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National Healthcare Quality Report, 2007

Patient Safety

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Postoperative Complications
Composite measure: Adult surgery patients with postoperative complications (postoperative pneumonia, catheter-associated urinary tract infection, or venous thromboembolic events)
Adult surgery patients with postoperative pneumonia
Adult surgery patients with postoperative catheter-associated urinary tract infection
Adult surgery patients with postoperative venous thromboembolic events
Composite measure: Adult Medicare patients having surgery who received appropriate timing of antibiotics (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 hemorrhage or hematoma with surgical drainage or evacuation
Postoperative septicemia per 1,000 elective surgical discharges of 4+ days
Postoperative pulmonary embolus or deep vein thrombosis per 1,000 surgical discharges
Postoperative respiratory failure per 1,000 elective surgical discharges
Postoperative physiologic/metabolic derangements per 1,000 elective surgeries
Postoperative hip fractures
Postoperative abdominal wound dehiscence (discharged based and area based)
Foreign body left in during procedure (discharge based and area based)
Complications of anesthesia
Decubitus ulcers per 1,000 selected stays of 5 or more days
Other Complications of Hospital Care
Central vascular catheter placement with associated bloodstream infections (BSIs) or mechanical adverse events
Blood stream infections (BSIs) associated with central vascular catheters (CVCs)
Mechanical adverse events associated with central vascular catheters (CVCs)
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 replacement
Selected infections due to medical care (discharge based and area based)
Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue)
Accidental laceration or puncture during procedure (discharge based and area based)
Iatrogenic pneumothorax (discharge based and area based)
Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs)
Transfusion reaction
Birth-Related Trauma
Birth trauma injury to neonate 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
Complications of Medication
Inappropriate drug use among community-dwelling adults age 65 and over
Percent of adults who report that usual source of care asks about prescription medications and treatments from other providers
Adverse drug events-anticoagulant: warfarin
Adverse drug events-anticoagulant: IV heparin
Adverse drug events-anticoagulant: low molecular weight heparin (LMWH) and factor Xa
Adverse drug events-hypoglycemic agents: insulin/oral hypoglycemics/combination of both
Ambulatory care visits due to adverse drug effects

Postoperative Complications

Measure Title

Composite measure: Adult surgery patients with postoperative complications (postoperative pneumonia, catheter-associated urinary tract infection, or venous thromboembolic events).

Measure Source

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

Tables

2.1 Percent of surgical discharges with postoperative pneumonia events, catheter-associated urinary tract infection, or venous thromboembolic events, United States, 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample that had one 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 diagnosed 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 three components of the composite measure for further details about the methodology.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for post-discharge, readmission, and clinical criteria processing, as appropriate for each component of the composite measure.

For more detailed information regarding the Surgical Care Improvement Project, see http://www.qualitynet.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents.

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Postoperative Complications

Measure Title

Adult surgery patients with postoperative pneumonia.

Measure Source

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

Tables

2.2 Percent of surgical discharges with postoperative pneumonia events, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample that had one 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 and physician ordered antibiotic to treat postoperative pneumonia.

Comments

Postoperative nosocomial pneumonia is determined by evidence in the medical record of a new infiltrate, consolidation, or cavitation noted on a chest x-ray, and documentation of physician diagnosis of postoperative pneumonia and a physician-ordered antibiotic to treat the pneumonia or the patient was discharged or died the same day the pneumonia was diagnosed.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to identify a major surgical procedure, for 30-day post-procedure and post-discharge mortality, and to identify readmission within 30 days of procedure.

For more detailed information regarding the Surgical Care Improvement Project, see http://www.qualitynet.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents.

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Postoperative Complications

Measure Title

Adult surgery patients with postoperative catheter-associated urinary tract infection.

Measure Source

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

Tables

2.3 Percent of surgical discharges with catheter-associated urinary tract infection, United States, 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample who were without an indwelling catheter on admission, were not on a straight catheter regime prior to admission, had no evidence of a urinary tract infection on admission, and had an indwelling urinary or straight catheter inserted during the index hospital stay.

Numerator

Subset of the denominator with a diagnosed urinary tract infection (UTI) after an indwelling urinary or straight catheter was inserted during the index hospital stay.

Comments

Diagnosed postoperative UTIs are defined as a physician diagnosis of UTI and an antibiotic ordered by a physician to treat the UTI.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to identify a major surgical procedure, for 30-day post-procedure and post-discharge mortality, and to identify readmission within 30 days of procedure.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier. Data may not be comparable.

For more detailed information regarding the Surgical Care Improvement Project, see http://www.qualitynet.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents.

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Postoperative Complications

Measure Title

Adult surgery patients with postoperative venous thromboembolic events.

Measure Source

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

Tables

2.4 Percent of surgical discharges with postoperative venous thromboembolic events, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample that had one or more of certain surgical procedures identified as part of the Surgical Care Improvement Project.

Numerator

The subset of the denominator with a diagnosed pulmonary embolus (PE) or deep vein thrombosis (DVT) during the index hospital stay (per medical record abstraction) or 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, and 453.9).

Comments

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

Venous thromboembolic events (VTEs) include at least one 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 one of the following:

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

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

  1. High probability ventilation-perfusion (V/Q) scan.
  2. Moderate probability V/Q scan and abnormal duplex US 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 (MR) exam of the pulmonary arteries indicating pulmonary embolus.

For more detailed information regarding the Surgical Care Improvement Project, see http://www.qualitynet.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to identify a major surgical procedure, for 30-day post-procedure readmission diagnosis of DVT or PE, for 30-day post-procedure and post-discharge mortality, and to identify readmission within 30 days of procedure.

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Postoperative Complications

Measure Title

Composite measure: Adult Medicare patients having surgery who received appropriate timing of antibiotics (prophylactic antibiotics begun at the right time and ended at the right time).

Measure Source

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

National Tables

2.5a Percent of adult surgery patients who received appropriate timing of antibiotics, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National 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.

State Tables

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

2.5c Percent of adult surgery patients who received appropriate timing of antibiotics, all payers, by State, 2005 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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

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Postoperative Complications

Measure Title

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

Measure Source

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

National Tables

2.6a Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

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

2.6c Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, all payers, by State, 2005 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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Postoperative Complications

Measure Title

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

Measure Source

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

National Tables

2.7a Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, United States, 2005.

National Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

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

2.7c Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, all payers, by State, 2005 and 2006.

State Data Source

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

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Postoperative Complications

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation.

Measure Source

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

Tables

2.8a Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges (excluding obstetrical admissions), age 18 and over, United States, 2003 and 2004.

2.8b Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery (excluding obstetrical admissions), per 100,000 population, age 18 and over, United States, 2003 and 2004.

Data Source

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

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, and (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 group (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 PSI 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 septicemia per 1,000 elective surgical discharges of 4+ days.

Measure Source

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

Tables

2.9 Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure (excluding patients admitted for infection, patients with cancer or immunocompromised states, obstetric conditions, stays under 4 days, and admissions specifically for sepsis).

Data Source

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

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 group (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 PSI 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 pulmonary embolus or deep vein thrombosis per 1,000 surgical discharges.

Measure Source

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

Tables

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), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 group (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 PSI 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 per 1,000 elective surgical discharges.

Measure Source

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

Tables

2.11 Postoperative respiratory failure per 1,000 elective surgical discharges with an operating room procedure (excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, and admissions specifically for acute respiratory failure), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 group (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 PSI 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/metabolic derangements per 1,000 elective surgeries.

Measure Source

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

Tables

2.12 Postoperative physiologic and metabolic derangements per 1,000 elective surgical discharges (excluding some serious disease and obstetric admissions), age 18 and over, United States, 2003 and 2004.

Data Source

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

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 acute myocardial infarction, 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 group (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 PSI 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 fractures.

Measure Source

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

Tables

2.13 Postoperative hip fracture per 1,000 surgical patients age 18 and over who were not susceptible to falling (excluding obstetrical admissions), United States, 2003 and 2004.

Data Source

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

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 group (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 PSI 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

Postoperative abdominal wound dehiscence (discharged based and area based).

Measure Source

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

Tables

2.14a Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges (excluding immunocompromised patients, stays under 2 days, and obstetric conditions), United States, 2003 and 2004.

2.14b Reclosure of postoperative abdominal wound dehiscence (excluding immunocompromised and obstetric patients) per 100,000 population, age 18 and over, United States, 2003 and 2004.

Data Source

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

Denominator

Discharge table: All inpatient hospital abdominopelvic surgical discharges. Excludes obstetrical patients. Population table: U.S. population.

Numerator

Discharge table: 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). Population table: 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

Discharge table: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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.

Population table: 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 PSI 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 left in during procedure (discharge based and area based).

Measure Source

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

Tables

2.15a Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges age 18 and over or obstetric admissions, United States, 2003 and 2004.

2.15b Foreign body accidentally left in during procedure per 100,000 population age 18 and over or obstetric admissions, United States, 2003 and 2004.

Data Source

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

Denominator

Discharge table: All non-neonatal medical and surgical inpatient hospital discharges. Population table: U.S. population.

Numerator

Discharge table: Non-neonatal medical and surgical discharges with any secondary diagnosis indicating foreign body left in during procedure. Population table: Non-neonatal medical and surgical discharges with any principal or secondary diagnosis indicating foreign body left in during procedure.

Comments

Discharge table: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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.

Population table: 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 PSI 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 (PSI).

Tables

2.16 Complications of anesthesia in any secondary diagnosis per 1,000 surgical discharges (excluding patients with anesthesia complications as a principal diagnosis and patients with self-inflicted injury, poisoning due to anesthetics, and active drug dependence or abuse) age 18 and over or obstetric admissions, United States, 2003 and 2004.

Data Source

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

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 group (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 PSI 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 per 1,000 selected stays of 5 or more days.

Measure Source

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

Tables

2.17 Decubitus ulcers per 1,000 discharges of length 5 or more days (excluding transfers, patients admitted from long-term care facilities, patients with diseases of the skin, subcutaneous tissue, and breast, and obstetrical admissions), age 18 and over, United States, 2003 and 2004.

Data Source

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

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; 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 group (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 PSI 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

Central vascular catheter placement with associated bloodstream infections (BSIs) or mechanical adverse events.

Measure Source

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

Tables

2.18 Percent of central vascular catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample with documentation of placement of at least one 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 that did not have evidence of a prior BSI.

Numerator

Subset of the denominator with either a CVC-associated blood stream 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.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for post-discharge, readmission, and clinical criteria processing, as appropriate for each component of the composite measure.

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Other Complications of Hospital Care

Measure Title

Blood stream infections (BSIs) associated with central vascular catheters (CVCs).

Measure Source

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

Tables

2.19 Percent of discharges with central vascular catheter placement with associated bloodstream infections, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All discharges from the MPSMS sample with documentation of placement of at least one 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 that did not have evidence of a prior BSI.

Numerator

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

Comments

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

  1. At least one blood culture, drawn at least 2 days after placement of a CVC, and positive for at least one of the following pathogens: Staphylococcus aureus, Escherichia coli, Enterococcus species, Klebsiella species, Pseudomonas aeruginosa, beta-hemolytic Streptococcus, Enterobacter species, Viridans-group Streptococci, Candida, Acinetobacter, Proteus mirabilis, MRSA, Candida glabrata, Enterococcus faecalis or Stenotrophomonas; or at least two blood cultures drawn at least 2 days after placement of a CVC and positive for Coagulase negative staphylococcus or other Staphylococcus.
  2. No other source of infection documented.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier versions. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and post-discharge mortality, and to identify readmission within 30 days of procedure.

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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

2.20 Percent of central vascular catheter placement with associated mechanical adverse events, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All instances in records from the MPSMS sample of placement of at least one vascular access device 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 mechanical adverse events.

Comments

A CVC-associated mechanical adverse event is defined as the presence in the medical record of at least one of the following: allergic reaction (with CPR within 15 minutes), perforation, pneumothorax, hematoma, shearing off of the catheter, air embolism, misplaced catheter, thrombosis/embolism, knotting of the pulmonary artery catheter, and certain other events.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier versions. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and post-discharge mortality, and to identify readmission within 30 days of procedure.

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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).

Tables

2.21 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 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

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 one of the following: postoperative infections (acute or early deep), dehiscence, necrosis, hematoma, nerve injury, major bleeding, dislocation, cardiovascular complications, catheter-associated urinary tract infection, or pneumonia; return to operating room after procedure (excludes same side revision); revision during the index hospital stay (same side as index procedure); postoperative venous thromboembolic event during hospital stay (per abstracted information from medical records); readmission to the hospital post-index hospital stay for a pulmonary embolus or deep vein thrombosis within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1X, 451.2, 451.81, 451.83, 451.84, 451.89, 453.8, 453.9).

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. Rates for 2003 and later may not be comparable with earlier years.

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

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

The analytic approach used to produce these tables differs from NHQR 2005 and earlier versions. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure mortality, to distinguish between hip procedures, to determine 30-day post-procedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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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).

Tables

2.22 Percent of patients who had a hip joint replacement due to fracture with adverse events associated with the hip joint replacement, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

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

Numerator

Subset of the denominator who experienced at least one 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 four 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 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.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier versions. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare dministrative data are used for 30-day post-procedure mortality, to distinguish between hip procedures, to determine 30-day post procedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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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).

Tables

2.23 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 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

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 one of the complications of hip replacement detailed in the prior hip replacement measures.

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 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.

The analytic approach used to produce these tables differs from NHQR 2005 and earlier. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure mortality, to distinguish between hip procedures, to determine 30-day post procedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Other Complications of Hospital Care

Measure Title

Adverse events associated with knee replacement.

Measure Source

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

Tables

2.24 Percent of patients who had a knee joint replacement with adverse events associated with the knee joint replacement, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

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 one of the following: postoperative infection, dehiscence, necrosis, hematoma, nerve injury, major bleeding, or cardiovascular complications; return to the operating room after procedure (excluding same side revision); revision during index stay; postoperative venous thromboembolic event during the hospital stay (per abstracted information from medical records); readmission to the hospital post-index hospital stay for a pulmonary embolus or deep vein thrombosis within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1X, 451.2, 451.81, 451.83, 451.84, 451.89, 453.8, 453.9); or postoperative catheter-associated urinary tract infection.

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. Rates for 2003 and later may not be comparable with earlier years.

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

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

The analytic approach used to produce these tables differs from NHQR 2005 and earlier. Data may not be comparable.

Major bleeding/hematoma is defined as return to the operating room for evacuation and/or hemostasis, or hemoglobin drop of more than 2.0 gm/dL compared to first postoperative day.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure mortality, to determine 30-day post procedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Other Complications of Hospital Care

Measure Title

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

Measure Source

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

Tables

2.25a Selected infections due to medical care per 1,000 medical and surgical discharges (excluding immunocompromised and cancer patients, stays under 2 days, and admissions specifically for such infections) age 18 and over or obstetric admissions, United States, 2003 and 2004.

2.25b Selected infections due to medical care per 100,000 population (excluding immunocompromised and cancer patients and neonates) age 18 and over or obstetric admissions, United States, 2003 and 2004.

Data Source

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

Denominator

Discharge table: All medical and surgical hospital discharges, excluding immunocompromised or cancer patients. Population table: U.S. population.

Numerator

Discharge table: 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. Population table: 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

Discharge table: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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.

Population table: 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 PSI 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 (PSI).

Tables

2.26 Failure to rescue or deaths per 1,000 discharges having developed specified complications of care during hospitalization (excluding patients transferred in or out and patients admitted from long-term care facilities), ages 18-74, United States, 2003 and 2004.

Data Source

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

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 group (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 PSI software. This measure is referred to as indicator 4 in the software documentation.

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Other Complications of Hospital Care

Measure Title

Accidental laceration or puncture during procedure (discharge based and area based).

Measure Source

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

Tables

2.27a Accidental puncture or laceration during procedure per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2003 and 2004.

2.27b Accidental puncture or laceration during procedure (excluding obstetric admissions) per 100,000 population, age 18 and over, United States, 2003 and 2004.

Data Source

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

Denominator

Discharge table: Hospital medical and surgical discharges, excluding obstetric admissions. Population table: U.S. population.

Numerator

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

Comments

Discharge table: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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.

Population table: 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 PSI 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 area based).

Measure Source

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

Tables

2.28a Iatrogenic pneumothorax per 1,000 discharges (excluding obstetrical admissions and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2003 and 2004.

2.28b Iatrogenic pneumothorax cases per 100,000 population (excluding obstetrical admissions and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2003 and 2004.

Data Source

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

Denominator

Discharge table: All non-neonatal medical and surgical hospital discharges, excluding patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery. Population table: U.S. population.

Numerator

Discharge table: 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. Population table: 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

Discharge table: Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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.

Population table: 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 PSI 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

Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs).

Measure Source

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

Tables

2.29 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), age 18 and over, or obstetric admissions, United States, 2003 and 2004.

Data Source

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

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 PSI 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 reaction.

Measure Source

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

Tables

2.30a Transfusion reactions per 1,000 discharges, age 18 and over, or obstetric admissions, United States, 2003 and 2004.

2.30b Transfusion reactions per 100,000 population, age 18 and over, or obstetric admissions, United States, 2003 and 2004.

Data Source

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

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 PSI 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 per 1,000 selected live births.

Measure Source

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

Tables

2.31 Birth trauma injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2004.

Data Source

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

Denominator

U.S. live birth discharges, excluding infants with subdural or cerebral hemorrhage or 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 PSI 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 per 1,000 instrument-assisted deliveries.

Measure Source

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

Tables

2.32 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2003 and 2004.

Data Source

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

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 PSI 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 per 1,000 vaginal deliveries without instrument assistance.

Measure Source

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

Tables

2.33 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2003 and 2004.

Data Source

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

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 PSI 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 per 1,000 Cesarean deliveries.

Measure Source

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

Tables

2.34 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 Cesarean deliveries, United States, 2003 and 2004.

Data Source

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

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 PSI 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

Inappropriate drug use among community-dwelling adults age 65 and over.

Measure Source

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

Tables

2.35 Percent of adults age 65 and over with inappropriate medication use, United States, 2002 and 2004.

Data Source

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

Denominator

U.S. population age 65 and over.

Numerator

Persons age 65 and over prescribed 1 or more medications on lists of 11 or 33 medications potentially inappropriate for the elderly.

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. JAMA 286(22), 2823-2829, 2001.

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Complications of Medication

Measure Title

Percent of adults who report that usual source of care 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).

Tables

2.36 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, 2002 and 2004.

Data Source

AHRQ, CFACT, Medical Expenditure Panel Survey (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. Go to the MEPS entry in the Data Sources 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).

Tables

2.37 Percent of patients with adverse drug events: anticoagulant-related warfarin, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All MPSMS sample patients who had a hospital stay in which they received warfarin and had documented international normalized ratio (INR) result.

Numerator

Subset of the denominator who experience one of the following: an INR of 4.0 or higher with cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, a hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding, a new hematoma, or other types of bleeding or pulmonary bleeding; an INR of 1.5 or higher and abrupt cessation/hold of warfarin with one or more of the above symptoms; an INR of 1.5 or higher and administration of Vitamin K or fresh frozen plasma with one or more of the above symptoms; an INR of 1.5 or higher and a blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and readmission within 30 days.

Numerator events occurring on the day of arrival are not counted in the numerator.

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Complications of Medication

Measure Title

Adverse drug events-anticoagulant: IV heparin.

Measure Source

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

Tables

2.38 Percent of patients with adverse drug events: anticoagulant-related IV intravenous heparin, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All MPSMS sample patients who had a hospital stay in which they received heparin and had documented partial thromboplastin time (PTT) result.

Numerator

Subset of the denominator who experience one of the following: a PTT of 100 or higher with cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, a hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding, a new hematoma, or other types of bleeding or pulmonary bleeding; a PTT of 45 or higher and abrupt cessation/hold of heparin with one or more of the above symptoms; a PTT of 45 or higher and administration of Vitamin K or fresh frozen plasma with one or more of the above symptoms; a PTT of 45 or higher and a blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and readmission within 30 days.

Numerator events occurring on the day of arrival are not counted in the numerator.

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Complications of Medication

Measure Title

Adverse drug events-anticoagulant: low molecular weight heparin (LMWH) and factor Xa.

Measure Source

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

Tables

2.39 Percent of patients with adverse drug events: anticoagulant-related low molecular weight heparin and factor Xa, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All MPSMS sample patients who received low molecular weight heparin (LMWH) or factor Xa inhibitor during the hospital stay.

Numerator

Subset of the denominator who experience one of the following: an abrupt cessation/hold of LMWH or factor Xa inhibitor with cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, a hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding, a new hematoma, or other types of bleeding or pulmonary bleeding; administration of Vitamin K or fresh frozen plasma with one or more of the above symptoms; a blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and readmission within 30 days.

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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

2.40 Percent of patients with adverse drug events: hypoglycemic agents including insulin, oral hypoglycemic, or combination of both, United States, 2004 and 2005.

Data Source

CMS, MPSMS.

CMS, Medicare Administrative Data.

Denominator

All MPSMS sample patients who received insulin, oral hypoglycemics, or both, and had a glucose result during the hospital stay.

Numerator

Subset of the denominator who experienced a glucose level of 70 or less with one or more of the following: administration of D50, glucagons, juice, and/or sugar; anxiety or confusion; CPR; drowsiness, sweating, weakness, irritability, or trembling; increased heart rate; seizure or stroke; transient ischemic attack or myocardial infarction; coma or loss of consciousness.

Comments

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day post-procedure and readmission within 30 days.

Numerator events occurring on the day of arrival are not counted in the numerator.

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Complications of Medication

Measure Title

Ambulatory care visits due to adverse drug effects.

Measure Source

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

Tables

2.41 Ambulatory care visits due to adverse drug effects, United States, 2004.

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS-NHAMCS).

Denominator

Visits to physician offices, hospital outpatient departments, and hospital emergency departments.

Numerator

Visits with a reported adverse drug event.

Comments

ICD-9-CM codes E930-E947 were used to identify adverse drug events. Adverse effects due to bacterial vaccine, other vaccine, and biological substances, and adverse reactions to heroin and methadone were excluded from the range.

For further information, see Zhan et al.: Ambulatory care visits for treating adverse drug effects in the United States, 1995-2001. Joint Commission Journal on Quality and Patient Safety, July 2005, 31(7): 372-378.

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