2012 National Healthcare Quality Report

Chapter 3, Text Descriptions for Figures

Figure 3.1. Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, by age and income, 2008-2009

Age Group / Income20082009
Total14.5815.31
18-4411.410.5
45-6412.113.0
65+17.518.5
Poor15.014.9
Low Income14.316.0
Middle Income14.815.0
High Income14.215.2

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: People age 18 and over. For this measure, lower rates are better. Rates are adjusted by age, gender, age-gender interactions, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers into the hospital. When reporting is by age, the adjustment is by gender, comorbidities, MDC, DRG, and transfers into the hospital; when reporting is by gender, the adjustment is by age, comorbidities, MDC, DRG, and transfers into the hospital.

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Figure 3.2. Adult surgery patients with postoperative catheter-associated urinary tract infection, overall and by age, obesity, and COPD status, 2009-2010

Age Group / Obesity / COPD20092010
Total3.13.6
Under 651.61.9
65-743.33.4
75-844.75.1
85+5.06.3
Not Obese3.03.5
Obese3.53.8
COPD - No2.83.2
COPD - Yes4.14.6

Key: COPD = chronic obstructive pulmonary disease.
Source: Agency for Healthcare Research and Quality, Medicare Patient Safety Monitoring System, 2009-2010.
Denominator: Selected discharges of hospitalized patients age 18 and over having major surgery and meeting specific criteria for each measure.
Note: For this measure, lower rates are better.

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Figure 3.3. Admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, by insurance status and gender, 2008-2009

Insurance / Gender20082009
Total2.62.8
Any Private2.62.7
Medicaid3.53.8
Medicare2.52.6
Other Insurance2.92.8
Uninsured1.81.8
Male4.03.9
Female2.12.3

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.1, 2008-2009.
Denominator: People age 18 and over or obstetric admissions.
Note: For this measure, lower rates are better.

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Figure 3.4. State variation: Standardized infection ratios for central line-associated bloodstream infections, 2010

QuartileStates
First (best) QuartileWashington, Oregon, Montana, New Mexico, Oklahoma, Iowa, Arkansas, Michigan, West Virginia, Pennsylvania, New Hampshire
2nd QuartileCalifornia, Colorado, Kansas, Texas, Illinois, Kentucky, Ohio, Virginia, Connecticut, Rhode Island, Massachusetts
3rd QuartileNevada, Missouri, Louisiana, Mississippi, Wisconsin, Florida, Georgia, North Carolina, New Jersey, Vermont
4th (worst) QuartileArizona, Nebraska, Indiana, Tennessee, Alabama, South Carolina, Maryland, Delaware, New York, Maine, Hawaii
MissingIdaho, Utah, Wyoming, North Dakota, South Dakota, Minnesota, District of Columbia, Puerto Rico, Alaska

Source: Centers for Disease Control and Prevention, National Healthcare Safety Network, 2010.
Denominator: Infections per 100,000 central-line days.

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Figure 3.5. Bloodstream infections per 1,000 central-line days, by type of pediatric intensive care unit (PICU) and birth weight of child, 2009-2010

Type of PICU / Birth Weight20092010
Pediatric Medical/Surgical ICU2.21.8
Pediatric Cardiothoracic ICU2.52.1
Pediatric Medical ICU2.61.9
0-750 g3.42.6
751-1,000 g2.72.2
1,001-1,500 g1.91.3
1,501-2,500 g1.51
>2,500 g1.30.8

Key: ICU = intensive care unit.
Source: Centers for Disease Control and Prevention, National Healthcare Safety Network, 2009-2010.
Denominator: Infections per 100,000 central-line days.
Note: For this measure, lower rates are better.

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Figure 3.6. Composite: Mechanical adverse events associated with central venous catheter placement, by obesity status, CHF/pulmonary edema status, and renal disease status, 2009-2010

Obesity/CHF/Renal Disease Status20092010
Total3.93.3
Not Obese3.83.0
Obese4.14.0
CHF/Pulmonary Edema - No3.12.6
CHF/Pulmonary Edema - Yes5.14.0
Renal Disease - No3.22.8
Renal Disease - Yes5.44.1

Key: CHF = congestive heart failure.
Source: Agency for Healthcare Research and Quality, Medicare Patient Safety Monitoring System, 2009-2010.
Denominator: Selected discharges of hospitalized patients age 18 and over with central venous catheter placement.
Note: For this measure, lower rates are better. 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.

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Figure 3.7. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by age and insurance, 2004-2009

Year10-1415-1718-2425-3435-54
200450.534.626.733.024.9
200540.334.326.330.524.6
200646.227.923.527.622.0
200737.828.321.525.920.6
200832.726.021.326.219.4
200936.723.919.324.918.8

 

Insurance200420052006200720082009
Total30.028.525.623.823.722.2
Private36.334.431.929.829.328.2
Medicare19.226.824.917.417.411.9
Medicaid19.820.317.415.815.914.6
Uninsured25.225.523.323.721.319.6

Key: Private indicates private health insurance as the payment source; uninsured indicates self-pay, uninsured, and no charge as the payment source.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, modified version 4.1.
Denominator: All patients hospitalized for vaginal delivery without indication of instrument assistance.
Note: For this measure, lower rates are better. Rates are adjusted by age. Rates by age are not age adjusted.

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Figure 3.8. 2010 national overall hospital-acquired condition rate

Hospital-acquired Condition2010
Adverse Drug Events34.1
Catheter-Associated Urinary Tract Infections8.4
Central Line-Associated Bloodstream Infections0.4
Falls5.5
Obstetric Adverse Events1.7
Pressure Ulcers27.8
Surgical Site Infections2
Ventilator-Associated Pneumonia0.8
Venous Thromboembolism0.3
All Other HACs18.8

Source: Agency for Healthcare Research and Quality, Medicare Patient Safety Monitoring System, 2010; Centers for Disease Control and Prevention, National Healthcare Safety Network, 2009-2010; and Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.1.
Note: People age 18 and over.

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Figure 3.9. 2011 Patient Safety Culture Composite Findings

Patient Safety Culture Aspect% Positive Response
1. Teamwork Within Units80%
2. Supv/Mgr Expectations & Actions Promoting Patient Safety75%
3. Organizational Learning - Continuous Improvement72%
4. Management Support for Patient Safety72%
5. Overall Perceptions of Patient Safety66%
6. Feedback & Communication About Error64%
7. Frequency of Events Reported63%
8. Communication Openness62%
9. Teamwork Across Units58%
10. Staffing56%
11. Handoffs & Transitions45%
12. Nonpunitive Response to Error44%

Source: U.S. Agency for Healthcare Research and Quality, Hospital Survey on Patient Safety Culture: 2012 Comparative Database Report.
Denominator: Hospital staff responding to the 2011 Hospital Survey on Patient Safety Culture.

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Figure 3.10. 2011 Overall Average Patient Safety Culture Percent Positive Response Across Composites by Geographic Region

Geographic RegionPercentage
West South Central65%
South Atlantic65%
East South Central65%
West North Central64%
Mountain62%
East North Central62%
Pacific62%
Mid-Atlantic61%
New England60%

Source: U.S. Agency for Healthcare Research and Quality, Hospital Survey on Patient Safety Culture: 2012 Comparative Database Report.
Denominator: Hospital staff responding to the 2011 Hospital Survey on Patient Safety Culture.

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Current as of May 2013
Internet Citation: 2012 National Healthcare Quality Report: Chapter 3, Text Descriptions for Figures. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqr12/chap3-text.html