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Nursing Quality Indicators and Their Application

The efforts to advance the quality of modern healthcare have led to the development of relevant tools that are being continually improved (Centers for Medicare & Medicaid Services, 2014; Stukenborg, 2011). For example, the Quality Indicators (QI) proposed by Agency for Healthcare Research and Quality (n.d.) include four groups of QIs, and one of them was chosen to discuss it at length in the present paper.

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Inpatient Quality Indicator 16 – Heart Failure Mortality Rate

The Inpatient Quality Indicator 16 (IQI 16) belongs to the Inpatient Quality Indicators group that has been introduced in 2002 to measure the in-hospital quality of service based on the easily accessible data such as hospitalization and mortality rates or procedures utilization and volume. IQI 16 is concerned with heart failure mortality rate. Like many other QIs, it has been introduced since there are noticeable variations in the performance of different institutions with respect to it, which indicates that some of them may be providing better-quality healthcare (Agency for Healthcare Research and Quality, 2015). The Agency for Healthcare Research and Quality (2015) has developed the IQIs together with University of California, Stanford University Evidence-based Practice Center, and the University of California. Nowadays, free software with benchmark data and guides for their measurement are offered.

The Potential of IQI 16

IQI 16 is directly concerned with public health although its impact on the wellbeing of patients and their families is relatively indirect: it can be used to measure the performance of a healthcare institution and detect issues and difficulties with respect to heart failure-related activates. In other words, it can be regarded as a tool for improvement of an institution’s performance with respect to one of the vital indicators of public health. Naturally, IQI 16 is incapable of providing definite information on the quality of healthcare, but it can track the performance and indicate issues if it is used properly (Agency for Healthcare Research and Quality, 2015).

The Data Available on IQI 16 and the Leadership’s Goal for Improvement

Heart failure is an exception among cardiac disorders as it is resistant to the overall tendency of public health and healthcare improvement. In particular, there is an increase in the prevalence of heart failure while the prolongations in survival remain dissatisfactory (Braunwald, 2013). The issue is being researched, new approaches to therapy are being proposed, and given the varied performance of different institutions, it can be concluded that the IQI 16 is of significant importance for healthcare. However, as it has been pointed out by Glance, Osler, Mukamel, and Dick (2008), IQI 16 needs to be used properly. At the same time, as demonstrated by Ma, Shang, and Bott (2015), the role of nurses and especially nursing leadership and collaboration in healthcare quality improvement is vital. Therefore, it is logical to employ supportive leadership to empower nurses with the goal of improving healthcare with respect to heart failure by properly using IQI 16.

The Proposal of IQI 16 Solution

The research carried out by Glance et al. (2008) indicated that the present-on-admission indicator is capable of significantly biasing the results of IQI 16 assessment. Several years later, Stukenborg (2011) studied the use of present on admission diagnoses as a means of improving the quality of assessment and concluded that it was a viable strategy. However, the author also indicated that the addition of the information was capable of only improving IQI 16, not perfecting it. According to Stukenborg (2011), modern QIs allow the use of present on admission information, which means that nurses are provided with the means of improving IQI 16 data, but training may be required to ensure success. Therefore, it can be concluded that nurse training and leadership can be employed to improve IQI 16 (and other QIs) application, and nurses should be encouraged to participate in the training, use, and feedback on the tool. The feedback of nurses can be used to detect issues in the indicator’s use, which is of particular value to the continuous quality improvement in healthcare.


Agency for Healthcare Research and Quality. (2015). Inpatient Quality Indicators. Web.

Agency for Healthcare Research and Quality. (n.d.). AHRQuality indicators. Web.

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Braunwald, E. (2013). Heart failure. Journal of The American College Of Cardiology: Heart Failure, 1(1), 1-20. Web.

Centers for Medicare & Medicaid Services. (2014). 2014 clinical quality measures. Web.

Glance, L., Osler, T., Mukamel, D., & Dick, A. (2008). Impact of the present-on-admission indicator on hospital quality measurement. Medical Care, 46(2), 112-119. Web.

Ma, C., Shang, J., & Bott, M. J. (2015). Linking unit collaboration and nursing leadership to nurse outcomes and quality of care. Journal of Nursing Administration, 45(9), 435–442. Web.

Stukenborg, G. (2011). Hospital mortality risk adjustment for heart failure patients using present on admission diagnoses. Medical Care, 49(8), 744-751. Web.

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