Patient Safety

2008 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.

Surgical Care
Composite measure: Adult surgery patients with postoperative complications (postoperative pneumonia or venous thromboembolic events)
Adult surgery patients with postoperative pneumonia events
Adult surgery patients with postoperative venous thromboembolic events
Adult surgery patients with postoperative catheter-associated urinary tract infection
Composite measure: Adult surgery patients who received appropriate timing of antibiotics (prophylactic antibiotics begun at the right time and ended at the right time)
Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision
Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time
Accidental puncture or laceration during procedure per 1,000 discharges, adults (age 18 and over)
Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical hospital discharges, adults (age 18 and over)
Postoperative septicemia per 1,000 elective surgical hospital discharges of 4 or more days, adults (age 18 and over)
Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges, adults (age 18 and over)
Postoperative respiratory failure per 1,000 elective surgical hospital discharges
Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges, adults (age 18 and over)
Postoperative hip fractures per 1,000 surgical hospital discharges, adults (age 18 and over)
Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges, adults (age 18 and over)
Foreign body left in during procedure per 1,000 hospital discharges
Complications of anesthesia per 1,000 surgical hospital discharges
Adverse events in patients receiving hip joint replacement due to degenerative conditions
Adverse events in patients receiving hip joint replacement due to fracture
Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions
Adverse events in patients receiving knee replacement

Complications of Hospital Care
Composite measure: Bloodstream infections (BSIs) or mechanical adverse events per 1,000 central venous catheter (CVC) placements
Bloodstream infections (BSIs) per 1,000 central venous catheter (CVC) placements
Mechanical adverse events per 1,000 central venous catheter (CVC) placements
Iatrogenic pneumothorax per 1,000 discharges, adults (age 18 and over)
Decubitus ulcers per 1,000 selected stays of 5 or more days, adults (age 18 and over)
Selected infections due to medical care per 1,000 discharges
Transfusion reactions per 1,000 discharges
Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue), adults ages 18-74
Deaths per 1,000 admissions in low-mortality DRGs

Complications of Medication
Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (prescription medications received includes all prescribed medications initially purchased or otherwise obtained during calendar year, as well as any refills)
People with a usual source of care who usually asks about prescription medications and treatments from other doctors
Hospital patients with an anticoagulant-related adverse drug event with warfarin
Hospital patients with an anticoagulant-related adverse drug event with IV heparin
Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) and factor Xa
Hospital patients with an adverse drug event with a hypoglycemic agent
Ambulatory care visits due to adverse drug effects per 1,000 visits

Birth-Related Complications
Birth trauma—injury to neonate per 1,000 selected live births
Obstetric trauma per 1,000 vaginal deliveries without instrument assistance
Obstetric trauma per 1,000 instrument-assisted deliveries
Obstetric trauma per 1,000 cesarean deliveries
 


Surgical Care

Measure Title

Composite measure: Adult surgery patients with postoperative complications (postoperative pneumonia or venous thromboembolic events).

Measure Source

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

Tables

10_1_1.1 Surgical discharges with postoperative pneumonia events or venous thromboembolic events, United States, 2004 and 2006.

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 or diagnosed deep vein thrombosis or pulmonary embolism during the index hospital stay (the sum of the percentages of the two individual measures).

Comments

See entries for each of the two 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 postdischarge, 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 https://www.qualitynet.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&siteVersion=null&c=MQParents.

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Surgical Care

Measure Title

Adult surgery patients with postoperative pneumonia events.

Measure Source

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

Tables

10_1_2.1 Surgical discharges with postoperative pneumonia events, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All discharges from the MPSMS sample with documentation of one or more procedure codes in the Surgical Care Improvement Project Surgery List (Appendix A, Surgical Care Improvement Project Codes) who did not have a diagnosis of pneumonia or evidence of a new infiltrate, consolidation, or cavitation noted on chest x-ray prior to the procedure.

Numerator

Subset of the denominator with a diagnosis of postoperative nosocomial pneumonia and physician-ordered antibiotic to treat the postoperative pneumonia.

Comments

Data include Medicare beneficiaries discharged from January to December.

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

After 2004, cases in which patients did not have the variable “antibiotic to treat the pneumonia” but were discharged or died the same day the pneumonia was diagnosed were included as adverse events.

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Surgical Care

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

10_1_3.1 Surgical discharges with postoperative venous thromboembolic events, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All discharges from the MPSMS sample with documentation of one or more procedure codes in the Surgical Care Improvement Project Surgery List (see Appendix A).

Numerator

Subset of the denominator with a diagnosed postoperative pulmonary embolism (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 International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9).

Comments

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

  • DVT: Thrombosis or occlusion within the venous system, most commonly of the lower extremities.
  • PE: Obstruction 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:

  • Physician diagnosis of a DVT.
  • Abnormal compression Duplex or Doppler ultrasonography, contrast computerized tomography (CT), contrast venography, impedance plethysmography, or magnetic resonance venography.

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

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

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Surgical Care

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

10_1_4.1 Surgical discharges with catheter-associated urinary tract infection, United States, 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All discharges from the MPSMS sample who had an indwelling urinary catheter or straight catheter inserted during the index hospital stay and on admission to the hospital did not have an indwelling catheter or evidence of a urinary tract infection (UTI).

Numerator

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

Comments

A urinary tract infection is determined by a physician diagnosis of UTI and an antibiotic ordered by a physician to treat the UTI.

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Surgical Care

Measure Title

Composite measure: Adult surgery patients 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

10_1_5.1 Adult surgery patients who received appropriate timing of antibiotics, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

10_1_5.2 Adult surgery patients who received appropriate timing of antibiotics, by State, 2005 and 2006.

10_1_5.3 Adult surgery patients who received appropriate timing of antibiotics, by State, 2005 and 2007.

State Data Source

CMS, QIO.

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.

For State tables, appropriate timing of antibiotics includes receiving preventive antibiotics 1 hour before incision and discontinuing the antibiotics within 24 hours after surgery end time. Data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Surgical Care

Measure Title

Adult surgery patients who received 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

10_1_6.1 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

10_1_6.2 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, by State, 2005 and 2006.

10_1_6.3 Surgery patients who received preventive antibiotics 1 hour before incision, by State, 2005 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Surgical Care

Measure Title

Adult surgery patients who had 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

10_1_7.1 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, United States, 2005 and 2006.

National Data Source

CMS, Medicare Quality Improvement Organization Program (QIO).

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

10_1_7.2 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, by State, 2005 and 2006.

10_1_7.3 Surgery patients whose preventive antibiotics are stopped within 24 hours after surgery, by State, 2005 and 2007.

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

For State tables, data were downloaded from http://www.medicare.gov/Download/DownloadDB.asp in late April each year. Estimates were calculated using hospital-level scores.

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Surgical Care

Measure Title

Accidental puncture or laceration during procedure per 1,000 discharges, adults (age 18 and over).

Measure Source

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

Tables

10_1_8.1 Accidental puncture or laceration during procedure per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_1_8.2 Accidental puncture or laceration during procedure per 100,000 population (excluding obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_1_8.3 Accidental puncture or laceration during procedure per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

Hospital medical and surgical discharges age 18 and over, excluding obstetric admissions.

Numerator

Subset of the denominator with secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes E870.0-E870.9, 998.2).

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.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 15 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical hospital discharges, adults (age 18 and over).

Measure Source

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

Tables

10_1_9.1 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, per 1,000 surgical discharges (excluding obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_1_9.2 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, per 100,000 population (excluding obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_1_9.3 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, per 1,000 surgical discharges (excluding obstetric admissions), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

Inpatient hospital surgical discharges age 18 and over, excluding obstetric 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. Postoperative hemorrhage or hematoma is not verifiable as following surgery because information on day of procedure is not available for all discharges. Specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used to define postoperative hemorrhage or hematoma are available at http://www.qualityindicators.ahrq.gov.

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.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 9 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative septicemia per 1,000 elective surgical hospital discharges of 4 or more days, adults (age 18 and over).

Measure Source

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

National Tables

10_1_10.1 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), age 18 and over, United States, 2000 and 2005.

10_1_10.2 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), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

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

National Numerator

Subset of the denominator with any secondary diagnosis of sepsis. Postoperative septicemia is not verifiable as following surgery because information on day of procedure is not available for all discharges.

State Tables

10_1_10.3 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), age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 13 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges, adults (age 18 and over).

Measure Source

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

Tables

10_1_11.1 Postoperative pulmonary embolism 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, 2000 and 2005.

10_1_11.2 Postoperative pulmonary embolism 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, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

Hospital surgical patients, age 18 and over, excluding patients admitted for DVT or PE, obstetric conditions, and patients with secondary procedure of plication of vena cava (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 38.7) before or after surgery or as the only procedure.

Numerator

Subset of the denominator with any secondary diagnosis of DVT (ICD-9-CM codes 451.11, 451.19, 451.2, 451.81, 451.9, 453.40- 453.42, 453.8, 453.9) or PE (415.1, 415.11, 415.19). Postoperative PE or DVT is not verifiable as following surgery because information on day of procedure is not available for all discharges.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 12 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative respiratory failure per 1,000 elective surgical hospital discharges.

Measure Source

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

Tables

10_1_12.1 Postoperative respiratory failure per 1,000 elective-surgery 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, 2000 and 2005.

10_1_12.2 Postoperative respiratory failure per 1,000 elective-surgery 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, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All elective hospital surgical discharges age 18 and over, excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, and obstetric conditions, and patients with secondary procedure of tracheostomy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 31.21, 31.29, 31.74) before or after surgery or as the only procedure.

Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure (ICD-9-CM codes 518.81, 518.84) or reintubation procedure at specific postoperative intervals (ICD-9-CM codes 96.04, 96.70, 96.71, 96.72). Postoperative respiratory failure is not verifiable as following surgery because information on day of procedure is not available for all discharges.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 11 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges, adults (age 18 and over).

Measure Source

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

Tables

10_1_13.1 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious disease and obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_1_13.2 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious disease and obstetric admissions), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All elective hospital surgical discharges age 18 and over, 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. Specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used to define these conditions are available at http://www.qualityindicators.ahrq.gov.

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 (ICD-9-CM codes 39.95, 54.98). Postoperative physiologic and metabolic derangements are not verifiable as following surgery because information on day of procedure is not available for all discharges.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 10 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Postoperative hip fractures per 1,000 surgical hospital discharges, adults (age 18 and over).

Measure Source

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

Tables

10_1_14.1 Postoperative hip fracture per 1,000 surgical patients age 18 and over who were not susceptible to falling (excluding obstetric admissions), United States, 2000 and 2005.

10_1_14.2 Postoperative hip fracture per 1,000 surgical patients age 18 and over who were not susceptible to falling (excluding obstetric admissions), United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

Inpatient hospital surgical discharges, age 18 and over, who were not susceptible to falling, excluding patients with diseases and disorders of the musculoskeletal system and connective tissue; patients admitted for seizures, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium and other psychoses, or anoxic brain injury; patients with metastatic cancer, lymphoid malignancy, bone malignancy, or self-inflicted injury; and obstetric patients. Specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used to define these conditions are available at http://www.qualityindicators.ahrq.gov.

Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture (ICD-9-CM codes 820.0-820.3, 820.8, 820.9, including all 5th digits). Postoperative hip fracture is not verifiable as following surgery because information on day of procedure is not available for all discharges.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 8 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges, adults (age 18 and over).

Measure Source

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

National Tables

10_1_15.1 Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery discharges (excluding immunocompromised patients, stays under 2 days, and obstetric conditions), age 18 and over, United States, 2000 and 2005.

10_1_15.2 Reclosure of postoperative abdominal wound separation (excluding immunocompromised and obstetric patients) per 100,000 population, age 18 and over, United States, 2000 and 2005.

10_1_15.3 Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery discharges (excluding immunocompromised patients, stays under 2 days, and obstetric conditions), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Inpatient hospital abdominopelvic surgery discharges, excluding immunocompromised patients, stays under 2 days, and obstetric patients.

National Numerator

Subset of the denominator with secondary procedure for reclosure of postoperative disruption of abdominal wall (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 54.61). Postoperative abdominal wound separation not verifiable as following surgery because information on day of procedure is not available for all discharges.

State Tables

10_1_15.4 Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery discharges (excluding immunocompromised patients, stays under 2 days, and obstetric conditions), age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

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.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 14 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

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

Measure Source

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

Tables

10_1_16.1 Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges, age 18 and over or obstetric admissions, United States, 2000 and 2005.

10_1_16.2 Foreign body accidentally left in during procedure per 100,000 population, age 18 and over or obstetric admissions, United States, 2000 and 2005.

10_1_16.3 Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges, age 18 and over or obstetric admissions, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All medical and surgical inpatient hospital discharges age 18 and over or obstetric admissions.

Numerator

Subset of the denominator with any secondary diagnosis indicating foreign body left in during procedure.

Comments

No risk adjustment is performed for this outcome of interest.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 5 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Complications of anesthesia per 1,000 surgical hospital discharges.

Measure Source

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

Tables

10_1_17.1 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, 2000 and 2005.

10_1_17.2 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, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All surgical hospital discharges age 18 or over, 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 (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 968.1-968.7, E855.1, E876.3, E938.1-E938.9).

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 1 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to degenerative conditions.

Measure Source

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

Tables

10_1_18.1 Adverse events in patients receiving hip joint replacement due to degenerative conditions, United States, 2004 and 2006.

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), wound separation, 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 embolism (PE) or deep vein thrombosis (DVT) within 30 days of the surgical procedure (per Medicare administrative data International Classification of Diseases, Ninth Revision, Clinical Modification [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 or wound infection or acute and early deep hip infection, excluding superficial infection. Wound complications other than infection include separation, 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, and postoperative venous thromboembolic event are all determined in the same fashion as those in other MPSMS measures.

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

The analytic approach used to produce these tables differs from the 2005 National Healthcare Quality Report and earlier reports. 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 postprocedure mortality to distinguish between hip procedures, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to fracture.

Measure Source

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

Tables

10_1_19.1 Adverse events in patients receiving hip joint replacement due to fracture, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

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

Numerator

Subset of the denominator who experienced at least one of the following: postoperative infections, postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE), 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 the operating room 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 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 embolism are all determined in the same fashion as those in prior MPSMS measures.

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

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

The analytic approach used to produce these tables differs from the 2005 National Healthcare Quality Report and earlier reports. 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 postprocedure mortality to distinguish between hip procedures, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Surgical Care

Measure Title

Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions.

Measure Source

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

Tables

10_1_20.1 Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions, United States, 2004 and 2006.

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 hip joint.

Numerator

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

  • Postoperative acute or early deep infections.
  • Postoperative wound separation.
  • Postoperative necrosis.
  • Postoperative hematoma.
  • Postoperative nerve injury.
  • Postoperative major bleeding/hematoma.
  • Postoperative dislocation.
  • Postoperative cardiovascular complications.
  • Return to the operating room after procedure (excludes same-side revision during the index hospital stay).
  • Revision during the index hospital stay (same side as index procedure).
  • Postoperative periprosthetic fracture.
  • Postoperative venous thromboembolic event.
    • - During hospital stay (per abstracted information from medical records).
    • - Readmission to the hospital post-index hospital stay for a pulmonary embolism or deep vein thrombosis within 30 days of the surgical procedure (per Medicare administrative data International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9).
  • Postoperative catheter-associated urinary tract infection.
  • Postoperative pneumonia.

Comments

Postoperative infections are determined by documentation of:

 

  • Early prosthetic joint and/or wound infection.
  • Acute and early deep hip infection excluding superficial infection.

Postoperative pneumonias, postoperative venous thromboembolic events, and catheter-associated urinary tract infections are determined using the same methods as those in prior MPSMS measures.

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

Major bleeding/hematoma is defined as:

  • Return to the operating room for evacuation or hemostasis.
  • Hemoglobin drop of more than 2.0 gm/dL compared with the value obtained on the first postoperative day (for example, a drop of 13.1 to 11.1 gm/dL).

Differences in the hip replacement measure specifications between Year 1 (2002 discharges) and Years 2-5 (2003-2006 discharges):

  • Revision of the definition of major bleeding/hematoma.
  • Addition of periprosthetic fracture to the numerator as an adverse event in Years 2-5.

Differences in the hip replacement measure specifications between Year 3 (2004) and Years 4-5 (2005-2006 discharges):

  • The postoperative urinary tract infection measure was revised to catheter-associated urinary tract infections in 2005.

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Surgical Care

Measure Title

Adverse events in patients receiving knee replacement.

Measure Source

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

Tables

10_1_21.1 Adverse events in patients receiving knee replacement, United States, 2004 and 2006.

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 acute or early deep infections.
  • Postoperative wound separation.
  • Postoperative necrosis.
  • Postoperative hematoma.
  • Postoperative nerve injury.
  • Postoperative major bleeding/hematoma.
  • Postoperative cardiovascular complications.
  • Return to the operating room after procedure (excludes same-side revision during the index hospital stay).
  • Revision during the index hospital stay (same side as index procedure).
  • Postoperative periprosthetic fracture.
  • Postoperative venous thromboembolic event:
    • - During hospital stay (per abstracted information from medical records).
    • - Readmission to the hospital post-index hospital stay for a pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days of the surgical procedure (per Medicare administrative data International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9).
  • Postoperative catheter-associated urinary tract infection (UTI).
  • Postoperative pneumonia.

Comments

Postoperative infections are determined by documentation of:

  • Early prosthetic joint or wound infection.
  • Acute and early deep knee infection, excluding superficial infection.

Postoperative pneumonias, postoperative venous thromboembolic events, and catheter-associated urinary tract infections are determined using the same methods as those in prior MPSMS measures.

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

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

Major bleeding/hematoma is defined as:

  • Return to the operating room for evacuation or hemostasis.
  • Hemoglobin drop of more than 2.0 gm/dL compared with the value obtained on the first postoperative day (for example, a drop of 13.1 to 11.1 gm/dL).

Differences in the knee replacement measure specifications between Year 1 (2002 discharges) and Years 2-5 (2003-2006 discharges):

  • Revision of the definition of major bleeding/hematoma.
  • Addition of periprosthetic fracture to the numerator as an adverse event in Years 2-5.

Differences in the knee replacement measure specifications between Year 3 (2004) and Years 4-5 (2005-2006 discharges):

  • The postoperative urinary tract infection measure was revised to catheter-associated urinary tract infections in 2005.

The analytic approach used to produce these tables differs from the 2005 National Healthcare Quality Report and earlier reports. 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 postprocedure mortality to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Complications of Hospital Care

Measure Title

Composite measure: Bloodstream infections (BSIs) or mechanical adverse events per 1,000 central venous catheter (CVC) placements.

Measure Source

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

Tables

10_2_1.1 Discharges with central venous catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2004 and 2006.

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 bloodstream infection or CVC-associated mechanical adverse event.

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 postdischarge, readmission, and clinical criteria processing, as appropriate for each component of the composite measure.

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Complications of Hospital Care

Measure Title

Bloodstream infections (BSIs) per 1,000 central venous catheter (CVC) placements.

Measure Source

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

Tables

10_2_2.1 Discharges with central venous catheter placement with associated bloodstream infections, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All discharges from the MPSMS sample who did not have evidence of a prior BSI, 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.

Numerator

Subset of the denominator with a CVC-associated bloodstream infection.

Comments

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

  • 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: Acinetobacter, beta-hemolytic streptococci, Candida, Candida glabrata, coagulase-negative staphylococci, Enterobacter spp., Enterococcus spp., Escherichia coli, Klebsiella spp., methicillin-resistant Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Pseudomonas other, Serratia marcescens, Staphylococcus aureus, Staphylococcus not otherwise specified, Staphylococcus other, viridans streptococci.
  • No other source of documented infection.

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Complications of Hospital Care

Measure Title

Mechanical adverse events per 1,000 central venous catheter (CVC) placements.

Measure Source

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

Tables

10_2_3.1 Central venous catheter placement with associated mechanical adverse events, United States, 2004 and 2006.

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, or CVC, terminating at, or close to, the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated 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 (only when CPR is performed within15 minutes).
  • Perforation.
  • Pneumothorax.
  • Hematoma.
  • Shearing off of the catheter.
  • Air embolism.
  • Misplaced catheter.
  • Thrombosis/embolism.
  • Knotting of the pulmonary artery catheter.
  • Bleeding.
  • Catheter occlusion.
  • Leaking.
  • Other.

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Complications of Hospital Care

Measure Title

Iatrogenic pneumothorax per 1,000 discharges, adults (age 18 and over).

Measure Source

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

National Tables

10_2_4.1 Iatrogenic pneumothorax per 1,000 discharges (excluding obstetric admissions and patients with chest trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2000 and 2005.

10_2_4.2 Iatrogenic pneumothorax cases per 100,000 population (excluding obstetric admissions and patients with trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2000 and 2005.

10_2_4.3 Iatrogenic pneumothorax per 1,000 discharges (excluding obstetric admissions and patients with chest trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Discharge table: All medical and surgical hospital discharges, age 18 and over, excluding patients with chest trauma or pleural effusion, thoracic surgery, lung or pleural biopsy, cardiac surgery, or diaphragmatic surgery, or obstetric admissions.

National Numerator

Subset of the denominator with any secondary diagnosis of iatrogenic pneumothorax (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnosis code 512.1).

State Tables

10_2_4.4 Iatrogenic pneumothorax per 1,000 discharges (excluding obstetric admissions and patients with chest trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery), age 18 and over, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

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.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 6 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Complications of Hospital Care

Measure Title

Decubitus ulcers per 1,000 selected stays of 5 or more days, adults (age 18 and over).

Measure Source

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

Tables

10_2_5.1 Decubitus ulcers per 1,000 discharges of 5 or more days (excluding transfers; patients admitted from long-term care facilities; patients with diseases of the skin, subcutaneous tissue, and breast; and obstetric admissions), age 18 and over, United States, 2000 and 2005.

10_2_5.2 Decubitus ulcers per 1,000 discharges of 5 or more days (excluding transfers, patients admitted from long-term care facilities, patients with diseases of the skin, subcutaneous tissue and breast, and obstetric admissions), age 18 and over, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All medical and surgical hospital discharges, age 18 and over, with length of stay of 5 or more days, excluding patients in Major Diagnostic Category 9 (skin, subcutaneous tissue, and breast); patients with hemiplegia, paraplegia, or quadriplegia, spina bifida, anoxic brain damage, or debridement of pedicle graft before major procedure; patients transferred from other institutions or admitted from long-term-care facilities; or obstetric admissions.

Numerator

Subset of the denominator with any secondary diagnosis of decubitus ulcer (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 707.00-707.09 and, through fiscal year 2005, 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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 3 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Complications of Hospital Care

Measure Title

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

Measure Source

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

National Tables

10_2_6.1 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, 2000 and 2005.

10_2_6.2 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, 2000 and 2005.

10_2_6.3 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, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Discharge table: All medical and surgical hospital discharges, age 18 and over or obstetric admissions, excluding immunocompromised and cancer patients, stays under 2 days, and admissions specifically for such infections.

National Numerator

Subset of the denominator with any secondary diagnosis of infection (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 999.3, 996.62).

State Tables

10_2_6.4 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, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

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.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 7 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Complications of Hospital Care

Measure Title

Transfusion reactions per 1,000 discharges.

Measure Source

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

Tables

10_2_7.1 Transfusion reactions per 1,000 discharges, age 18 and over or obstetric admissions, United States, 2000 and 2005.

10_2_7.2 Transfusion reactions per 100,000 population, age 18 and over or obstetric admissions, United States, 2000 and 2005.

10_2_7.3 Transfusion reactions per 1,000 discharges, age 18 and over or obstetric admissions, United States, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

All medical and surgical hospital discharges, age 18 and over or obstetric admissions (per 1,000 discharges).

U.S. resident population age 18 and over (per 100,000 population).

Numerator

Subset of the denominator with a secondary diagnosis indicating transfusion reaction (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 999.6, 999.7, E876.0).

Comments

No risk adjustment is performed because outcome of interest is a relatively rare event.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

These tables were created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 16 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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

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Complications of Hospital Care

Measure Title

Deaths per 1,000 discharges with complications potentially resulting from care (failure to rescue), adults ages 18-74.

Measure Source

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

Tables

10_2_8.1 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, 2000 and 2005.

10_2_8.2 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, 2005, by:

  • Race/ethnicity.

Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

Denominator

Hospital inpatient discharges, ages 18-74, 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, and neonates. Specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used to define the failure to rescue definition are available at http://www.qualityindicators.ahrq.gov.

Numerator

Subset of the denominator with discharge disposition of death.

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.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 4 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

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

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Complications of Hospital Care

Measure Title

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

Measure Source

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

National Tables

10_2_9.1 Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs), age 18 and over or obstetric admissions, United States, 2000 and 2005.

10_2_9.2 Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs), age 18 and over or obstetric admissions, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Hospital admissions, age 18 and over or obstetric admissions, in low-mortality DRGs (with an NIS 1997 benchmark of less than 0.5% mortality), excluding patients with any code for trauma, immunocompromised state, or cancer.

National Numerator

Subset of the denominator with discharge disposition of death.

State Tables

10_2_9.3 Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs), age 18 and over or obstetric admissions, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

No risk adjustment is performed for this outcome of interest.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 2 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Complications of Medication

Measure Title

Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year (prescription medications received includes all prescribed medications initially purchased or otherwise obtained during calendar year, as well as any refills).

Measure Source

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

Tables

10_3_1.1 Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year, United States, 2002 and 2005.

10_3_1.2 Adults age 65 and over who received at least 1 of 33 potentially inappropriate prescription medications in the calendar year, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

10_3_1.3 Adults age 65 and over who received at least 1 of 11 prescription medications in the calendar year that should be avoided for older patients, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

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

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

Comments

Prescription medications received includes all prescribed medications initially purchased or otherwise obtained during calendar year, as well as any refills.

For additional information concerning potentially inappropriate medications, see Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from 1996 Medical Expenditure Panel Survey. JAMA 2001;286(22):2823-9.

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Complications of Medication

Measure Title

People with a usual source of care who usually asks about prescription medications and treatments from other doctors.

Measure Source

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

Tables

10_3_2.1 People with a usual source of care who usually asks about prescription medications and treatments from other doctors, United States, 2002 and 2005.

10_3_2.2 People with a usual source of care who usually asks about prescription medications and treatments from other doctors, United States, 2005, by:

  • Race.
  • Ethnicity.
  • Family income.
  • Education.

Data Source

AHRQ, CFACT, MEPS.

Denominator

People who had a usual source of care and answered the question, “Does [respondent's usual care provider] usually ask about prescription medications and treatments other doctors may give you?” Nonresponses and “Don't know” responses were excluded.

Numerator

Subset of the denominator population who answered “Yes” to the question.

Comments

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

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

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with warfarin.

Measure Source

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

Tables

10_3_3.1 Hospital patients with an anticoagulant-related adverse drug event with warfarin, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All MPSMS sample patients who received warfarin during hospitalization and had a documented International Normalized Ratio (INR) result during the hospital stay.

Numerator

Subset of the denominator who during the hospital stay experienced:

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

Comments

INR ≥4.0, INR >1.5 and an abrupt cessation/hold of warfarin, INR >1.5 and administration of vitamin K or fresh frozen plasma, and INR >1.5 and a blood transfusion (absent a surgical procedure) that occur on the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with IV heparin.

Measure Source

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

Tables

10_3_4.1 Hospital patients with an anticoagulant-related adverse drug event with IV heparin, United States, 2004 and 2006.

Data Source

CMS, MPSMS.

CMS, Medicare administrative data.

Denominator

All MPSMS sample patients who received heparin during hospitalization and had a documented partial thromboplastin time (PTT) result during the hospital stay.

Numerator

Subset of the denominator who experienced:

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

Comments

PTT ≥100, PTT > 45 and an abrupt cessation/hold of IV heparin, PTT >45 and administration of vitamin K or fresh frozen plasma, and PTT >45 and a blood transfusion (absent a surgical procedure) that occur on the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) and factor Xa.

Measure Source

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

Tables

10_3_5.1 Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) and factor Xa, United States, 2004 and 2006.

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 experienced:

  • Abrupt cessation/hold of LMWH or factor Xa inhibitor with one of the following: cardiac arrest/emergency measures to sustain life, death, gastrointestinal bleeding, genitourinary bleeding, hematocrit drop of 3 or more points more than 48 hours after admission, intracranial bleeding (subdural hematoma), new hematoma, other types of bleeding or pulmonary bleeding;
  • Administration of vitamin K or fresh frozen plasma with one or more of the above symptoms; or
  • Blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

Abrupt cessation/hold of LMWH or factor Xa inhibitor, administration of vitamin K or fresh frozen plasma, and blood transfusion (absent a surgical procedure) that occur on the date of arrival are not counted.

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Complications of Medication

Measure Title

Hospital patients with an adverse drug event with a hypoglycemic agent.

Measure Source

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

Tables

10_3_6.1 Hospital patients with adverse drug events with hypoglycemic agents, including insulin, oral hypoglycemic, or combination of both, United States, 2004 and 2006.

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 ≤70 with one or more of the following: administration of dextrose 50% (D50), administration of glucagons, administration of juice or sugar, anxiety, code blue (CPR), confusion, death, drowsiness, sweating, weakness, trembling, increased heart rate, irritability, seizure, stroke, transient ischemic attack, myocardial infarction, coma/loss of consciousness.

Comments

Incidents that occur on the date of arrival are not counted.

Using the “trigger tool” method to determine adverse drug events, the MPSMS team recognizes the inherent possibility of undercounting the adverse event rate due to the absence of a potential trigger. In the case of adverse drug events due to hypoglycemics, we used “a documented blood glucose level during the hospital stay” as a trigger to continue including the patient in the algorithm. We recognize that the failure to record a glucose level for patients in an acute care admission who are being given hypoglycemics (70% using some form of insulin, 54% insulin alone) is a potential quality of care issue.

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Complications of Medication

Measure Title

Ambulatory care visits due to adverse drug effects per 1,000 visits.

Measure Source

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

Table

Data table will not be presented this year.

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 by community-dwelling individuals.

Numerator

Visits for treatment of a reported adverse drug event.

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Birth-Related Complications

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 (PSIs).

National Tables

10_4_1.1 Birth trauma—injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2004 and 2005.

10_4_1.2 Birth trauma—injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

Live birth discharges in the United States.

National Numerator

Subset of the denominator with any diagnosis of birth trauma (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 767.0, 767.11, 767.3, 767.4, 767.7, 767.8, 767.9) in any diagnosis field, excluding preterm infants with subdural or cerebral hemorrhage and osteogenesis imperfecta births with injury to skeleton.

State Tables

10_4_1.3 Birth trauma—injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births), by State, 2004 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Live birth discharges in participating States.

State Numerator

Same as national.

Comments

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

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 17 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Birth-Related Complications

Measure Title

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

Measure Source

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

National Tables

10_4_2.1 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2000 and 2005.

10_4_2.2 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

All vaginal delivery hospital discharges without indication of instrument assistance.

National Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma with 3rd or 4th degree lacerations.

State Tables

10_4_2.3 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 19 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Birth-Related Complications

Measure Title

Obstetric trauma per 1,000 instrument-assisted deliveries.

Measure Source

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

National Tables

10_4_3.1 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2000 and 2005.

10_4_3.2 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

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

National Numerator

Subset of the denominator with any diagnosis or procedure indicating obstetric trauma with 3rd or 4th degree lacerations.

State Tables

10_4_3.3 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

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

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 18 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

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Birth-Related Complications

Measure Title

Obstetric trauma per 1,000 cesarean deliveries.

Measure Source

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

National Tables

10_4_4.1 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 cesarean deliveries, United States, 2000 and 2005.

10_4_4.2 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 cesarean deliveries, United States, 2005, by:

  • Race/ethnicity.

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases (SID), disparities analysis file.

National Denominator

All cesarean section delivery hospital discharges.

National Numerator

Subset of the denominator population with any diagnosis or procedure indicating obstetric trauma with 3rd or 4th degree lacerations.

State Tables

10_4_4.3 Obstetric trauma with 3rd or 4th degree lacerations per 1,000 cesarean deliveries, by State, 2000 and 2005.

State Data Source

AHRQ, CDOM, HCUP, SID.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

No risk adjustment is performed for this outcome of interest.

This table was created using version 3.1 of the AHRQ PSI software. This measure is referred to as PSI 20 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community nonrehabilitation hospitals in the American Hospital Association Annual Survey Database.

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

Return to Measure Specifications

Current as of September 2009
Internet Citation: Patient Safety: 2008 National Healthcare Quality and Disparities Reports. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/measurespec/patient_safety.html