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2006 National Healthcare Quality Report

Patient Safety

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Postoperative Complications
Composite measure: Postoperative pneumonia events, urinary tract infections 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 sepsis
Postoperative hemorrhage or hematoma
Postoperative pulmonary embolism or deep venous thrombosis
Postoperative respiratory failure
Postoperative physiologic and metabolic derangements
Postoperative hip fracture
Reclosure of postoperative disruption of abdominal wall (discharge-based, area-based)
Foreign body accidentally left in body during procedure (discharge-based, area-based)
Complications of anesthesia
Decubitus ulcers
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
Adverse events associated with hip joint replacement due to degenerative conditions
Adverse events associated with hip joint replacement due to fracture
Adverse events associated with hip joint replacement due to fracture or degenerative conditions
Adverse events associated with knee joint replacement
Selected infections due to medical care (discharge-based, area-based)
Deaths per 1,000 discharges with complications potentially resulting from care
Accidental puncture or laceration during procedures (discharge-based, area-based)
Iatrogenic pneumothorax (discharge-based, area-based)
Death in low mortality DRGs
Transfusion reactions (discharge-based, area-based)
Birth Related Trauma
Birth trauma—injury to neonate
Obstetric trauma—vaginal with instrument
Obstetric trauma—vaginal without instrument
Obstetric trauma—Cesarean delivery
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
Persons who report that their usual source of care (USC) asks about prescription medications and treatments from other providers
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

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Postoperative Complications

Measure Title

Composite measure: Postoperative pneumonia events, urinary tract infections and venous thromboembolic events.

Measure Source

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

Table

2.1. Composite of postoperative pneumonia, urinary tract infection, and venous thromboembolic events, United States, 2004.

Data Source

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

Denominator

All discharges from the MPSMS sample that had 1 or more of certain surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia prior to the procedure.

Numerator

Subset of the denominator with a diagnosis of postoperative nosocomial pneumonia, a diagnosed postoperative urinary tract infection during the index hospital stay, or diagnoses deep vein thrombosis or pulmonary embolism during the index hospital stay (the sum of the percents of the three individual measures).

Comments

See entries for each of the 3 components of the composite measure for further details about the methodology.

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Postoperative Complications

Measure Title

Postoperative pneumonia events.

Measure Source

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

Table

2.2. Percent surgical discharges with postoperative pneumonia events, United States, 2004.

Data Source

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

Denominator

All discharges from the MPSMS sample that had 1 or more of certain surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia prior to the procedure.

Numerator

The subset of the denominator with a diagnosis of postoperative nosocomial pneumonia.

Comments

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

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

The criteria determine a postoperative pneumonia adverse event differ between 2002 and 2003 due to differences in the data elements collected.

For more detailed information regarding the Surgical Care Improvement Project see http://www.medqic.org/scip/.

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Postoperative Complications

Measure Title

Postoperative urinary tract infections (UTIs).

Measure Source

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

Table

2.3. Percent of surgical discharges with postoperative urinary tract infections, United States, 2004.

Data Source

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

Denominator

All discharges from the MPSMS sample with documentation of 1 or more procedure identified in conjunction with the Surgical Care Improvement Project without an indwelling catheter on arrival or evidence of a urinary tract infection before the procedure.

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 postoperative urine culture containing more than 105 organisms/cc with 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.
  • A physician diagnosis of UTI and an antibiotic ordered by a physician to treat the UTI.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

For more detailed information regarding the Surgical Care Improvement Project see http://www.medqic.org/scip/.

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Postoperative Complications

Measure Title

Postoperative venous thromboembolic events.

Measure Source

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

Table

2.4. Percent surgical discharges with postoperative venous thromboembolic events, United States, 2004.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used to identify a major surgical procedure, for 30-day post-procedure readmission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism and for 30-day post-procedure and post-discharge mortality.

Denominator

All discharges from the MPSMS sample that had 1 or more of certain surgical procedures identified as part of the Surgical Care Improvement Project during the index hospital stay.

Numerator

The subset of the denominator with a diagnosed pulmonary embolism or DVT during the index hospital stay (per medical record abstraction) or readmission to the hospital post-index hospital stay for a pulmonary embolism 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, and 453.9).

Comments

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

Venous thromboembolic events include at least 1 of the following:

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

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

  1. Physician diagnosis of a DVT
  2. An abnormal compression duplex or Doppler ultrasonography, contrast venography, impedence plethysmography, or magnetic resonance venography

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

  1. High probability ventilation-perfusion (V/Q) scan
  2. Moderate probability V/Q scan and abnormal duplex ultrasonography exam of the lower extremities or lower extremity venogram
  3. Abnormal helical (spiral) computerized tomographic (CT) exam of the pulmonary arteries indicating pulmonary embolus
  4. Abnormal pulmonary angiography indicating pulmonary embolus
  5. Abnormal magnetic resonance angiography exam of the pulmonary arteries indicating pulmonary embolus

For more detailed information regarding the Surgical Care Improvement Project see http://www.medqic.org/scip/.

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Postoperative Complications

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

2.5a. Percent of adult surgery patients who received appropriate timing of antibiotics, Medicare beneficiaries, United States, 2004.

2.5b. Percent of adult surgery patients who received appropriate timing of antibiotics, Medicare beneficiaries, by State, 2004.

2.5c. Percent of adult surgery patients who received appropriate timing of antibiotics, all payers, by State, 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients 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.

The State average percents on table 2.5c were pre-calculated and supplied as part of the Hospital Compare database.

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Postoperative Complications

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

2.6a. Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, Medicare beneficiaries, United States, 2004.

2.6b. Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, Medicare beneficiaries, by State, 2004.

2.6c. Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, all payers, by State, 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with indication of surgery.

Numerator

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

The State average percents on table 2.6c were pre-calculated and supplied as part of the Hospital Compare database.

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Postoperative Complications

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

2.7a. Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, Medicare beneficiaries, United States, 2004.

2.7b. Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, Medicare beneficiaries, by State, 2004.

2.7c. Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, all payers, by State, 2005.

Data Source

CMS, Medicare Quality Improvement Organization Program.

CMS, Hospital Compare.

Denominator

Discharged hospital patients with indication of surgery.

Numerator

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

The State average percents on table 2.7c were pre-calculated and supplied as part of the Hospital Compare database.

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Postoperative Complications

Measure Title

Postoperative sepsis.

Measure Source

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

Table

2.8. Postoperative sepsis per 1,000 elective-surgery discharges of longer than 3 days (excluding patients admitted for infection; patients with cancer or immunocompromised states, and obstetric conditions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All elective hospital surgical discharges with length of stay longer than 3 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 Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Postoperative hemorrhage or hematoma.

Measure Source

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

Table

2.9. Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges (excluding obstetrical admissions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

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

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Postoperative pulmonary embolism or deep venous thrombosis.

Measure Source

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

Table

2.10. Postoperative pulmonary embolus 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, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

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

Numerator

Subset of the denominator with any secondary diagnosis of deep vein thrombosis (45111, 45119, 4512, 45181, 4519, 4538, 4539) or pulmonary embolism (41511, 41519).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Postoperative respiratory failure.

Measure Source

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

Table

2.11. Postoperative respiratory failure per 1,000 elective-surgery discharges (excluding patients with respiratory disease, circulatory disease, and obstetric conditions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All elective hospital surgical discharges, excluding patients with respiratory disease, circulatory disease, and obstetric or neonatal 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 Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Postoperative physiologic and metabolic derangements.

Measure Source

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

Table

2.12. Postoperative physiologic and metabolic derangements per 1,000 elective surgical discharges (excluding some serious disease and obstetric admissions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All elective hospital surgical discharges, excluding some serious disease (i.e., patients with both a diagnosis code of ketoacidosis, hyperosmolarity, or other coma and a principal diagnosis of diabetes; 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.

Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure code for dialysis (3995, 5498).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.


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Postoperative Complications

Measure Title

Postoperative hip fracture.

Measure Source

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

Table

2.13. 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, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Inpatient hospital surgical discharges age 18 and over who were not susceptible to falling, excluding patients with diseases and disorder of musculoskeletal system and connective tissue; patients admitted for seizures, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium, psychoses, or anoxic brain injury; patients with metastatic cancer, lymphoid malignancy, bone malignancy, or self-inflicted injury; and obstetrical patients.

Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture (ICD-9-CM code 820.0-820.3, 820.8, 820.9).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Reclosure of postoperative disruption of abdominal wall (discharge-based) and reclosure of postoperative disruption of abdominal wall (area-based).

Measure Source

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

Tables

2.14a. Reclosure of postoperative disruption of abdominal wall (postoperative abdominal wound dehiscence) per 1,000 abdominopelvic-surgery discharges (excluding obstetric conditions), United States, 2001 and 2003.

2.14b. Reclosure of postoperative disruption of abdominal wall (postoperative abdominal wound dehiscence) per 100,000 population (excluding obstetric conditions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Table 2.14a: All inpatient hospital abdominopelvic surgical discharges. Excludes obstetrical patients.

Table 2.14b: U.S. population.

Numerator

Table 2.14a: 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).

Table 2.14b: Non-maternal/non-neonatal abdominopelvic surgery discharges with any principal or secondary procedure for reclosure of postoperative disruption of abdominal wall (ICD-9-CM procedure code 54.61).

Comments

Table 2.14a: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Table 2.14b: Rates are adjusted by age and gender, using year 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator details 14 (discharge-based, table a) and 24 (area-based, table b) in the software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Foreign body accidentally left in body during procedure (discharge-based) and foreign body accidentally left in body during procedure (area-based).

Measure Source

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

Tables

2.15a. Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges (excluding neonates), United States, 2001 and 2003.

2.15b. Foreign body accidentally left in during procedure per 100,000 population (excluding neonatal procedures), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Table 2.15a: All non-neonatal medical and surgical inpatient hospital discharges.

Table 2.15b: U.S. population.

Numerator

Table 2.15a: Non-neonatal medical and surgical discharges with any secondary diagnosis indicating foreign body left in during procedure.

Table 2.15b: Non-neonatal medical and surgical discharges with any principal or secondary diagnosis indicating foreign body left in during procedure.

Comments

Table 2.15a: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Table 2.15b: Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator 5 (discharge-based, table a) and 21 (area-based, table b) in the software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Complications of anesthesia.

Measure Source

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

Table

2.16. Complications of anesthesia per 1,000 surgical discharges (excluding patients with such complications who also have substance use disorders), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All surgical hospital discharges, excluding patients with poisoning due to anesthetics, active drug dependence, active nondependent abuse of drugs, or 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 Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Postoperative Complications

Measure Title

Decubitus ulcers.

Measure Source

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

Table

2.17. 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, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All non-neonatal medical and surgical hospital discharges with length of stay of 5 or more days, excluding patients in MDC 9 (skin, subcutaneous tissue, and breast) or patients with hemiplegia, paraplegia, or quadriplegia, or admitted from long-term-care facilities, or obstetrical admissions.

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 Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site 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).

Table

2.18. Percent of central vascular catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2004.

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 BSI.

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).

Table

2.19. Percent of discharges with central vascular catheter placement with associated bloodstream infections, United States, 2004.

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 BSI.

Numerator

Subset of the denominator with CVC-associated blood stream infection.

Comments

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

  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. A physician diagnosis of BSI. The detailed specifications for this criterion differ between 2002 and 2003 due to differences in the collected data elements

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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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).

Table

2.20. Percent of central vascular catheter placement with associated mechanical adverse events, United States, 2004.

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 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, and certain other events.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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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).

Table

Data not available for this edition of the National Healthcare Quality Report

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 patients who experienced ventilator exposure during the index hospital stay who did not have evidence of pneumonia prior to intubation or within 2 days of intubation/ventilation exposure.

Numerator

All patients who experienced intubation/ventilator exposure during the index hospital stay for more than 2 days without prior evidence of pneumonia.

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 include 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. The criteria to determine a ventilator-associated pneumonia event differ between 2002 and 2003 due to differences in the data elements collected.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Other Complications of Hospital Care

Measure Title

Adverse events associated with hip joint replacement due to degenerative conditions.

Measure Source

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

Table

2.22. Percent of patients who had a hip joint replacement due to degenerative conditions with adverse events associated with the hip joint replacement, United States, 2004.

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 to distinguish between cases who had hip arthroplasty for a fracture and cases who had total hip replacements for degenerative conditions and to determine 30-day post-procedure readmission.

Denominator

All patients in the MPSMS sample who experienced a surgical procedure performed to replace a damaged hip joint.

Numerator

Subset of the denominator population that experienced at least 1 of the following:

  • Postoperative infections
  • Postoperative pneumonia
  • Postoperative urinary tract infection
  • Postoperative venous thromboembolic event meeting either of the following criteria:
  • During hospital stay (per abstracted information from medical records), or
  • Readmission to the hospital post-index hospital stay for a pelvic embolism or deep vein thrombosis 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)
  • Dislocation
  • Wound complications other than infection
  • Nerve injury
  • Postoperative bleeding requiring 4 or more blood transfusions
  • Cardiovascular complications
  • Same side revision during the index hospital stay
  • Return to operating room for reasons other than same side revision during the index hospital stay
  • Periprosthetic fracture (only applies to 2003 data)

Comments

Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection or acute and early deep hip infection, excluding superficial infection. Wound complications other than infection include dehiscence, hematoma, and necrosis.

The definition of major bleeding/hematoma underwent revision between 2002 and 2003.

Postoperative pneumonia, postoperative urinary tract infection, postoperative venous thromboembolic event are all determined in the same fashion as those in other MPSMS measures.

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Other Complications of Hospital Care

Measure Title

Adverse events associated with hip joint replacement due to fracture.

Measure Source

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

Table

2.23. Percent of patients who had a hip joint replacement due to fracture with adverse events associated with the hip joint replacement, United States, 2004.

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, to identify procedure codes for hip arthroplasty and replacement and to determine 30-day post-procedure readmission.

Denominator

All patients in the MPSMS sample that experienced a surgical procedure performed to replace a fractured hip joint.

Numerator

Subset of the denominator who experienced at least 1 of the following:

Postoperative infections, postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis or pulmonary embolus, dislocation, wound complications other than infection, nerve injury, postoperative bleeding requiring 4 or more blood transfusions, cardiovascular complications, same side revision during the index hospital stay, return to or for reasons other than same side revision during the index hospital stay, and death.

Comments

Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection and acute and early deep hip infection excluding superficial infection.

Postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis, and pulmonary embolus are all determined in the same fashion as those in prior MPSMS measures.

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

Wound complications other than infection include dehiscence, hematoma, and necrosis.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Other Complications of Hospital Care

Measure Title

Adverse events associated with hip joint replacement due to fracture or degenerative conditions.

Measure Source

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

Table

2.24. Percent of patients who had a hip joint replacement due to fracture or degenerative conditions with adverse events associated with the hip joint replacement, United States, 2004.

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, to identify procedure codes for hip arthroplasty and replacement and to determine 30-day post-procedure readmission.

Denominator

All patients in the MPSMS sample who experienced a surgical hip replacement procedure performed on a hip joint with degenerative damage or fracture.

Numerator

Subset of the denominator who experienced at least 1 of the complications of hip replacement detailed in the prior hip replacement measures (2.34 and 2.35).

Comments

Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection and acute and early deep hip infection excluding superficial infection.

Postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis, and pulmonary embolus are all determined in the same fashion as those in prior MPSMS measures.

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

Wound complications other than infection include dehiscence, hematoma, and necrosis.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Other Complications of Hospital Care

Measure Title

Adverse events associated with knee joint replacement.

Measure Source

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

Table

2.25. Percent of patients who had a knee joint replacement with adverse events associated with the knee joint replacement, United States, 2004.

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, and to determine 30-day post-procedure readmission.

Denominator

All patients in the MPSMS sample who experienced a surgical procedure performed to replace an arthritic or damaged knee joint.

Numerator

Subset of the denominator who experienced at least 1 of the following:

  • Postoperative infection
  • Postoperative pneumonia
  • Postoperative urinary tract infection
  • Postoperative venous thromboembolic event meeting either of the following criteria:
  • During the hospital stay (per abstracted information from medical records)
  • Readmission 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)
  • Dislocation
  • Wound complication other than infection
  • Nerve injury
  • Postoperative bleeding requiring 4 or more blood transfusions
  • Cardiovascular complications
  • Same side revision during the index hospital stay
  • Return to operating room for reasons other than same side revision during the index hospital stay
  • Periprosthetic fracture (only applies to 2003 data)

Comments

Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection and acute and early deep hip infection, excluding superficial infection.

Postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis and pulmonary embolus are all determined in the same fashion as those in other MPSMS measures.

The definition of major bleeding/hematoma underwent revision between 2002 and 2003.

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

Wound complications other than infection include dehiscence, hematoma, and necrosis.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Other Complications of Hospital Care

Measure Title

Selected infections due to medical care (discharge-based) and selected infections due to medical care (area-based).

Measure Source

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

Tables

2.26a. Selected infections due to medical care per 1,000 discharges (excluding immunocompromised and cancer patients and neonates), United States, 2001 and 2003.

2.26b. Selected infections due to medical care per 100,000 population (excluding immunocompromised and cancer patients and neonates), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Table 2.26a: All medical and surgical hospital discharges, excluding immunocompromised or cancer patients.

Table 2.26b: U.S. population.

Numerator

Table 2.26a: All non-neonatal medical and surgical hospital discharges with any secondary diagnosis of infection (ICD-9-CM diagnosis code 999.3 or 996.62), excluding immunocompromised and cancer patients.

Table 2.26b: All non-neonatal medical and surgical hospital discharges with any principal or secondary diagnosis of infection (ICD-9-CM diagnosis code 999.3 or 996.62), excluding immunocompromised and cancer patients.

Comments

Table 2.26a: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Table 2.26b: Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator 7 (discharge-based, table a) and 23 (area-based, table b) in the software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site 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

2.27. 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, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

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

There may be additional diagnostic criteria specific to each complication that affect inclusion or exclusion from this measure statistic. Detailed information can be found at http://www.qualityindicators.ahrq.gov.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Accidental puncture or laceration during procedures (discharge-based) and accidental puncture or laceration during procedures (area-based).

Measure Source

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

Tables

2.28a. Accidental puncture or laceration during procedures per 1,000 discharges (excluding obstetric admissions), United States, 2001 and 2003.

2.28b. Accidental puncture or laceration during procedures per 100,000 population (excluding obstetric admissions), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Table 2.28a: Hospital medical and surgical discharges, excluding obstetric admissions.

Table 2.28b: U.S. population.

Numerator

Table 2.28a: Discharges with ICD-9-CM code denoting accidental cut, puncture, perforation, or laceration during a procedure in any secondary diagnosis.

Table 2.28b: Discharges with ICD-9-CM code denoting accidental cut, puncture, perforation, or laceration during a procedure in any diagnosis field (principal or secondary).

Comments

Table 2.28a: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Table 2.28b: Rates are adjusted by age and gender, using year 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator details 15 (discharge-based, table a) and 25 (area-based, table b) in the software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Iatrogenic pneumothorax (discharge-based) and iatrogenic pneumothorax (area-based) among relevant discharges.

Measure Source

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

Tables

2.29a. 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, 2001 and 2003.

2.29b. Iatrogenic pneumothorax cases per 100,000 population (excluding neonates, obstetrical admissions, and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Table 2.29a: All non-neonatal medical and surgical hospital discharges, excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery.

Table 2.29b: U.S. population.

Numerator

Table 2.29a: Non-neonatal 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.

Table 2.29b: Non-neonatal medical and surgical discharges with any principal or 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

Table 2.29a: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Groups (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.

Table 2.29b: Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator 6 (discharge-based, table a) and 22 (area-based, table b) in the software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Death in low mortality DRGs.

Measure Source

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

Table

2.30. 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, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

Hospital admissions in low mortality DRGs (with a NIS 1997 benchmark of less than 0.5% mortality), excluding patients with any code for trauma, immunocompromised state, or cancer.

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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Other Complications of Hospital Care

Measure Title

Transfusion reactions (discharge-based) and transfusion reactions (area-based).

Measure Source

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

Table

2.31. Transfusion reactions per 100,000 population (excluding neonates), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

U.S. population.

Numerator

Non-neonatal medical and surgical discharges with any principal or secondary diagnosis indicating transfusion reaction.

Comments

Rates are adjusted by age and gender using the total U.S. population for 2000 as the standard population. When reporting is by age, the adjustment is by gender only; when reporting is by gender, the adjustment is by age only.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

These tables were created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. These measures are referred to as indicator 16 (discharge-based, table a) and 26 (area-based, table b) in the software documentation Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Birth trauma—injury to neonate.

Measure Source

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

Table

2.32. Birth trauma-injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

U.S. live birth discharges, excluding infants with subdural or cerebral hemorrhage, with injury to skeleton, preterm infants, and osteogenesis imperfecta births.

Numerator

Subset of the denominator with any diagnosis of birth trauma (ICD-9-CM codes 767.0, 767.3, 767.4, 767.7, 767.8, 767.9) in any diagnosis field.

Comments

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

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma—vaginal with instrument.

Measure Source

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

Table

2.33. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma—vaginal without instrument.

Measure Source

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

Table

2.34. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

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.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site at http://www.qualityindicators.ahrq.gov.

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Birth-Related Trauma

Measure Title

Obstetric trauma—Cesarean delivery.

Measure Source

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

Table

2.35. Obstetric trauma with 3rd degree, 4th degree, or other obstetric lacerations per 1,000 Cesarean deliveries, United States, 2001 and 2003.

Data Source

AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample.

Denominator

All Cesarean section delivery hospital discharges.

Numerator

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

Comments

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

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

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 software documentation. Further information about this and other safety and quality indicators is available from the AHRQ Quality Indicators Web site 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

2.36. 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

Percent of persons who report that their usual source of care (USC) asks about prescription medications and treatments from other providers.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Financing, Access and Cost Trends (CFACT), Medical Expenditure Panel Survey (MEPS).

Table

2.37. Percent of persons with a usual source of care (USC) who reported that their USC usually asked about prescription medications and treatments from other doctors, United States, 2000 and 2003.

Data Source

AHRQ, MEPS.

Denominator

Persons who had a USC and answered the question "Does (respondent's usual care provider) usually ask about prescription medications and treatments other doctors may give you?" Nonresponses, as well as "Don't Know" responses, were excluded.

Numerator

Subset of the denominator population who answered "Yes" to the question.

Comments

Usual source of care is defined as a particular doctor's office, clinic, health center, or other health care facility to which an individual usually would go to obtain health care services.

This table reports data from the MEPS Access to Care section. See the MEPS entry in the Data Sources section of this appendix for more information.

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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).

Table

2.38. Percent of patients with adverse drug events: anticoagulant related Warfarin, United States, 2004.

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

Medicare beneficiaries discharged from acute care facilities January to December who were administered Warfarin.

Numerator

Discharged Medicare patients administered Warfarin with documented adverse effects.

Comments

Readmissions were not counted in the numerators, as specified by the measure qualifications, because the data were not available.

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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).

Table

2.39. Percent of patients with adverse drug events: anticoagulant related IV heparin, United States, 2004.

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

Medicare beneficiaries discharged from acute care facilities January to December who were administered Heparin.

Numerator

Discharged Medicare patients administered Heparin with documented adverse effects.

Comments

Readmissions were not counted in the numerators, as specified by the measure qualifications, because the data were not available.

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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).

Table

2.40. Percent of patients with adverse drug events: anticoagulant related low molecular weight heparin and factor Xa, United States, 2004.

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

Medicare beneficiaries discharged from acute care facilities January to December who were administered low molecular weight heparin and factor Xa.

Numerator

Discharged Medicare patients administered low molecular weight heparin and factor Xa with documented adverse effects.

Comments

Readmissions were not counted in the numerators, as specified by the measure qualifications, because the data were not available.

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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).

Table

2.41. Percent of patients with adverse drug events: hypoglycemic agents including insulin, oral hypoglycemic, or combination of both, United States, 2004.

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

Medicare beneficiaries discharged from acute care facilities January to December who were administered hypoglycemic agents.

Numerator

Discharged Medicare patients administered hypoglycemic agents with documented adverse effects.

Comments

Readmissions were not counted in the numerators, as specified by the measure qualifications, because the data were not available.

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