Every time a CDI specialist checks whether a pressure ulcer was present on admission before it can trigger a Patient Safety Indicator (PSI) or builds physician education around a sepsis definition drawn from federal data, they are standing on infrastructure most of us never stop to name: the Agency for Healthcare Research and Quality (AHRQ).
Many of us know about AHRQ because of PSIs but as I have mentioned in prior articles, AHRQ can also be a great resource for CDI professionals as a tool to engage medical staff and refute denials.
AHRQ began in 1989 as the Agency for Health Care Policy and Research. It remains the only federal agency with statutory authority to fund health services research including studies about how care is organized, delivered, and paid for, rather than basic biology. Housed within the Department of Health and Human Services (HHS), its portfolio touches every corner of hospital operations, from diagnostic accuracy to care transitions to cost.
A recent KFF Health News investigation found AHRQ has effectively halted most of its grantmaking. Although Congress appropriated $345 million for the agency this fiscal year, AHRQ had spent less than $15 million on grants and has not issued a new one in over a year. On July 15, the agency sent cancellation letters to grantees, halting over one hundred research projects, many of them focused on patient safety.
In addition, staffing has fallen by an estimated 75 percent, including every grant manager who would oversee future awards, since the start of the current administration according to a former AHRQ program officer cited in that report. In my opinion, it puts the future of the agency in limbo.
More than two dozen senators, led by Sens. Richard Blumenthal and Tammy Baldwin, wrote to HHS Secretary Robert F. Kennedy Jr. in mid-August demanding the cancellations be rescinded and giving him until Aug. 25 to respond, as MedPage Today reported. They wrote that AHRQ has saved the country billions of dollars in health care costs and improved patient safety.
These recent actions have resulted in a grant pipeline that has dried up, run by a fraction of the staff who once vetted awards and refreshed technical guidance.
For CDI professionals, its best-known product is Patient Safety Indicators. Historically, hospitals track performance on PSIs, and the composite PSI 90 is a measure set CMS uses within the Hospital-Acquired Condition Reduction Program (HACRP). Once the domain of the quality department, as hospitals better understood the impact of coded data on performance, many hospitals moved responsibility for these quality measures to CDI.
The HRQ PSI technical specifications determine which ICD-10-CM codes, procedures and present-on-admission designations trigger a safety event and which are excluded. Whether a stage 3 pressure injury is excluded from the PSI 03 numerator depends on whether it was clarified as present on admission; whether a postoperative bleed counts against PSI 09 can depend on whether a documented coagulation disorder appears among the case’s diagnosis codes. Every concurrent query built around those distinctions operates inside an AHRQ rulebook.
There is also a relationship between AHRQ and hospital mortality measures. However, PSI 02 Death rate in low-mortality diagnosis related groups was removed from the AHRQ software effective with the 2025 update and is expected to be formally retired in the next update. Although PSI 04 (mortality among surgical inpatients with serious treatable complications) is being retired, the Inpatient Quality Reporting Program (Hospital IQR) will retain a mortality measure, ISCMR: Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications. This measure is more commonly known as “Failure-to-Rescue.”
Even though this is no longer called a PSI, information about it can be found under the 2026 PSI resource page at QualityNet. This will likely lead to confusion for CDI professionals responsible for supporting hospital performance on this measure. If it is not a PSI, why is it listed as a PSI resource, but information about it is not available on AHRQ?
Instead, CDISs who work with quality measures need to become familiar with the Partnership for Quality Measurement site as this is where information about ISCMR and many other measures is available. CDI departments also need to be aware that outcomes associated with the new measure will likely be very different from PSI 04 trends because the population now includes Medicare Advantage and the timing of death is extended to 30 days post procedure regardless of the site of death (it is no longer restricted to patients who die in the hospital.)
AHRQ’s relevance to CDI does not stop at PSIs. Sepsis remains one of the most heavily scrutinized diagnoses in payer clinical-validation denials and AHRQ has built a deep evidence base around it. Its Healthcare Cost and Utilization Project publishes recurring statistical briefs on sepsis-related inpatient stays, cost, and mortality. They also created a formal report quantifying sepsis’s burden on hospitals as directed by Congress that was released on September, 2024. Its Making Healthcare Safer series has evaluated the evidence behind sepsis prediction and recognition tools, and its antibiotic stewardship toolkit walks clinicians through when to start and when to stop treatment for suspected sepsis. CDI professionals creating physician education on sepsis, or defending a sepsis diagnosis at appeal, have been leaning on this work for years, whether AHRQ’s name ever registered.
AHRQ’s Patient Safety Network also curates literature and commentary on diagnostic error, a topic that overlaps with CDI’s own clinical-validation work. Its National Healthcare Quality and Disparities Report benchmarks hospital performance nationally, and its HCUP and Medical Expenditure Panel Survey databases underpin much of the health services research CDI leaders cite when building the case for a query program’s value. None of this is peripheral to CDI. It helps build the foundation of documentation integrity by grounding it in clinical practice.
That foundation is beginning to crack.
What does this mean for CDI professionals? PSI technical specifications and code lists need annual maintenance to keep pace with new diagnosis codes and procedures. An agency with no grant managers and a decimated research staff is a slower, less dependable partner for that work. Sepsis surveillance data CDI leaders use to benchmark their own institutions will grow stale if the statistical briefs behind it stop refreshing.
Diagnostic-safety research, still a young field with direct bearing on clinical-validation queries, loses its primary federal sponsor at the exact moment denial volume tied to diagnostic accuracy keeps climbing. What happens to a query process built on evidence that stops updating?
CDI professionals spend days defending the accuracy of the medical record. If the AHRQ grant pipeline and technical capacity continue to erode, CDI departments may find themselves citing PSI specifications and sepsis guidance that no longer reflect current medical practice or arguing appeals against a moving clinical landscape with an increasingly frozen evidentiary toolkit.
That is a quiet risk to patients, not just an inconvenience to CDI professionals.
