Patient Safety

2010 National Healthcare Quality and Disparities Reports

Patient Safety

Healthcare-Associated Infections
Adult surgery patients who received appropriate timing of antibiotics
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
Postoperative septicemia per 1,000 elective surgical hospital discharges of 4 or more days, adults age 18 and over
Selected infections due to medical care per 1,000 discharges

Surgical Care
Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical hospital discharges, adults
Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges, adults
Postoperative respiratory failure per 1,000 elective surgical hospital discharges
Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges, adults
Postoperative hip fractures per 1,000 surgical hospital discharges, adults
Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges, adults
Foreign body left in during procedure per 1,000 hospital discharges
Complications of anesthesia per 1,000 surgical hospital discharges

Other Complications of Hospital Care
Accidental puncture or laceration during procedure per 1,000 discharges
Iatrogenic pneumothorax per 1,000 adult discharges
Decubitus ulcers per 1,000 selected stays of 5 or more days, adults age 18 and over
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
People with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors
Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year
Ambulatory medical care visits due to adverse effects of medical care per 1,000 persons

Healthcare-Associated Infections

Measure Title

Adult surgery patients who received appropriate timing of antibiotics.

Measure Source

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

National Table

12_1_2.1 Adult surgery patients who received appropriate timing of antibiotics, United States, 2005-2008

National Data Source

CMS, Quality Improvement Organization (QIO) Program.

National Denominator

Discharged adult 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 Table

12_1_2.2 Adult surgery patients who received appropriate timing of antibiotics, by State, 2005-2008

State Data Source

CMS, QIO.

CMS, Hospital Compare (HC).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

This is a composite measure. 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 in late April each year from: http://www.medicare.gov/Download/DownloadDB.asp.

Estimates are calculated using hospital-level scores.

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

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Healthcare-Associated Infections

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 Table

12_1_3.1 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, United States, 2005 -2008

National Data Source

CMS, Quality Improvement Organization (QIO) Program.

National Denominator

Discharged adult hospital patients with indication of surgery.

National Numerator

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

State Table

12_1_3.2 Adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, by State, 2005 and 2008

State Data Source

CMS, QIO.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

For State Tables, data were downloaded in late April each year from: http://www.medicare.gov/Download/DownloadDB.asp.

Estimates are calculated using hospital-level scores.

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Healthcare-Associated Infections

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 Table

12_1_4.1 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, United States, 2005-2008

National Data Source

CMS, Quality Improvement Organization (QIO) Program.

National Denominator

Discharged adult hospital patients with indication of surgery.

National Numerator

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

State Table

12_1_4.2 Adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, by State, 2005-2008

State Data Source

CMS, QIO.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

For State Tables, data were downloaded in late April each year from: http://www.medicare.gov/Download/DownloadDB.asp.

Estimates are calculated using hospital-level scores.

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Healthcare-Associated Infections

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

12_1_5.1 Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, age 18 and over, United States, 2000-2007

12_1_5.2 Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

All elective hospital surgical discharges among persons age 18 or over, with length of stay of 4 or more days.

National Numerator

Subset of the denominator with any secondary diagnosis of sepsis.

State Table

12_1_5.3 Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure, age 18 and over, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Patients admitted for infection, cancer, or immunocompromised states and obstetric conditions are excluded. Postoperative septicemia is not verifiable as following surgery because information on day of procedure is not available for all discharges.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related groups (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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Healthcare-Associated Infections

Measure Title

Selected infections due to medical care per 1,000 hospital 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 or obstetric admissions, age 18 and over ,United States, 2000, 2004-2007

12_1_6.2 Selected infections due to medical care or obstetric admissions, per 100,000 population age 18 and over, United States, 2000, 2004-2007

12_1_6.3 Selected infections due to medical care or obstetric admissions, per 1,000 medical and surgical discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

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

National Numerator

Subset of the denominator with any secondary diagnosis of infection (ICD-9-CM code 999.3 or 996.62).

State Table

12_1_6.4 Selected infections due to medical care per 1,000 medical and surgical discharges, age 18 and over or obstetric admissions, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Immunocompromised and cancer patients, stays under 2 days, and admissions specifically for such infections are excluded.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Surgical Care

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical hospital discharges, adults.

Measure Source

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

National Tables

12_2_4.1 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges, age 18 and over, United States, 2000, 2004-2007

12_2_4.2 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 100,000 population, age 18 and over, United States, 2000, 2004-2007

12_2_4.3 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

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

Population measures: U.S. population age 18 and over.

Numerator

Discharge measure: Subset of the denominator with a secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma.

Population measure: Subset of the denominator with any principal or secondary diagnosis of hemorrhage or postoperative hematoma.

Comments

Postoperative control of hemorrhage or hematoma may not be verifiable as following surgery because information on day of procedure is not available for all discharges.

For discharge measures, rates are adjusted by age, gender, age-gender interaction, comorbidities, and diagnosis-related group (DRG) clusters.

For population measures, rates are adjusted by age and gender using the total U.S population for 2000 as the standard population.

These tables were created using version 3.1 of the AHRQ PSI software. Discharge measures are referred to as PSI 9 and population measures are referred to as PSI 27 in the software documentation. More information about the AHRQ Quality Indicators and ICD-9-CM codes used to define postoperative hemorrhage or hematoma are 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Surgical Care

Measure Title

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

Measure Source

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

National Tables

12_2_5.1 Postoperative pulmonary embolism or deep vein thrombosis (DVT) per 1,000 surgical discharges, age 18 and over, United States, 2000, 2004-2007

12_2_5.2 Postoperative pulmonary embolism or deep vein thrombosis (DVT) per 1,000 surgical discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

Denominator

Hospital surgical patients, age 18 and over, excluding patients admitted for DVT or PE, obstetric conditions, and patients with secondary procedures for interruption of vena cava (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 (ICD-9-CM codes 415.1, 415.11, 415.19).

Comments

PE or DVT may not be verifiable as following surgery, as information on day of procedure is not available for all discharges.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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,WI and WY.

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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), Pediatric Quality Indicators (PDIs).

National Tables

12_2_6.1 Postoperative respiratory failure per 1,000 elective-surgery discharges with an operating room procedure, age 18 and over, United States, 2000, 2004-2007

12_2_6.2 Postoperative respiratory failure per 1,000 elective-surgery discharges with an operating room procedure, under age 18, United States, 2000, 2004-2007

12_2_6.3 Postoperative respiratory failure per 1,000 elective-surgery discharges with an operating room procedure, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

All elective hospital surgical discharges age 18 and over, excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, or obstetric conditions, and patients with secondary procedure of tracheostomy (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).

Comments

Postoperative respiratory failure may not be verifiable as following surgery because information on day of procedure is not available for all discharges.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related groups (DRG) clusters.

This table was created using version 3.1 of the AHRQ PSI software. For adults, 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. For children, these measures are referred to as PDI 9 in the software documentation. More information about the AHRQ Pediatric Quality Indicators is available at http://www.qualityindicators.ahrq.gov/pdi_overview.htm.

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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Surgical Care

Measure Title

Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges, adults.

Measure Source

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

National Tables

12_2_7.1 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges, age 18 and over, United States, 2000, 2004-2007

12_2_7.2 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

Denominator

All elective hospital surgical discharges for persons age 18 and over, excluding some serious disease and obstetric admissions.

Numerator

Subset of the denominator with any secondary diagnosis indicating physiologic and metabolic derangements; discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure code for dialysis (ICD-9-CM codes 39.95, 54.98).

Comments

"Serious disease" includes patients with both a diagnosis code of ketoacidosis, hyperosmolarity, or coma and a principal diagnosis of diabetes, and patients with renal failure who were admitted foracute myocardial infarction, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage. Specific ICD-9-CM codes used to define these conditions are available at http://www.qualityindicators.ahrq.gov.

Postoperative physiologic and metabolic derangements may not be verifiable as following surgery because information on day of procedure is not available for all discharges.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Surgical Care

Measure Title

Postoperative hip fractures per 1,000 surgical hospital discharges, adults.

Measure Source

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

National Tables

12_2_8.1 Postoperative hip fracture per 1,000 surgical patients who were not susceptible to falling, age 18 and over, United States, 2000, 2004-2007

12_2_8.2 Postoperative hip fracture per 1,000 surgical patients who were not susceptible to falling, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National 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.

National 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).

Comments

Specific ICD-9-CM codes used to define these conditions are available at http://www.qualityindicators.ahrq.gov.

Postoperative hip fractures may not be verifiable as following surgery because information on day of procedure is not available for all discharges.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Surgical Care

Measure Title

Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges among adults.

Measure Source

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

National Tables

12_2_9.1 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges, age 18 and over, United States, 2000, 2004-2007

12_2_9.2 Reclosure of postoperative abdominal wound dehiscence per 100,000 population, age 18 and over, United States, 2000, 2004-2007

12_2_9.3 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

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

National Numerator

Subset of the denominator with a secondary procedure indicating reclosure of postoperative disruption of abdominal wall (ICD-9-CM code 54.61).

State Table

12_2_9.4 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges, age 18 and over, by State, 2000, 2004-2007

State Data Source

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

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Postoperative abdominal wound separation may not be verifiable as following surgery because information on day of procedure is not available for all discharges.

Discharge measures for National and State Tables: Rates per surgical discharge are adjusted by age, gender, age-gender interaction, comorbidities, and diagnosis-related group (DRG) clusters.

Population measures: Rates are adjusted by age and gender using the total U.S population for 2000 as the standard population.

These tables were created using version 3.1 of the AHRQ PSI software. Discharge measures are referred to as PSI 14 and population measures are referred to as PSI 24. Note that "wound separation" is used in the measure table title whereas PSI 14 uses the term "wound dehiscence." 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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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).

National Tables

12_2_10.1 Foreign body accidentally left in during procedure, per 1,000 medical and surgical discharges or obstetric admissions, age 18 and over, United States, 2000, 2004-2007

12_2_10.2 Foreign body accidentally left in during procedure or obstetric admissions, per 100,000 population, age 18 and over, United States, 2000, 2004-2007

12_2_10.3 Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges or obstetric admissions, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

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

Population measures: U.S. population age 18 and over, excluding patients with ICD-9 codes for foreign body left in during procedure in principal diagnosis field or secondary diagnosis present on admission.

National Numerator

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

Population measures: Subset of the denominator with any principal or secondary diagnosis indicating foreign body left in during procedure.

Comments

No risk adjustment is performed for discharge measures. Population measures are adjusted by age and gender using the total U.S. population for 2000 as the standard population.

These tables were created using version 3.1 of the AHRQ PSI software. Discharge measures are referred to as PSI 5 and population measures are referred to as PSI 21 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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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).

National Tables

12_2_11.1 Complications of anesthesia in any secondary diagnosis per 1,000 surgical discharges or obstetric admissions, age 18 and over, United States, 2000, 2004-2007

12_2_11.2 Complications of anesthesia in any secondary diagnosis per 1,000 surgical discharges or obstetric admissions, age 18 and over, United States, 2007, 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 surgical hospital discharges for persons 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 (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.

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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other Complications of Hospital Care

Measure Title

Accidental puncture or laceration during procedure, per 1,000 discharges.

Measure Source

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

National Tables

12_3_2.1 Accidental puncture or laceration during procedure per 1,000 discharges, age 18 and over, United States, 2000, 2004-2007

12_3_2.2 Accidental puncture or laceration during procedure per 1,000 discharges, under age 18, United States, 2000, 2004-2007

12_3_2.3 Accidental puncture or laceration during procedure per 100,000 population, age 18 and over, United States, 2000, 2004-2007

12_3_2.4 Accidental puncture or laceration during procedure per 1,000 discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

12_3_2.5 Accidental puncture or laceration during procedure per 1,000 discharges, under age 18, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

Discharge measures: Hospital medical and surgical discharges among persons age 18 and under or age 18 and over, as appropriate, excluding obstetric admissions.

Population measures: U.S. population age 18 and over.

National Numerator

Discharge measures: Subset of the denominator with secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure (ICD-9-CM codes E870.0-E870.9, 998.2).

Population measures: Subset of the denominator with any principal or secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure, such as cases from earlier admissions or from other hospitals.

Comments

Rates per surgical discharge are adjusted by age, gender, age-gender interaction, comorbidities, and diagnosis-related group (DRG) clusters.

Population measures are adjusted by age and gender using the total U.S population for 2000 as the standard population.

These tables were created using version 3.1 of the AHRQ PSI software. Discharge measures are referred to as PSI 15 and population measures are referred to as 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 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other Complications of Hospital Care

Measure Title

Iatrogenic pneumothorax per 1,000 adult discharges.

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, age 18 and over, United States, 2000, 2004-2007

12_3_5.2 Iatrogenic pneumothorax cases per 100,000 population, age 18 and over, United States, 2000, 2004-2007

12_3_5.3 Iatrogenic pneumothorax per 1,000 discharges, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

Discharge measure: 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 measures: U.S. population age 18 and over.

National Numerator

Discharge measure: Subset of the denominator with any secondary diagnosis of iatrogenic pneumothorax (ICD-9-CM diagnosis code 512.1).

Population measure: Subset of the denominator with any principal or secondary diagnosis of iatrogenic pneumothorax.

State Table

12_3_5.4 Iatrogenic pneumothorax per 1,000 discharges, age 18 and over, by State, 2000, 2004-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Rates per surgical discharge are adjusted by age, gender, age-gender interaction, comorbidities, and diagnosis-related group (DRG) clusters.

Population measures are adjusted by age and gender using the total U.S population for 2000 as the standard population.

These tables were created using version 3.1 of the AHRQ PSI software. Discharge measures are referred to as PSI 6 and population measures are referred to as 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 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other 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).

National Tables

12_3_6.1 Decubitus ulcers per 1,000 discharges of length 5 or more days, age 18 and over, United States, 2000, 2004-2007

12_3_6.2 Decubitus ulcers per 1,000 discharges of length 5 or more days, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National 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, debridement of pedicle graft before major procedure, and transfers from other institutions, admissions from long-term-care facilities, and obstetric admissions.

National Numerator

Subset of the denominator with any secondary diagnosis of decubitus ulcer (ICD-9-CM codes 707.00-707.09, and, through FY2005, 707.0).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related groups (DRG) clusters.

This table was created using version 3.1 of the AHRQ PSI software and 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other 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).

National Tables

12_3_7.1 Transfusion reactions per 1,000 discharges or obstetric admissions, age 18 and over, United States, 2000, 2004-2007

12_3_7.2 Transfusion reactions per 100,000 population or obstetric admissions, age 18 and over, United States, 2000, 2004-2007

12_3_7.3 Transfusion reactions per 1,000 discharges or obstetric admissions, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

Denominator

Discharge measures: All medical and surgical hospital discharges, among persons age 18 and over or obstetric admissions.

Population measures: U.S. population age 18 and over.

Numerator

Discharge measure: Subset of the denominator with a secondary diagnosis indicating transfusion reaction (ICD-9-CM codes 999.6, 999.7, E876.0).

Population measure: Subset of the denominator with a principal or secondary diagnosis indicating transfusion reaction.

Comments

Rates per surgical discharge are adjusted by age, gender, age-gender interaction, comorbidities, and diagnosis-related group (DRG) clusters.

Rates for population measures are adjusted by age and gender using the total U.S population for 2000 as the standard population.

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. Discharge measures are referred to as PSI 16 and population measures are referred to as 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other Complications of Hospital Care

Measure Title

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

Measure Source

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

National Tables

12_3_8.1 Failure to rescue, or deaths per 1,000 discharges having developed specified complications of care during hospitalization, ages 18-74, United States, 2000, 2004-2007

12_3_8.2 Failure to rescue, or deaths per 1,000 discharges having developed specified complications of care during hospitalization, ages 18-74, United States, 2007, by:

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

Hospital inpatient discharges, ages 18-74, with potential complications of care, as listed in the definition of failure to rescue, excluding patients transferred in or out or patients admitted from long-term-care facilities.

National Numerator

Subset of the denominator with discharge disposition indicating death.

Comments

Potential complications of care include pneumonia, deep vein thrombosis/pulmonary embolism, sepsis, acute renal failure, shock/cardiac arrest, and gastrointestinal hemorrhage/acute ulcer. Additional diagnostic criteria, specific to each complication, may affect inclusion or exclusion from this measure statistic.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and diagnosis-related group (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 and specific ICD-9-CM codes used to define the failure to rescue definition are 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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Other Complications of Hospital Care

Measure Title

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

Measure Source

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

National Tables

12_3_9.1 Deaths per 1,000 admissions in low-mortality diagnosis-related groups or obstetric admissions, age 18 and over, United States, 2000, 2004-2007

12_3_9.2 Deaths per 1,000 admissions in low-mortality diagnosis-related groups or obstetric admissions, age 18 and over, United States, 2007, by:

• Race/ethnicity.

National Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, version 3.1.

National Denominator

Hospital admissions among persons age 18 and over or obstetric conditions, in low-mortality DRGs, excluding patients with trauma, immunocompromised state, or cancer.

National Numerator

Subset of the denominator with discharge disposition indicating death.

State Table

12_3_9.3 Deaths per 1,000 admissions in low-mortality diagnosis-related groups or obstetric admissions, age 18 and over, by State, 2000, 2005-2007

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, version 3.1, and State Inpatient Databases (SID).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Low-mortality DRGs include those with a mortality rate less than 0.5% in 1997.

Data were not risk adjusted.

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 the NHQR/NHDR to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 26 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, WI, and WY.

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Complications of Medication

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).

National Tables

12_4_1.1 People with a usual source of care who usually asks about prescription medications and treatments from other doctors, 2002-2007

12_4_1.2a-d People with a usual source of care who usually asks about prescription medications and treatments from other doctors, by race, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

Persons who had a usual source of care and had a valid response to the question: "Does [respondent's usual care provider] usually ask about prescription medications and treatments other doctors may give you?"

National Numerator

Subset of the denominator who answered "Yes" to the question identified in the denominator.

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

Adults age 65 and over who received potentially inappropriate prescription medications in the calendar year.

Measure Source

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

National Tables

12_4_6.1 Adults age 65 and over with at least 1 prescription from 33 medications that are potentially inappropriate, 2002-2007

12_4_6.2 Adults age 65 and over with at least 1 prescription from 11 medications that should be avoided in older adults, 2002-2007

12_4_6.3a-d Adults age 65 and over with at least 1 prescription from 33 medications that are potentially inappropriate, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

12_4_6.4a-d Adults age 65 and over with at least 1 prescription from 11 medications that should be avoided in older adults, United States, 2007, by:

• Race.
• Ethnicity.
• Family Income.
• Education.

National Data Source

AHRQ, CFACT, MEPS.

National Denominator

U.S. population age 65 and over.

National Numerator

Persons age 65 and over who received 1 or more of the 11 or 33 (as appropriate) 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

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

Measure 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).

National 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 and 2007-2008

12_4_7.2a Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, United States, 2007-2008, by:

• Race.

National Data Source

CDC, NCHS, NAMCS, NHAMCS.

National Denominator

U.S. civilian noninstitutionalized population.

National Numerator

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

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