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Refinement of the HCUP Quality Indicators

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Table 2S. Area Indicator List


Area Level Indicator Name Type of Indicator Indicator Description Empirical Ratinga Risk Adjustment Recommended Literature Review Findingsb Better Quality May Be Associated with:
CABG rate (#13)d Utilization Number of CABGs per 100,000 population 19 Age and sex X Proxy
X Unclear construct validity
X Unclear benchmark
Lower ratesc
Hysterectomy rate (#14) Utilization Number of hysterectomies per 100,000 population 22 Age and additional factors such as parity X Proxy
? Confounding bias
X Unclear construct validity
X Unclear benchmark
Lower ratesc
Laminectomy rate (#15) Utilization Number of laminectomies per 100,000 population 20 Age and sex X Proxy
X Unclear construct validity
X Unclear benchmark
Lower ratesc
PTCA rate (#16)d Utilization Number of PTCAs per 100,000 population 19 Age and sex X Proxy
? Selection bias
X Unclear construct validity
X Unclear benchmark
Lower ratesc
Dehydration admission rate (#17)d ACSC Number of admissions for dehydration per 100,000 population 14 Age and sex ? Proxy
? Unclear construct validity
? Easily manipulated
X Unclear benchmark
Lower ratesc
Bacterial pneumonia admission rate (#18)d ACSC Number of admissions for bacterial pneumonia per 100,000 population 17 Age and sex ? Proxy
? Unclear construct validity
? Easily manipulated
X Unclear benchmark
Lower ratesc
Urinary infection admission rate (#19)d ACSC Number of admissions for urinary infection per 100,000 population 11 Age and sex ? Proxy
? Unclear construct validity
? Easily manipulated
X Unclear benchmark
Lower ratesc
Perforated appendix admission rate (#20) ACSC Number of admissions for perforated as a share of all admissions for appendicitis within an area 17
Smoothing recommended
Age and sex ? Proxy Lower rates
Angina admission rate (#21)d ACSC Number of admissions for angina per 100,000 population 19 Age and sex ? Proxy
? Unclear construct validity
? Easily manipulated
X Unclear benchmark
Lower ratesc
Adult asthma admission rate (#22) ACSC Number of admissions for asthma in adults per 100,000 population 16 Age and sex ? Proxy
? Easily manipulated
X Unclear benchmark
Lower ratesc
COPD admission rate (#23) ACSC Number of admissions for COPD per 100,000 population 17 Age and sex. Potential supplement includes patient characteristics, such as smoking. ? Proxy
? Confounding bias
? Easily manipulated
X Unclear benchmark
Lower ratesc
CHF admission rate (#24) ACSC Number of admissions for CHF per 100,000 population 14 Age and sex ? Proxy
? Easily manipulated
X Unclear benchmark
Lower ratesc
Diabetes short term complication admission rate (#25) ACSC Number of admissions for diabetes short term complications per 100,000 population 14 Age and sex. Potential supplement includes population diabetes incidence rates. ? Proxy
? Confounding bias
Lower rates
Uncontrolled diabetes admission rate (#26)d ACSC Number of admissions for uncontrolled diabetes per 100,000 population 14 Age and sex. Potential supplement includes population diabetes incidence rates. ? Proxy
? Confounding bias
? Easily manipulated
Lower rates
Diabetes long term complication admission rate (#27) ACSC Number of admissions for diabetes long term diabetes per 100,000 population 11 Age and sex. Potential supplement includes population diabetes incidence rates. ? Proxy
? Confounding bias
? Easily manipulated
X Unclear benchmark
Lower rates
Hypertension admission rate (#28) ACSC Number of admissions for hypertension per 100,000 population 14 Age and sex ? Proxy
? Easily manipulated
X Unclear benchmark
Lower ratesc
Lower extremity amputation in diabetics rate (#29)d ACSC Number of admissions for lower extremity amputation in diabetics per 100,000 population 10
Smoothing recommended
Age and sex. Potential supplement includes population diabetes incidence rates. ? Proxy
? Unclear construct validity
Lower rates
Low birth weight rate (#30)d ACSC Number low birth weight births as a share of all births in an area 11 out of 16e
Smoothing recommended
None available in HCUP. Potential supplement include clinical, link to mother's record, or link to birth record. ? Proxy
? Confounding bias
X Unclear construct validity
Lower rates
Pediatric asthma admission rate (#31) ACSC Number of admissions for pediatric asthma per 100,000 population 18 Age and sex ? Proxy
? Easily manipulated
X Unclear benchmark
Lower ratesc
Pediatric gastroenteritis admission rate (#32)d ACSC Number of admissions for pediatric gastroenteritis per 100,000 population 17 Age and sex ? Proxy
? Unclear construct validity
? Easily manipulated
X Unclear benchmark
Lower ratesc

a. Each indicator is rated from 0-26 on its empirical performance of precision and minimum bias with 0 indicating the lowest empirical rating (poor performance) and 26 indicating the highest performance.
b. Each indicator was evaluated for seven caveats (proxy, selection bias, information bias, confounding bias, unclear construct validity, easily manipulated, unclear benchmark). A question mark preceding the caveat means that this is a theoretical or suggested concern. A checkmark means that this is a concern that has been demonstrated.
c. For some indicators, very low or very high rates may indicate a potential quality problem. The direction listed is the direction for improvement given the current rates for these indicators.
d. CABG and PTCA area utilization are not recommended as stand alone indicators. They are designed only for use with the corresponding volume and/or mortality measures. Seven ACSC measures (low birth weight, angina, urinary tract infection, bacterial pneumonia, lower extremity amputation, pediatric gastroenteritis, and dehydration) do not have studies confirming their construct validity as individual indicators of access to health care services. For this reason, it is recommended that they be used in conjunction with other ACSC indicators. Uncontrolled diabetes is designed to be combined with diabetes short term complications.
e. Adequate risk adjustment for low birth weight was not available, and thus, bias was not tested.


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