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National Healthcare Disparities Report, 2006

Patient Safety

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Postoperative Complications: Events
Composite measure: postoperative pneumonia, urinary tract infection, and venous thromboembolic events.
Postoperative pneumonia events
Postoperative urinary tract infections (UTIs)
Postoperative venous thromboembolic events
Composite measure: Adult Medicare patients having surgery who had prophylactic antibiotics begun at the right time and ended at the right time
Adult Medicare patients having surgery who receive prophylactic antibiotics within 1 hour prior to surgical incision
Adult Medicare patients having surgery who have prophylactic antibiotics discontinued within 24 hours after surgery end time
Postoperative septicemia (per 1,000 elective surgical discharges of 4+ days)
Postoperative Complications: Discharges
Postoperative hemorrhage or hematoma.
Postoperative pulmonary embolus or deep venous thrombosis
Postoperative respiratory failure
Postoperative physiologic and metabolic derangements
Postoperative hip fracture (age 18+)
Postoperative abdominal wound dehiscence
Foreign body left in during procedure
Complications of anesthesia
Decubitus ulcers (per 1,000 discharges of length 5+ days)
Other Complications of Hospital Care
Composite measure: bloodstream infections and mechanical adverse events associated with central vascular catheters (CVCs)
Bloodstream infections associated with central vascular catheters (CVCs)
Mechanical adverse events associated with central vascular catheters (CVCs)
Ventilator associated pneumonia (VAP) events
Selected infections due to medical care
Deaths per 1,000 discharges with complications potentially resulting from care
Accidental puncture or laceration during procedure
Iatrogenic pneumothorax (discharge-based, area-based)
Deaths per 1,000 admissions in low mortality DRGs
Complications of Medication
Community-dwelling elderly who had at least 1 prescription (from a list of 11 medications and from a list of 33 medications) potentially inappropriate for the elderly
Adverse drug events: Anticoagulant: warfarin
Adverse drug events: Anticoagulant: intravenous heparin
Adverse drug events: Anticoagulant: low molecular weight heparin and factor Xa
Adverse drug events: Hypoglycemic agents: insulin/oral hypoglycemics/combination of both
Birth Related Trauma
Birth trauma injury per 1,000 selected live births
Obstetric trauma per 1,000 instrument-assisted deliveries
Obstetric trauma per 1,000 vaginal deliveries without instrument assistance
Obstetric trauma per 1,000 cesarean deliveries


Postoperative Complications: Events

Measure Title

Composite measure: postoperative pneumonia, urinary tract infection, and venous thromboembolic events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with an adverse event of postoperative nosocomial pneumonia, urinary tract infection or venous thromboembolic event (the sum of the percents of the three individual measures).

Comments

See entries for each of the components of the composite measure for further details about the methodology.

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Postoperative Complications
Events

Measure Title

Postoperative pneumonia events

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with an adverse event of postoperative nosocomial pneumonia in patients who were not admitted with tracheostomies during the index hospitalization.

Comments

Postoperative nosocomial pneumonia is determined by evidence in the medical record of new infiltrate, consolidation, or cavitations noted on chest X-ray, and documentation of physician diagnosis of postoperative pneumonia.

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Postoperative Complications
Events

Measure Title

Postoperative urinary tract infections (UTIs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with a diagnosed postoperative urinary tract infection during the index hospital stay.

Comments

Diagnosed postoperative UTIs are defined as cases with 1 of the following:

  • A physician diagnosis of UTI
  • Antibiotic treatment for UTI
  • A postoperative urine culture containing >105 organisms/cc of no more than 2 of the following pathogens: Escherichia coli, Enterococcus species, Klebsiella species, Pseudomonas species, Proteus species, Enterobacter species, Citrobacter species, fungi including Candida species and Staphylococcus aureus.

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Postoperative Complications
Events

Measure Title

Postoperative venous thromboembolic events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality and for 30 day post-procedure readmission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE).

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with a diagnosed postoperative PE or DVT during the index hospital stay (per medical record abstraction) or were readmitted to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9).

Comments

The measure specification has changed to include 30-day postoperative readmissions for pneumonia and venous thromboembolic events.

Venous thromboembolic events (VTE) include at least 1 of the following:

  • Deep venous thromboses: Thromboses or occlusions within the venous system, most commonly of the lower extremities.
  • Pulmonary emboli: Obstructions of the pulmonary artery vasculature (PE) usually arising from thrombi in the deep venous system of the lower extremities.

Diagnostic criteria for DVT include at least 1 of the following:

  • Physician diagnosis of a DVT
  • An abnormal compression Duplex or Doppler ultrasonography, contrast venography, impedence plethysmography (IPG), or magnetic resonance venography (MR).

Diagnostic criteria for PE include a clinical index of suspicion and at least 1 of the following:

  • high probability ventilation-perfusion (V/Q) scan
  • moderate probability V/Q scan and abnormal duplex US of the lower extremities or lower extremity venogram
  • abnormal helical (spiral) computerized tomographic (CT) exam of the pulmonary arteries indicating pulmonary embolus
  • abnormal pulmonary angiography indicating pulmonary embolus
  • abnormal magnetic resonance angiography (MR) exam of the pulmonary arteries indicating pulmonary embolus

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Postoperative Complications
Events

Measure Title

Composite measure: Adult Medicare patients having surgery who had prophylactic antibiotics begun at the right time and ended at the right time.

Measure Source

Centers for Medicare and Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics within 1 hour prior to surgery and prophylactic antibiotics discontinued within 24 hours after surgery end time.

Comments

See entries for each of the components of the composite measure for further details about the methodology.

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Postoperative Complications
Events

Measure Title

Percent of adult Medicare patients having surgery who receive prophylactic antibiotics within 1 hour prior to surgical incision.

Measure Source

Centers for Medicare and Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics within 1 hour prior to surgery.

Comments

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Postoperative Complications
Events

Measure Title

Percent of adult Medicare patients having surgery who have prophylactic antibiotics discontinued within 24 hours after surgery end time.

Measure Source

Centers for Medicare and Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Tables

Data source does not support detailed tables.

Data Source

CMS, Medicare Quality Improvement Organization Program.

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics discontinued within 24 hours after surgery end time.

Comments

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Postoperative Complications
Events

Measure Title

Postoperative septicemia per 1,000 elective surgical discharges of 4+ days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

147. Postoperative sepsis per 1,000 elective-surgery discharges of longer than 3 days (excluding patients admitted for infection, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All elective hospital surgical discharges with length of stay of 4 or more days, excluding patients admitted for infection, patients with cancer or immunocompromised states, and obstetric conditions.

Numerator

Subset of the denominator with any secondary diagnosis of sepsis.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 13 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators .

Table

148. Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges (excluding obstetrical admissions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Inpatient hospital surgical discharges, excluding obstetrical admissions.

Numerator

Subset of the denominator meeting the following criteria:

  1. Secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma
  2. Secondary procedure indicating postoperative control of hemorrhage or drainage of hematoma

Comments

Procedure code for postoperative control of hemorrhage or hematoma not verified as following surgery.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 9 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative pulmonary embolus (PE) or deep vein thrombosis (DVT) per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

149. Postoperative pulmonary embolus (PE) or deep vein thrombosis (DVT) per 1,000 surgical discharges (excluding patients admitted for DVT, obstetrics, and plication of vena cava before or after surgery), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Hospital surgical patients, excluding patients admitted for deep vein thrombosis, obstetrics, neonatal, and plication of vena cava before or after surgery.

Numerator

Subset of the denominator with any secondary diagnosis of deep vein thrombosis or pulmonary embolism.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 12 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative respiratory failure per 1,000 elective surgery discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

150. Postoperative respiratory failure per 1,000 elective-surgery discharges (excluding patients with respiratory disease, circulatory disease, and obstetric conditions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All elective hospital surgical discharges, excluding patients with respiratory disease, circulatory disease, and obstetric conditions.

Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure (ICD-9-CM diagnosis codes 518.81 and 518.84).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 11 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative physiologic and metabolic derangements per 1,000 elective-surgery patients.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

151. Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious disease and obstetric admissions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All elective hospital surgical discharges, excluding some serious disease (i.e., patients with diabetic coma; patients with renal failure who were admitted for AMI, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage ) and obstetric admissions.

Numerator

Subset of the denominator with any secondary diagnosis indicating physiologic and metabolic derangements.

Comments

Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure for dialysis.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 10 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative hip fractures per 1,000 surgical discharges age 18+ years.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators

Table

152. Postoperative hip fracture for adults per 1,000 surgical patients age 18 years and older who were not susceptible to falling (excluding obstetrical admissions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Inpatient hospital surgical discharges age 18 and over who were not susceptible to falling. (i.e., excluding patients with musculoskeletal disease; those admitted for seizures, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium, psychoses, anoxic brain injury; patients with metastatic cancer, lymphoid malignancy, bone malignancy, and self-inflicted injury).

Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 8 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Postoperative abdominal wound dehiscence per 1,000 relevant discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

153. Reclosure of postoperative disruption of abdominal wall (postoperative abdominal wound dehiscence) per 1,000 abdominopelvic-surgery discharges (excluding obstetric conditions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Inpatient hospital abdominopelvic surgery discharges, excluding obstetric conditions.

Numerator

Non-maternal/non-neonatal abdominopelvic surgery discharges with secondary procedure for reclosure of postoperative disruption of abdominal wall (ICD-9-CM procedure code 54.61).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 14 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Foreign body left in body during procedure per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

154. Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges (excluding neonates), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All non-neonatal medical and surgical inpatient hospital discharges.

Numerator

Non-neonatal medical and surgical discharges with any secondary diagnosis indicating foreign body left in during procedure.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 5 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Complications of anesthesia per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

155. Complications of anesthesia per 1,000 surgical discharges (excluding patients with such complications who also have substance use disorders), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All surgical hospital discharges, excluding patients with active drug dependence, active nondependent abuse of drugs, and self-inflicted injury.

Numerator

Subset of the denominator with any secondary diagnosis indicating anesthesia complications.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 1 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications
Discharges

Measure Title

Decubitus ulcers per 1,000 discharges of length 5 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

156. Decubitus ulcers per 1,000 discharges of length 5 or more days (excluding paralysis patients, patients admitted from long-term-care facilities, patients with diseases of the skin, subcutaneous tissue, and breast, and obstetrical admissions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All non-maternal medical and surgical hospital discharges with length of stay of 5 or more days, excluding paralysis patients, patients admitted from long-term-care facilities, and patients with diseases of the skin, subcutaneous tissue, and breast.

Numerator

Subset of the denominator with any secondary diagnosis of decubitus ulcer (ICD-9-CM diagnosis code 707.0).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 3 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Composite measure: bloodstream infections and mechanical adverse events associated with central vascular catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample with documentation of placement of at least 1 vascular access device, or CVC, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins who did not have evidence of a prior bloodstream infection.

Numerator

Subset of the denominator with either a CVC-associated bloodstream infection or CVC-associated mechanical adverse events.

Comments

See entries for each of the components of the composite measure for further details about the methodology.

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Other Complications of Hospital Care

Measure Title

Bloodstream infections associated with central vascular catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample with record of placement of at least 1 vascular access device, or CVC, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated bloodstream infection.

Comments

CVC-associated bloodstream infection is determined by documentation of all of the following:

  1. At least 1 blood culture, drawn at least 2 days after placement of a CVC, and positive for at least 1 of the following pathogens: Staphylococcus aureus, Escherichia coli, Coagulase negative Staphylococcus, Enterococcus species, Klebsiella species, Pseudomonas Aeruginosa, beta-hemolytic Streptococcus, Enterobacter species, Viridans-group Streptococci, Candida and all other fungi, atypical mycobacteria, Acinetobacter, Citrobacter freundii, Proteus mirabilis, and Serratia marcescens.
  2. No other source of infection documented.
  3. At least 1 of the following: Temperature > 100.4°F or <96.8°F, white blood cell count >12,000 or < 4000/hpf, band Neutrophils > 10% of white blood cell count, and hypotension.

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Other Complications of Hospital Care

Measure Title

Mechanical adverse events associated with central vascular catheters (CVCs).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All instances in records from the MPSMS sample of placement of at least 1 vascular access device terminating at, or close to, the heart or in 1 of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated mechanical adverse events.

Comments

A CVC-associated mechanical adverse event is defined as the presence in the medical record of at least 1 of the following: allergic reaction, tamponade, perforation, pneumothorax, Hematoma, shearing off of the catheter, air embolism, misplaced catheter, thrombosis/embolism, knotting of the pulmonary artery catheter, arrhythmia requiring treatment during insertion, bleeding, equipment malfunction, and pain.

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Other Complications of Hospital Care

Measure Title

Ventilator-associated pneumonia (VAP) events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS Medicare Patient Safety Monitoring System inpatient medical records: used for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All patients who experienced ventilator exposure during the index hospital stay.

Numerator

Subset of the denominator who developed ventilator-associated pneumonia at least 2 days after initial ventilator exposure and who were not admitted with a tracheostomy.

Comments

Ventilator exposure is determined by documentation of a patient's use of a device to assist or control respiration continuously through a tracheostomy or by endotracheal intubation for at least 2 days. Devices includes ventilators or other lung expansion devices delivering O2 via tracheostomy or endotracheal intubation.

Ventilator-associated pneumonia is determined by evidence in the medical record of new infiltrate, consolidation, or cavitations noted on chest X-ray at least 2 days after intubation, and documentation of physician diagnosis of postoperative pneumonia 2 or more days after intubation.

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Other Complications of Hospital Care

Measure Title

Selected infections due to medical care per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

161. Selected infections due to medical care per 1,000 discharges (excluding immunocompromised and cancer patients and neonates), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All medical and surgical hospital discharges, excluding immunocompromised and cancer patients and neonates.

Numerator

All medical and surgical hospital discharges with any secondary diagnosis of infection (ICD-9-CM diagnosis code 999.3 or 996.62), excluding immunocompromised or cancer patients.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 7 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue).

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

162. Failure to rescue or deaths per 1,000 discharges having developed specified complications of care during hospitalization (excluding patients transferred in or out, patients admitted from long-term care facilities, neonates, and patients over 74 years old), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Inpatient hospital discharges with potential complications of care listed in failure to rescue definition (i.e., pneumonia, deep vein thrombosis/pulmonary embolism, sepsis, acute renal failure, shock/cardiac arrest, or gastrointestinal hemorrhage/acute ulcer), excluding patients transferred in or out, patients admitted from long-term-care facilities, neonates, and patients over 74 years old.

Numerator

Subset of the denominator with discharge disposition of "death."

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 4 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Accidental laceration or puncture during procedure per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

163. Accidental puncture or laceration during procedures per 1,000 discharges (excluding obstetric admissions), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Hospital medical and surgical discharges, excluding obstetric admissions.

Numerator

Non-maternal medical and surgical discharges with any secondary diagnosis denoting technical difficulty (e.g., accidental cut, puncture, perforation or laceration during a procedure).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 15 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Iatrogenic pneumothorax per 1,000 relevant discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

164. Iatrogenic pneumothorax per 1,000 discharges (excluding neonates, obstetrical admissions, and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All non-maternal/non-neonatal medical and surgical hospital discharges, excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Numerator

Non-neonatal/non-maternal medical and surgical discharges with any secondary diagnosis of iatrogenic pneumothorax (ICD-9-CM diagnosis code 512.1,) excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 6 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 admissions in low-mortality DRGs.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

165. Deaths per 1,000 admissions in low mortality DRGs (DRGs with a NIS 1997 benchmark of less than 0.5% mortality, excluding trauma, immunocompromised, and cancer patients), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Hospital admissions in low-mortality DRGs, excluding trauma, immunocompromised, and cancer patients.

Numerator

Subset of the denominator with discharge disposition of "death"

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and DRG clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 2 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Complications of Medication

Measure Title

Percent of community-dwelling elderly who had at least 1 prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety.

Table

166. Inappropriate drug use among community-dwelling elderly, United States, 2000 and 2003.

Data Source

AHRQ, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey (MEPS).

Denominator

U.S. population: age 65 and over.

Numerator

Persons age 65 and over who had 1 or more of the 11 or 33 potentially inappropriate medications.

Comments

For additional information concerning potentially inappropriate medications, see Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickzier SW, Meyer GS. Potentially Inappropriate Medication Use in the Community-Dwelling Elderly: Findings from 1996 Medical Expenditure Panel Survey, Journal of American Medical Association, 286(22), 2823-2829, 2001.

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Complications of Medication

Measure Title

Adverse drug events: Anticoagulant: warfarin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample administered Warfarin during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

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Complications of Medication

Measure Title

Adverse drug events: Anticoagulant: intravenous heparin.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample administered IV Heparin during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

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Complications of Medication

Measure Title

Adverse drug events: Anticoagulant: low molecular weight heparin and factor Xa.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample administered low molecular weight heparin and factor Xa during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

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Complications of Medication

Measure Title

Adverse drug events: Hypoglycemic agents: insulin/oral hypoglycemics/combination of both.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Tables

Data source does not support detailed tables.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality.

Denominator

All discharges from the MPSMS sample administered insulin, oral hypoglycemics, or a combination of both during the index hospital stay.

Numerator

Subset of denominator with a documented adverse reaction to the indicated medication.

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Birth-Related Trauma

Measure Title

Birth trauma injury per 1,000 selected live births.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

171. Birth trauma—injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

Live birth discharges in the U.S., excluding preterm and osteogenesis imperfecta births.

Numerator

Subset of the denominator with any diagnosis of birth trauma.

Comments

Rates are adjusted by gender. When reporting is by gender, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 17 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma per 1,000 instrument-assisted deliveries.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

172. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All vaginal delivery hospital discharges with any procedure indicating instrument assisted delivery.

Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 27 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma per 1,000 vaginal deliveries without instrument assistance.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

173. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All vaginal delivery hospital discharges without indication of instrument assistance.

Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 28 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma per 1,000 cesarean deliveries.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators.

Table

174. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 Cesarean deliveries, United States, 2003, by

  • Race/ethnicity

Data Source

AHRQ, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases, disparities analysis file.

Denominator

All cesarean section delivery hospital discharges.

Numerator

Cesarean section delivery discharges with any diagnosis or procedure indicating obstetric trauma.

Comments

Rates are adjusted by age. When reporting is by age, there is no adjustment.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, PA, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 29 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.


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