Chapter 3 (Text Descriptions)

National Healthcare Quality Report, 2011


Figure 3.1. Adult surgery patients who received appropriate care: Overall composite and individual components, 2009

Overall Composite and Individual Components2009
Composite86.2%
SCIP-Inf-196.2%
SCIP-Inf-297.6%
SCIP-Inf-393.3%
SCIP-Inf-492.7%
SCIP-Inf-699.2%
SCIP-Card-291.1%
SCIP-VTE-193.3%
SCIP-VTE-291.3%

Key: Inf = infection; Card = cardiac; VTE = venous thromboembolism.

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2009.

Denominator: Hospitalized patients having surgery

Note: Some SCIP measures are not included in the composite, so gaps appear in the numbering.

Return to Document

Figure 3.2. Adult surgery patients who received appropriate care, by age, 2009

Age2009
Total86.2%
<6587.0%
65-7485.9%
75-8485.1%
85+83.7%

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2009.
2009 achievable benchmark: 91%.

Return to Document

Figure 3.3. Adult surgery patients who received appropriate timing of antibiotics: Overall composite, by age, 2005-2009

Age20052006200720082009
Total (percent)74.980.386.491.494.8
<65 (percent)77.582.187.492.095.1
65-74 (percent)72.879.285.991.494.8
75-84 (percent)71.778.085.090.594.3
85+ (percent)68.674.282.288.092.5

Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2009.

Denominator: Hospitalized patients having surgery.
2008 achievable benchmark: 95%.

Return to Document

Figure 3.4. Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, by age and gender, 2008

Age/Gender2008
Total (rate per 1,000 discharges)14.6
18-44 (rate per 1,000 discharges)11.4
45-64 (rate per 1,000 discharges)12.1
65+ (rate per 1,000 discharges)17.5
Male (rate per 1,000 discharges)17.2
Female (rate per 1,000 discharges)12.5

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, and AHRQ Quality Indicators, version 4.1.

Denominator: All elective hospital surgical discharges, age 18 and over, with length of stay of 4 or more days, excluding patients admitted for infection, patients with cancer or immunocompromised states, patients with obstetric conditions, and admissions specifically for sepsis.

Note: For this measure, lower rates are better.
Rates are adjusted by age, gender, age-gender interactions, co-morbidities, Major Diagnostic Category (MDC), Diagnosis Related Group (DRG), and transfers into the hospital. When reporting is by age, the adjustment is by gender, co-morbidities, MDC, DRG, and transfers into the hospital; when reporting is by gender, the adjustment is by age, co-morbidities, MDC, DRG, and transfers into the hospital.

Return to Document

Figure 3.5. Bloodstream infections per 1,000 central-line days, by type of pediatric intensive care unit and by birth weight of child in Level III neonatal intensive care units, 2009

Type of Intensive Care Unit (ICU) / Birth WeightCLABSIs Per 1000 Central Line Days
Pediatric Medical/Surgical ICU2.2
Pediatric Cardiothoracic ICU2.5
Pediatric Medical ICU2.6
≤ 750 grams3.4
751-1000 grams2.7
1001-1500 grams1.9
1501-2500 grams1.5
> 2500 grams1.3

Key: ICU = intensive care unit

Source: Centers for Disease Control and Prevention, National Healthcare Safety Network, 2009.

Note: For this measure, lower rates are better.

Return to Document

Figure 3.6. Ambulatory medical care visits due to adverse effects of medical care per 1,000 people, by age and geographic area, 2006-2009

Age2006-20072007-20082008-2009
0-17 (rate per 1,000 people)13.816.611.9
18-44 (rate per 1,000 people)22.927.323.3
45-64 (rate per 1,000 people)44.056.043.1
65+ (rate per 1,000 people)93.9105.283.6

Geographic Area2006-20072007-20082008-2009
MSA (rate per 1,000 people)36.144.133.2
Non-MSA (rate per 1,000 people)27.428.833.4

Key: MSA = metropolitan statistical area.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2007-2008.

Denominator: U.S. Census Bureau estimated civilian noninstitutionalized population on July 1, 2007, and July 1, 2008.

Note: For this measure, lower rates are better
Ambulatory care includes visits to office-based physicians, hospital outpatient departments, and hospital emergency departments.

Return to Document

Figure 3.7. Composite: Mechanical adverse events associated with central venous catheter placement, by age, 2005-2009

YearTotalUnder 6565-7475-8485+
2005 (percent)3.23.33.52.44.5
2006 (percent)4.14.13.84.15.2
2007 (percent)2.832.82.8-
2009 (percent)3.94.43.23.15.9

Source: Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System (MPSMS), 2005-2009.

Denominator: Adult hospitalized Medicare fee-for-service discharges from the MPSMS sample with central venous catheter placement.

Note: For this measure, lower rates are better.
Data for age 85+ in 2007 did not meet criteria for statistical reliability, quality, or confidentiality. Mechanical adverse events include allergic reaction to the catheter, tamponade, perforation, pneumothorax, hematoma, shearing off of the catheter, air embolism, misplaced catheter, thrombosis or embolism, knotting of the pulmonary artery catheter, and certain other events.

Footnote: - = no data value available.

Return to Document

Figure 3.8. Postoperative respiratory failure per 1,000 elective-surgery discharges after an operating room procedure, by age and gender, 2004-2008

Age2004200520072008
18-44 (rate per 1,000 discharges)4.74.95.14.7
45-64 (rate per 1,000 discharges)9.08.88.78.2
65-69 (rate per 1,000 discharges)12.112.212.411.0
70-74 (rate per 1,000 discharges)13.414.013.712.4
75-79 (rate per 1,000 discharges)15.215.615.014.6
80-84 (rate per 1,000 discharges)18.518.318.016.7
85+ (rate per 1,000 discharges)22.023.921.320.4

Gender2004200520072008
Total (rate per 1,000 discharges)10.410.410.29.5
Male (rate per 1,000 discharges)14.014.213.912.8
Female (rate per 1,000 discharges)7.98.18.17.6

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version of 4.1.

Denominator: All elective hospital surgical discharges age 18 and over, excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, selected surgeries for carniofascial anomalies, and secondary procedure of tracheostomy before or after surgery or as the only procedure.

Note: For this measure, lower rates are better.
Rates are adjusted by age, gender, age-gender interactions, co-morbidities, Major Diagnostic Category (MDC), Diagnosis Related Group (DRG), and transfers into the hospital. When reporting is by age, rates are adjusted by gender, co-morbidities, MDC, DRG, and transfers into the hospital; when reporting is by gender, the adjustment is by age, co-morbidities, MDC, DRG, and transfers into the hospital.
Data not available for 2006.

Return to Document

Figure 3.9. Deaths per 1,000 discharges with complications potentially resulting from care during hospitalization (failure to rescue), ages 18-89, by age and insurance status, 2004-2008

Age2004200520072008
Total (death rate per 1,000 discharges)137.9109.7119.0122.1
18-44 (death rate per 1,000 discharges)78.851.167.967.5
45-64 (death rate per 1,000 discharges)113.886.898.297.5
65-89 (death rate per 1,000 discharges)165.9133.2143.7148.6

Insurance Status2004200520072008
Private Insurance (death rate per 1,000 discharges)120.8115.9108.4101.8
Medicare (death rate per 1,000 discharges)129.5119.3112.6103.3
Medicaid (death rate per 1,000 discharges)134.9122.9120.1110.3
Uninsured (death rate per 1,000 discharges)149.0142.7136.2126.8

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version of 4.1.

Denominator: Patients ages 18-89 years from U.S. community hospitals whose hospitalizations are complicated by pneumonia, thromboembolic events, sepsis, acute renal failure, gastrointestinal bleeding or acute ulcer, shock, or cardiac arrest.

Note: For this measure, lower rates are better.
Rates are adjusted by age, co-morbidities, Major Diagnostic Category (MDC), Diagnosis Related Group (DRG), and transfers into the hospital. When reporting is by age, the adjustment is by co-morbidities, MDC, DRG, and transfers into the hospital.
Data not available for 2006.

Return to Document

Figure 3.10. Deaths per 1,000 hospital admissions with pneumonia as principal diagnosis, age 18 and over, United States, by age and gender, 2004-2008

Age2004200520072008
Total (death rate per 1,000 admissions)53.748.539.935.8
18-44 (death rate per 1,000 admissions)12.111.69.39.0
45-64 (death rate per 1,000 admissions)28.925.222.320.4
65+ (death rate per 1,000 admissions)70.964.552.447.0

Gender2004200520072008
Male58.252.743.438.7
Female52.648.037.634.0

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version of 4.1.

Denominator: All discharges age 18 and over with principal diagnosis code of pneumonia, excluding patients transferred to another short-term hospital and obstetric admissions.

Note: For this measure, lower rates are better.
Rates are adjusted by age, gender, age-gender interactions, co-morbidities, Major Diagnostic Category (MDC), Diagnosis Related Group (DRG), and transfers into the hospital. When reporting is by age, the adjustment is by gender, co-morbidities, MDC, DRG, and transfers into the hospital; when reporting is by gender, the adjustment is by age, co-morbidities, MDC, DRG, and transfers into the hospital.
Data not available for 2006.
2007 achievable benchmark: 28.

Return to Document

 

Current as of February 2011
Internet Citation: Chapter 3 (Text Descriptions): National Healthcare Quality Report, 2011. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap3txt.html