patient-Centered Care to Empower Patients and AHRQ 02-0024

Assist Providers

4 Managing Osteoarthritis: Helping the Elderly Maintain Function AHRQ 02-0023

and Mobility

3 Preventing Disability in the Elderly With Chronic Disease AHRQ 02-0018

2 Improving Care for Diabetes Patients Through Intensive AHRQ 02-0005

Therapy and a Team Approach

1 Reducing and Preventing Adverse Drug Events To Decrease AHRQ 01-0020

Hospital Costs
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AHRQ Pub. No. 03-0008

December 2002