Patient Safety

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

12_1_1.1 Surgical discharges with catheter-associated urinary tract infection, United States, 2005 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) 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.

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.

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

12_1_2.1 Adult surgery patients who received appropriate timing of antibiotics, United States, 2005 and 2007.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

12_1_2.2 Adult surgery patients who received appropriate timing of antibiotics, by State, 2005 and 2007.

12_1_2.3 Adult surgery patients who received appropriate timing of antibiotics, by State, 2005 and 2008.

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 are calculated using hospital-level scores.

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

12_1_3.1 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, United States, 2005 and 2007.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

12_1_3.2 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, by State, 2005 and 2007.

12_1_3.3 Surgery patients who received preventive antibiotics 1 hour before incision, by State, 2005 and 2008.

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 are calculated using hospital-level scores.

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

12_1_4.1 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, United States, 2005 and 2007.

National Data Source

CMS, Medicare Quality Improvement Organization (QIO) Program.

National Denominator

Discharged hospital patients with indication of surgery.

National Numerator

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

State Tables

12_1_4.2 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, by State, 2005 and 2007.

12_1_4.3 Surgery patients whose preventive antibiotic(s) are stopped within 24 hours after surgery, by State, 2005 and 2008.

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 are calculated using hospital-level scores.

Measure Title

Postoperative sepsis 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

12_1_5.1 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 2006.

12_1_5.2 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, 2006, 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, disparities analysis file.

National Denominator

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

National Numerator

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

State Tables

12_1_5.3 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 2006.

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.

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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_1_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 2006.

12_1_6.2 Selected infections due to medical care per 100,000 population (excluding immunocompromised and cancer patients), age 18 and over or obstetric admissions, United States, 2000 and 2006.

12_1_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, 2006, 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, 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.

Population table: U.S. population age 18 and over by subcategories (e.g. age group, gender, region, median household income level, and urbanization).

National Numerator

Subset of the denominator with any secondary diagnosis of infection (International Classification of Diseases, Ninth Revision, Clinical Modification code 999.3 or 996.62).

State Tables

12_1_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 2006.

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. These measures are 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_1.1 Surgical discharges with postoperative pneumonia events or venous thromboembolic events, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) 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 2 individual measures).

Comments

See entries for each of the 2 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 is used for postdischarge, readmission, and clinical criteria processing, as appropriate for each component of the composite measure.

Measure Title

Adult surgery patients with postoperative pneumonia events.

Measure Source

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

Tables

12_2_2.1 Surgical discharges with postoperative pneumonia events, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample with documentation of one or more procedure codes in the Surgical Care Improvement Project Surgery List (see Appendix A) 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 FFS beneficiaries discharged from January to December of the indicated year.

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 the patient was discharged or died the same day the pneumonia was diagnosed.

Differences in the "Postoperative Pneumonia" measure specifications between 2002-2003 discharges and 2004-2007 discharges:

• In 2003 and 2004, for his or her condition to be considered a postoperative pneumonia adverse event, the patient must have had a documented order for an antibiotic to treat the postoperative pneumonia. The "antibiotic to treat the pneumonia" variable was not collected in 2002.
• In 2004, patients who 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 an adverse event.

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

12_2_3.1 Surgical discharges with postoperative venous thromboembolic events, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) 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 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.

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

12_2_4.1 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery (excluding obstetric admissions), per 1,000 surgical discharges, age 18 and over, United States, 2000 and 2006.

12_2_4.2 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery (excluding obstetric admissions), per 100,000 population, age 18 and over, United States, 2000 and 2006.

12_2_4.3 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery (excluding obstetric admissions), per 1,000 surgical discharges, age 18 and over, United States, 2006, 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, disparities analysis file.

Denominator

Discharge table: Inpatient hospital surgical discharges age 18 and over, excluding obstetric admissions.

Population table: U.S. population age 18 and over by subcategories (e.g., age group, gender, region, median household income level, and urbanization).

Numerator

Discharge table: Subset of the denominator meeting the following criteria: (1) Secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma. (2) Secondary procedure indicating postoperative control of hemorrhage or drainage of hematoma, 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 codes used to define postoperative hemorrhage or hematoma are available at http://www.qualityindicators.ahrq.gov.

Population table: Same as discharge table except it allows any principal or secondary diagnosis of hemorrhage or hematoma.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

These tables were created using version 3.1 of the AHRQ PSI software. These measures are 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_5.1 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 2006.

12_2_5.2 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, 2006, 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, disparities analysis file.

Denominator

Hospital surgical patients, age 18 and over, excluding patients admitted for deep vein thrombosis or pulmonary embolism, 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 deep vein thrombosis (ICD-9-CM codes 451.11, 451.19, 451.2, 451.81, 451.9, 453.40- 453.42, 453.8, 453.9) or pulmonary embolism (415.1, 415.11, 415.19). Postoperative pulmonary embolism or deep vein thrombosis (DVT) 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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).

Agency for Healthcare Research and Quality (AHRQ), Pediatric Quality Indicators (PDIs).

Tables

12_2_6.1 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 2006.

12_2_6.2 Postoperative respiratory failure per 1,000 elective-surgery discharges with an operating room procedure (excluding patients with respiratory disease, circulatory disease, or neuromuscular disorders, neonates with a birth weight less than 500 grams, and admissions specifically for acute respiratory failure), under age 18, United States, 2000 and 2006.

12_2_6.3 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, 2006, 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, disparities analysis file.

Denominator

All elective hospital surgical discharges age 18 and over, excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, and patients with secondary procedure of tracheostomy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 312.21, 312.29, 317.4) 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 and 518.84) or reintubation procedure at specific postoperative intervals (ICD-9-CM codes 96.04, 96.70, 96.71, 96.72). Postoperative respiratory failure 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. These measures are 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_7.1 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious diseases and obstetric admissions), age 18 and over, United States, 2000 and 2006.

12_2_7.2 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious diseases and obstetric admissions), age 18 and over, United States, 2006, 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, 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 AMI, 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 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_8.1 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 2006.

12_2_8.2 Postoperative hip fracture per 1,000 surgical patients age 18 and over who were not susceptible to falling (excluding obstetric admissions), United States, 2006, 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, 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 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 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_9.1 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 2006.

12_2_9.2 Reclosure of postoperative abdominal wound separation (excluding immunocompromised and obstetric patients) per 100,000 population, age 18 and over, United States, 2000 and 2006.

12_2_9.3 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, 2006, 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, 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 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

12_2_9.4 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 2006.

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. These measures are referred to as PSI 14 and PSI 24 in the software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov. Note that "wound separation" is used in measure and table titles whereas PSI 14 uses the term "wound dehiscence."

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_10.1 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 2006.

12_2_10.2 Foreign body accidentally left in during procedure per 100,000 population, age 18 and over or obstetric admissions, United States, 2000 and 2006.

12_2_10.3 Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges, age 18 and over or obstetric admissions, United States, 2006, 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, disparities analysis file.

Denominator

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

Population table: U.S. population age 18 and over by subcategories (e.g., age group, gender, region, median household income level, and urbanization).

Numerator

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

Population table: Same as discharge table except it allows any principal or 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. These measures are referred to as PSI 5 and PSI 21in 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_11.1 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 2006.

12_2_11.2 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, 2006, 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, 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 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_2_12.1 Adverse events in patients receiving hip joint replacement due to degenerative conditions, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample who experienced a surgical procedure performed to replace a damaged hip joint.

Numerator

Subset of the denominator population that experienced at least one of the following: postoperative infections (acute or early deep ), dehiscence, necrosis, hematoma, nerve injury, major bleeding, dislocation, cardiovascular complications, catheter-associated urinary tract infection or pneumonia; return to operating room after procedure (excludes same side revision); revision during the index hospital stay (same side as index procedure); postoperative venous thromboembolic event during hospital stay (per abstracted information from medical records); readmission to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure (per Medicare administrative data International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 415.11, 415.19, 451.1X, 451.2, 451.81, 451.83, 451.84, 451.89, 453.8, 453.9).

Comments

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

The definition of major bleeding/hematoma underwent revision between January 1, 2002 and December 31, 2003. Rates for 2003 and later may not be comparable with earlier years.

Postoperative pneumonia, postoperative urinary tract infection, postoperative venous thromboembolic event are all determined in the same fashion as 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 National Healthcare Quality Report 2005 and earlier. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day 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.

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

12_2_13.1 Adverse events in patients receiving hip joint replacement due to fracture, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges 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 or pulmonary embolus, dislocation, wound complications other than infection, nerve injury, postoperative bleeding requiring 4 or more blood transfusions, cardiovascular complications, same side revision during the index hospital stay, return to the operating room, or for reasons other than same side revision during the index hospital stay, and death.

Comments

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

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

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

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

The analytic approach used to produce these tables differs from National Healthcare Quality Report 2005 and earlier. Data may not be comparable.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for 30-day 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.

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

12_2_14.1 Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges 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 infarction, 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 2002 discharges and 2003-2007 discharges:

• Revision of the definition of major bleeding/hematoma.
• Addition of periprosthetic fracture to the numerator as an adverse event in 2003-2007.

Differences in the hip replacement measure specifications between 2004 and 2005-2007 discharges:

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

Measure Title

Adverse events in patients receiving knee replacement.

Measure Source

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

Tables

12_2_15.1 Adverse events in patients receiving knee replacement, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges 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 2004 and 2005-2007 discharges:

• Revision of the definition of major bleeding/hematoma.
• Periprosthetic fracture was added as an adverse event to the numerator in 2003-2007.

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

• Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.
• Wound complications other than infection include dehiscence, hematoma, and necrosis.
• Major bleeding/hematoma is defined as: return to the operating room for evacuation and/or hemostasis, or hemoglobin drop of more than 2.0 gm/dL compared to first postoperative day.

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.

Measure Title

Adult hospitalized Medicare patients with one or more adverse events.

Measure Source

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

Table

Data table will not be presented this year.

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS annual sample of adult Medicare beneficiaries.

Numerator

Subset of the denominator with one or more adverse events such as those associated with central venous catheters (CVCs), femoral artery puncture for angiographic procedures, and hip and knee joint replacement; postoperative pneumonia, venous thromboembolic, and cardiac events; infections with methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE); adverse drug events; hospital-acquired pressure ulcers; catheter-associated urinary tract infection; in-hospital patient fall; and contrast nephropathy associated with catheter angiography.

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

12_3_1.1 Discharges with central venous catheter placement with associated bloodstream infections or mechanical adverse events, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) 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 events.

Comments

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

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

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

12_3_2.1 Accidental puncture or laceration during procedure per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2000 and 2006.

12_3_2.2 Accidental puncture or laceration during procedure (excluding obstetric admissions) per 100,000 population, age 18 and over, United States, 2000 and 2006.

12_3_2.3 Accidental puncture or laceration during procedure per 1,000 discharges (excluding obstetric admissions), age 18 and over, United States, 2006, 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, disparities analysis file.

Denominator

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

Population table: U.S. population age 18 and over by subcategories (e.g., age group, gender, region, median household income level, and urbanization).

Numerator

Discharge table: 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 codes E870.0-E870.9, 998.2).

Population table: Same as discharge table except it allows any principal or secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure.

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. These measures are referred to as PSI 15 and PSI 25 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_3_3.1 Discharges with central venous catheter placement with associated bloodstream infections, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) 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, 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.

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

12_3_4.1 Central venous catheter placement with associated mechanical adverse events, United States, 2002 and 2007.

Data Source

CMS, MPSMS.

Denominator

All instances in Medicare fee-for-service (FFS) discharges in the MPSMS sample of placement of at least one vascular access device terminating at, or close to,the heart or in one of the great vessels. The following are considered great vessels for this measure: aorta, vena cava, brachiocephalic veins, iliac vein, internal jugular veins, and subclavian veins.

Numerator

Subset of the denominator with CVC-associated mechanical adverse events.

Comments

A CVC-associated mechanical adverse event is defined as the presence in the medical record of at least one of the following:

• Allergic reaction (only when CPR is performed within 15 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.

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

12_3_5.1 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 2006.

12_3_5.2 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 2006.

12_3_5.3 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, 2006, by:

• Race/ethnicity

National Data Source

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

AHRQ, CDOM, HCUP, State Inpatient Databases, 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, diaphragmatic surgery, or obstetric admissions.

Population table: U.S. population age 18 and over by subcategories (e.g., age group, gender, region, median household income level, and urbanization).

National Numerator

Discharge table: Subset of the denominator with any secondary diagnosis of iatrogenic pneumothorax (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 512.1).

Population table: Same as discharge table except it allows any principal or secondary diagnosis of iatrogenic pneumothorax.

State Tables

12_3_5.4 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 2006.

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. These measures are referred to as PSI 6 and PSI 22 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_3_6.1 Decubitus ulcers per 1,000 discharges of length 5 or more days (excluding transfers; patients admitted from long-term care facilities; patients with diseases of the skin, subcutaneous tissue, and breast; and obstetric admissions), age 18 and over, United States, 2000 and 2006.

12_3_6.2 Decubitus ulcers per 1,000 discharges of length 5 or more days (excluding transfers; patients admitted from long-term care facilities; patients with diseases of the skin, subcutaneous tissue, and breast; and obstetric admissions), age 18 and over, United States, 2006, 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, 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) or patients with hemiplegia, paraplegia, or quadriplegia, spina bifida or anoxic brain damage or debridement of pedicle graft before major procedure; 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 codes 707.00-707.09, and, through FY2005, 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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

Measure Title

Transfusion reactions per 1,000 discharges.

Measure Source

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

Tables

12_3_7.1 Transfusion reactions per 1,000 discharges, age 18 and over or obstetric admissions, United States, 2000 and 2006.

12_3_7.2 Transfusion reactions per 100,000 population, age 18 and over or obstetric admissions, United States, 2000 and 2006.

12_3_7.3 Transfusion reactions per 1,000 discharges, age 18 and over or obstetric admissions, United States, 2006, 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, disparities analysis file.

Denominator

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

Population table: U.S. population age 18 and over (per 100,000 population).

Numerator

Discharge table: Subset of the denominator with a secondary diagnosis indicating transfusion reaction (International Classification of Diseases, Ninth Revision, Clinical Modification codes 999.6, 999.7, E876.0).

Population table: Same as discharge table except it allows any principal or secondary diagnosis of transfusion reaction.

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 Nationwide Inpatient Sample 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. These measures are referred to as PSI 16 and PSI 26 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_3_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 2006.

12_3_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, 2006, 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, disparities analysis file.

Denominator

Hospital inpatient discharges, ages 18 to 74 years, 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 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 statistic. Detailed information can be found at http://www.qualityindicators.ahrq.gov.

Although not all States participate in the HCUP database, the Nationwide Inpatient Sample is weighted to give national estimates using weights based on all U.S. community 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

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

12_3_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 2006.

12_3_9.2 Deaths per 1,000 admissions in low-mortality diagnosis-related groups (DRGs), age 18 and over or obstetric admissions, United States, 2006, 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, disparities analysis file.

National Denominator

Hospital admissions, age 18 and over or obstetric admissions, in low-mortality diagnosis-related groups (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

12_3_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 2006.

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

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 Nationwide Inpatient Sample 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 25 States that participate in HCUP and have high-quality race/ethnicity data: AR, AZ, CA, CO, CT, FL, GA, HI, KS, MA, MD, MI, MO, NH, NJ, NY, OK, RI, SC, TN, TX, UT, VA, VT, and WI.

Measure Title

Patients with hospital-acquired pressure ulcers.

Measure Source

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

Tables

12_3_10.1 Patients with hospital-acquired pressure ulcers, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges in the MPSMS sample.

Numerator

Subset of denominator who develop a pressure ulcer.

Measure Title

People with a usual source of care whose health provider 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

12_4_1.1 People with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors, United States, 2002 and 2006.

12_4_1.2 People with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors, United States, 2006, by:

• Race
• Ethnicity
• Family income
• Education

Data Source

AHRQ, CFACT, MEPS.

Denominator

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

Numerator

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

Comments

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

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

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

12_4_2.1 Hospital patients with an anticoagulant-related adverse drug event with warfarin, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received warfarin during hospitalization and had a documented 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

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

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

12_4_3.1 Hospital patients with an anticoagulant-related adverse drug event with IV heparin, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received heparin during hospitalization and had a documented 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

PTTs ≥ 100, PTTs > 45 and an abrupt cessation/hold of warfarin, PTTs > 45 and administration of Vitamin K or fresh frozen plasma (FFP), and PTTs > 45 and a blood transfusion (absent a surgical procedure) that occur the date of arrival are not counted.

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

12_4_4.1 Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) and factor Xa, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample 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/holds of LMWH or factor Xa inhibitor, administration of Vitamin K or fresh frozen plasma (FFP), and blood transfusions (absent a surgical procedure) that occur the date of arrival are not counted.

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

12_4_5.1 Hospital patients with adverse drug events with hypoglycemic agents, including insulin, oral hypoglycemic, or combination of both, United States, 2004 and 2007.

Data Source

CMS, MPSMS.

Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample 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 adverse events: administration of D50, administration of glucagons, administration of juice and/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 occurred 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 the 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.

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 the 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

12_4_6.1 Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year, United States, 2002 and 2006.

12_4_6.2 Adults age 65 and over who received at least one of 33 potentially inappropriate prescription medications in the calendar year, United States, 2006, by:

• Race
• Ethnicity
• Family income
• Education

12_4_6.3 Adults age 65 and over who received at least one of 11 prescription medications in the calendar year that should be avoided for older patients, United States, 2006, 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

People 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 the calendar year, as well as any refills.

For additional information concerning potentially inappropriate medications, see Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickzier SW, Meyer GS. Potentially Inappropriate Medication Use in the Community-Dwelling Elderly: Findings from 1996 Medical Expenditure Panel Survey, Journal of the American Medical Association, 286(22), 2823-2829, 2001.

Measure Title

Ambulatory medical care visits due to adverse effects of medical care per 1,000 people.

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Tables

12_4_7.1 Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, United States, 2006-2007.

12_4_7.2 Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, United States, 2006-2007, by:

• Race.

Data Source

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

Denominator

U.S. civilian noninstitutionalized population.

Numerator

Visits for treatment of adverse effects of medical or surgical care, or medicinal drug.