2012 National Healthcare Quality and Disparities Reports

Patient Safety

Healthcare-Associated Infections
Postoperative sepsis per 1,000 elective surgical hospital discharges of 4 or more days
Adult surgery patients with postoperative catheter-associated urinary tract infection
Admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, age 18 and over or obstetric admissions

Surgical Care
Adult surgery patients with postoperative complications
Adult surgery patients with postoperative pneumonia events
Adult surgery patients with postoperative venous thromboembolic events
Postoperative hemorrhage or hematoma with surgical drainage or evacuation
Postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT) per 1,000 surgical hospital discharges
Postoperative respiratory failure per 1,000 adult elective surgical hospital discharges
Postoperative respiratory failure per 1,000 pediatric elective surgical hospital discharges
Postoperative physiologic/metabolic derangements per 1,000 elective surgical hospital discharges
Postoperative hip fractures per 1,000 surgical hospital discharges
Reclosure of postoperative abdominal wound separation per 1,000 abdominopelvic-surgery hospital discharges
Foreign body left in during procedure
Complications of anesthesia per 1,000 surgical hospital discharges
Adverse events in patients receiving hip joint replacement due to degenerative conditions
Adverse events in patients receiving hip joint replacement due to fracture
Adverse events in patients receiving hip joint replacement due to fracture or degenerative conditions
Adverse events in patients receiving knee joint replacement

Other Complications of Hospital Care
Composite measure: Bloodstream infections or mechanical adverse events in adult patients receiving central venous catheter (CVC) placement
Discharges with central venous catheter (CVC) placement with associated bloodstream infections (BSIs)
Discharges with central venous catheter (CVC) placement with associated mechanical adverse events
Accidental puncture or laceration during procedure
Adult hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions
Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions
Deaths per 1,000 discharges in low-mortality diagnosis-related groups (DRGs)

Complications of Medication
Hospital patients with an anticoagulant-related adverse drug event with warfarin
Hospital patients with an anticoagulant-related adverse drug event with IV heparin
Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin (LMWH) or factor Xa
Hospital patients with an adverse drug event with a hypoglycemic agent

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

Healthcare-Associated Infections

Measure Title

Postoperative sepsis per 1,000 elective surgical hospital discharges of 4 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_1_1_1.1 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, United States, 2008-2009

3_1_1_1.2 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, by race/ethnicity, United States, 2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

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

National Numerator

Subset of the denominator with any secondary diagnosis of sepsis.

State Table

3_1_1_1.3 Postoperative sepsis per 1,000 elective-surgery admissions with a length of stay of 4 or more days, age 18 and over, by State, United States, 2008-2009

State Data Source

AHRQ, CDOM, HCUP, AHRQ Quality Indicators, modified version 4.1 and State Inpatient Databases (SID).

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The AHRQ PSI software requires that the sepsis be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the sepsis is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with a principal diagnosis of infection, admissions with cancer or in an immunocompromised state, and obstetric admissions. Rates prior to 2008 are not reported because of International Classification of Diseases, Ninth Revision coding changes.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by age, the adjustment is by gender, comorbidities, MDC, DRG, and transfers to the hospital; when reporting is by gender, the adjustment is by age, comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

Although not all States participate in the HCUP database, 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.

SID includes a powerful set of hospital databases from data organizations in participating States. SID contains the universe of the inpatient discharge abstracts in participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Together, SID encompasses about 90% of all U.S. community hospital discharges. SID contains a core set of clinical and nonclinical information on all patients, regardless of payer, including people covered by Medicare, Medicaid, and private insurance, as well as uninsured people. In addition to the core set of uniform data elements common to all SID, some databases within SID include other elements, such as the patient's race.

The SID disparities analysis file is designed to provide national estimates on disparities using weighted records from a sample of hospitals from the following 31 States: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Wisconsin, and Wyoming.

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Healthcare-Associated Infections

Measure Title

Adult surgery patients with postoperative catheter-associated urinary tract infection.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Tables

3_1_1_2.1 Hospital patients receiving an indwelling urinary catheter or straight catheter insertion who had a catheter-associated urinary tract infection, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All surgical patients from the MPSMS sample with documented placement of a urinary catheter.

National Numerator

Subset of the denominator with a diagnosis of a postoperative catheter-associated urinary tract infection.

Comment

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.

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized
fee-for-service Medicare population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Healthcare-Associated Infections

Measure Title

Admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, age 18 and over or obstetric admissions.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_1_1_3.1 Hospital admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, age 18 and over or obstetric admissions, United States, 2008-2009

3_1_1_3.2 Hospital admissions with central venous catheter-related bloodstream infection per 1,000 medical and surgical discharges of length 2 or more days, age 18 and over or obstetric admissions, by race/ethnicity, United States, 2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

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.

Comments

The AHRQ PSI software requires that the central venous catheter-related bloodstream infection be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with a diagnosis of cancer or in an immunocompromised state. Rates prior to 2008 are not reported because of International Classification of Diseases, Ninth Revision coding changes.

Rates are adjusted by comorbidities and diagnosis-related group (DRG). The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Adult surgery patients with postoperative complications.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_1.1 Surgical discharges with an adverse event of postoperative nosocomial pneumonia, deep vein thrombosis, or pulmonary embolus, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had at least one of selected surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia or venous thromboembolic events prior to the procedure.

National Numerator

Subset of the denominator with postoperative pneumonia events or venous thromboembolic events.

Comments

Data were not collected in 2008. The 2002-2007 data include Medicare beneficiaries discharged from January to December and the 2009 data include Medicare beneficiaries discharged from January to September. Venous thromboembolic events include 30-day postoperative readmissions for pneumonia and venous thromboembolic events.

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized fee-for-service Medicare population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Surgical Care

Measure Title

Adult surgery patients with postoperative pneumonia events.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_2.1 Surgical discharges with an adverse event of postoperative nosocomial pneumonia, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had at least one of selected surgical procedures identified as part of the Surgical Care Improvement Project who did not have pneumonia prior to the procedure.

National Numerator

Subset of the denominator with a diagnosis of postoperative pneumonia.

Comments

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized fee-for-service Medicare population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Surgical Care

Measure Title

Adult surgery patients with postoperative venous thromboembolic events.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_3.1 Surgical discharges with an adverse event of postoperative deep vein thrombosis or pulmonary embolus, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All discharges from the MPSMS sample that had one or more of certain surgical procedures identified as part of the Surgical Care Improvement Project during the index hospital stay.

National Numerator

Subset of the denominator with a diagnosed 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.

Comments

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized fee-for-service Medicare population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Surgical Care

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_2_1_4.1 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, United States, 2000, 2004-2009

3_2_1_4.2 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_4.4 Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical admissions, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

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

National Numerator

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

Comments

The AHRQ PSI software requires that the hemorrhage or hematoma complicating procedure be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the control of the hemorrhage or hematoma is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric conditions and admissions in which the control of the hemorrhage or hematoma is the only operating room procedure.

Rates are adjusted by gender, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by gender, the adjustment is by comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs)

National Tables

3_2_1_5.1 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, United States, 2000, 2004-2009

3_2_1_5.2 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_5.4 Postoperative pulmonary embolism or deep vein thrombosis per 1,000 surgical admissions, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital surgical patients, age 18 and over, excluding patients admitted for DVT or PE, obstetric admissions, and patients with secondary procedures for interruption of vena cava before or after surgery or as the only procedure.

National Numerator

Subset of the denominator with any secondary diagnosis of PE or DVT.

Comments

The AHRQ PSI software requires that the PE or DVT be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the interruption of vena cava is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric conditions and admissions in which the interruption of vena cava is the only operating room procedure.

Rates are adjusted by age, comorbidities, major diagnostic category (MDC), diagnosis-related group (DRG), and transfers to the hospital. When reporting is by age, the adjustment is by comorbidities, MDC, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_2_1_6.1 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, United States, 2000, 2004-2009

3_2_1_6.2 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_6.4 Postoperative respiratory failure per 1,000 elective-surgery admissions, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

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

National Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure or reintubation procedure at specific postoperative intervals.

Comments

The AHRQ PSI software requires that the respiratory failure be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the tracheostomy is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: admissions with respiratory disease, circulatory disease, craniofacial anomalies, or neuromuscular disorders; obstetric admissions; and admissions in which the tracheostomy is the only operating room procedure.

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Pediatric Quality Indicators (PDIs).

National Tables

3_2_1_7.1 Postoperative respiratory failure per 1,000 elective-surgery admissions, under age 18, United States, 2000, 2004, 2005, 2007, and 2008

3_2_1_7.3 Postoperative respiratory failure per 1,000 elective-surgery admissions, under age18, by income, United States, 2000-2008

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All elective hospital surgical discharges (under age 18), excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, and secondary procedure of tracheostomy before or after surgery or as the only procedure.

National Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure or reintubation procedure at specific postoperative intervals.

Comments

The AHRQ PDI software requires that the respiratory failure be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the tracheostomy is not verifiable as following surgery. Consistent with the AHRQ PDI software, the following cases are excluded: admissions with respiratory disease, circulatory disease, craniofacial anomalies, or neuromuscular disorders; obstetric admissions; and admissions in which the tracheostomy is the only operating room procedure.

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Organization, Delivery, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_2_1_8.1 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, United States, 2000, 2004-2009

3_2_1_8.2 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_8.4 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery admissions, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

All elective hospital surgical discharges for people age 18 and over, excluding some serious diseases (see Comments) and obstetric admissions.

National Numerator

Subset of the denominator with any secondary diagnosis indicating physiologic and metabolic derangements; discharges with acute renal failure must be accompanied by a procedure code for dialysis.

Comments

The AHRQ PSI software requires that the physiologic and metabolic derangements be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the derangement is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: cases with a preexisting condition of physiologic and metabolic derangements or chronic renal failure; cases with acute renal failure where a procedure for dialysis occurs before or on the same day as the first operating room procedure; cases with both a diagnosis code of ketoacidosis, hyperosmolarity, or other coma and a principal diagnosis of diabetes; cases with both a secondary diagnosis code for acute renal failure and a principal diagnosis of acute myocardial infarction, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage; and obstetric admissions.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, major diagnostic category (MDC), and diagnosis-related group (DRG). When reporting is by age, the adjustment is by gender, comorbidities, MDC, and DRG; when reporting is by gender, the adjustment is by age, comorbidities, MDC, and DRG. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

Postoperative hip fractures per 1,000 surgical hospital discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_2_1_9.1 Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, age 18 and over, United States, 2000, 2004-2009

3_2_1_9.2 Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_9.4 Postoperative hip fracture per 1,000 surgical admissions who were not susceptible to falling, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Inpatient hospital surgical discharges, age 18 and over, who were not susceptible to falling.

National Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture.

Comments

The AHRQ PSI software requires that the hip fracture be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the hip fracture repair is not verifiable as following surgery. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric cases; admissions for seizure, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium and other psychoses, anoxic brain injury, metastatic cancer, lymphoid/bone malignancy, or self-inflicted injury; admissions for diseases and disorders of the musculoskeletal system and connective tissue; and admissions in which hip fracture repair is the only operating room procedure.

Rates are adjusted by major diagnostic category (MDC). The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_2_1_10.1 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, age 18 and over, United States, 2000, 2004-2009

3_2_1_10.2 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, age 18 and over, by race/ethnicity, United States, 2009

3_2_1_10.4 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery admissions of length 2 or more days, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Inpatient hospital surgical (abdominopelvic surgery with a length of stay of 2 or more days) discharges age 18 and over, excluding obstetric admissions.

National Numerator

Subset of the denominator with a secondary procedure indicating reclosure of postoperative disruption of abdominal wall.

State Table

3_2_1_10.3 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges of length 2 or more days, age 18 and over, by State, United States, 2000, 2004, 2007-2009

State Data Source

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

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Reclosure of abdominal wound dehiscence is not verifiable as following surgery and may have occurred on or before the abdominopelvic procedure. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric admissions and admissions in an immunocompromised state.

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Surgical Care

Measure Title

Foreign body left in during procedure.

Measure Source

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

National Tables

Not reported in the 2012 NHQR and NHDR.

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

U.S. population age 18 and over, excluding patients with International Classification of Diseases, Ninth Revision codes for foreign body left during procedure in principal diagnosis field or secondary diagnosis present on admission.

National Numerator

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.

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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), Center for Delivery, Organization, and Markets (CDOM), Healthcare Utilization and Cost Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

Not reported in the 2012 NHQR and NHDR.

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators.

National 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.

National Numerator

Subset of the denominator with any secondary diagnosis indicating anesthesia complications.

Comments

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Surgical Care

Measure Title

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

Measure Source

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

National Table

3_2_1_13.1 Hospital patients receiving hip joint replacement due to degenerative conditions who had a joint-prosthesis-associated adverse event, age 18 and over, United States, 2009-2010

National Data Source

CMS, MPSMS.

National Denominator

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

National Numerator

Subset of the denominator who 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 pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days of the surgical procedure.

Comments

Postoperative infections are determined by documentation of early prosthetic joint or wound infection or acute and early deep hip infection, excluding superficial infection. Wound complications other than infection include 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, and postoperative venous thromboembolic event are all determined in the same fashion as those in other MPSMS measures. Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

The analytic approach used to produce these tables differs from the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used for to determine 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.

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized Medicare FFS population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient's interaction with the health care delivery system than from diseases the patient may have.

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_14.1 Surgical patients receiving hip joint replacement due to fracture who had a joint-prosthesis-associated adverse event, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

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

National Numerator

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

Postoperative infections.
Postoperative pneumonia.
Postoperative urinary tract infection.
Postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE).
Dislocation.
Wound complications other than infection.
Nerve injury.
Postoperative bleeding requiring four or more blood transfusions.
Cardiovascular complications.
Same-side revision during the index hospital stay.
Return to the operating room for reasons other than same-side revision during the index hospital stay.
Death.

Comments

Postoperative infections are determined by documentation of early prosthetic joint or wound infection and acute and early deep hip infection, excluding superficial infection. Postoperative pneumonia, postoperative urinary tract infection, postoperative DVT, and PE 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 the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to determine 30-day postprocedure mortality, to distinguish between hip procedures, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Surgical Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_15.1 Hospital patients receiving hip joint replacement due to fracture or degenerative conditions who had a joint-prosthesis-associated adverse event, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National 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.

National Numerator

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

Postoperative acute or early deep infection.
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.
Postoperative catheter-associated urinary tract infection.
Postoperative pneumonia.

Comments

The 2009 data include Medicare beneficiaries discharged from January to September.

Postoperative infections are determined by documentation of:

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

Postoperative pneumonia, 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 g/dL compared with the value obtained on the first postoperative day (for example, a drop of 13.1 to 11.1 g/dL).

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Surgical Care

Measure Title

Adverse events in patients receiving knee joint replacement.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_2_1_16.1 Hospital patients receiving a knee joint replacement who had a joint-prosthesis-associated adverse event, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National 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.

National Numerator

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

Postoperative acute or early deep infection.
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.
Postoperative catheter-associated urinary tract infection.
Postoperative pneumonia.

Comments

The 2009 data include Medicare beneficiaries discharged from January to September.

Postoperative infections are determined by documentation of:

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

Major bleeding/hematoma is defined as:

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

The analytic approach used to produce these tables differs from the 2005 NHQR and NHDR and earlier reports. Data may not be comparable with those years.

MPSMS data are used for abstracted data related to the index hospital stay. Medicare administrative data are used to determine 30-day postprocedure mortality, to determine 30-day postprocedure readmission for DVT or PE, and to identify readmission within 30 days of procedure.

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Other Complications of Hospital Care

Measure Title

Composite measure: Bloodstream infections or mechanical adverse events in adult patients receiving central venous catheter (CVC) placement.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_3_1_1.1 Hospital patients receiving a central venous catheter placement who had a catheter-associated bloodstream infection or mechanical adverse event, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample 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 that did not have evidence of a prior BSI.

National Numerator

Subset of the denominator with either a CVC-associated BSI or CVC-associated mechanical adverse event.

Comments

The 2009 data include Medicare beneficiaries discharged from January to September.

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Other Complications of Hospital Care

Measure Title

Discharges with central venous catheter placement (CVC) with associated bloodstream infections (BSIs).

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_3_1_2.1 Hospital patients receiving a central venous catheter placement who had a catheter-associated bloodstream infection, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National 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.

National Numerator

Subset of the denominator with a CVC-associated BSI.

Comments

The 2009 data include Medicare beneficiaries discharged from January to September.

CVC-associated BSI is determined by documentation of all of the following:

At least one blood culture, drawn at least 2 days after placement of a CVC, and positive for at least one of the following pathogens: Acinetobacter, beta-hemolytic streptococci, Candida, Candida glabrata, coagulase-negative staphylococci, Enterobacter spp., Enterococcus spp., Escherichia coli, Klebsiella spp., methicillin-resistant Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Pseudomonas other, Serratia marcescens, Staphylococcus aureus, Staphylococcus not otherwise specified, Staphylococcus other, viridans streptococci.
No other source of documented infection.

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Other Complications of Hospital Care

Measure Title

Discharges with central venous catheter (CVC) placement with associated mechanical adverse events.

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_3_1_3.1 Hospital patients receiving a central venous catheter placement who had a catheter-associated mechanical adverse event, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

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

National Numerator

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

Comments

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Other Complications of Hospital Care

Measure Title

Accidental puncture or laceration during procedure.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs) and Pediatric Quality Indicators (PDIs).

National Tables

3_3_1_4.1 Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age 18 and over, United States, 2000, 2004-2009

3_3_1_4.2 Accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, age 18 and over, by race/ethnicity, United States, 2009

3_3_1_4.4 Accidental punctures or lacerations per 1,000 medical and surgical admissions, age 18 and over, by income, United States, 2000-2009

3_3_1_5.1 Hospital admissions with accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, ages 0-17, United States, 2000, 2004-2009

3_3_1_5.2 Hospital admissions with accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, ages 0-17, United States, by race/ethnicity, United States, 2009

3_3_1_5.4 Hospital admissions with accidental puncture or laceration during procedure per 1,000 medical and surgical admissions, ages 0-17, United States, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) disparities analysis file, and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital medical and surgical discharges among people age 18 and under or age 18 and over, as appropriate, excluding obstetric admissions.

National Numerator

Subset of the denominator with secondary diagnosis denoting accidental cut, puncture, perforation, or laceration during a procedure.

Comments

The AHRQ PSI and PDI software requires that the accidental puncture or laceration be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI and PDI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI and PDI software, the following cases are excluded: obstetric admissions and admissions involving spinal surgery.

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Other Complications of Hospital Care

Measure Title

Adult hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_3_1_6.1 Hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, United States, 2000, 2004-2009

3_3_1_6.2 Hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, by race/ethnicity, United States, 2009

3_3_1_6.4 Hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

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.

National Numerator

Subset of the denominator with any secondary diagnosis of iatrogenic pneumothorax.

State Table

3_3_1_6.3 Hospital admissions with iatrogenic pneumothorax per 1,000 medical and surgical admissions, age 18 and over, by State, United States, 2000, 2004, 2007-2009

State Data Source

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

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The AHRQ PSI software requires that the iatrogenic pneumothorax be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. Consistent with the AHRQ PSI software, the following cases are excluded: obstetric admissions and admissions with chest trauma, pleural effusion, thoracic surgery, lung/pleural biopsy, diaphragmatic surgery repair, or cardiac surgery.

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Other Complications of Hospital Care

Measure Title

Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_3_1_7.1 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, United States, 2007-2009

3_3_1_7.2 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, by race/ethnicity, United States, 2009

3_3_1_7.4 Deaths per 1,000 elective-surgery admissions having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital inpatient discharges, ages 18-89 years, with potential complications of care, 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.

State Table

3_3_1_7.3 Deaths per 1,000 elective-surgery discharges having developed specified complications of care during hospitalization, ages 18-89 or obstetric admissions, by State, United States, 2000, 2004, 2007-2009

State Data Source

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

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Potential complications of care include pneumonia, deep vein thrombosis/pulmonary embolism, sepsis, acute renal failure, shock/cardiac arrest, and gastrointestinal hemorrhage/acute ulcer.

Consistent with the AHRQ PSI software, complications of care include acute renal failure, pneumonia, pulmonary embolism, deep vein thrombosis, sepsis, shock, cardiac arrest, gastrointestinal hemorrhage, and acute ulcer, excluding transfers to another hospital. The AHRQ PSI software requires that the complication be reported as a secondary diagnosis (rather than the principal diagnosis), but unlike the AHRQ PSI software, the secondary diagnosis could be present on admission. In addition, the surgery is not verifiable as occurring in the first 2 days of the inpatient stay.

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Other Complications of Hospital Care

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP), Patient Safety Indicators (PSIs).

National Tables

3_3_1_8.1 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, United States, 2000, 2004-2009

3_3_1_8.2 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by race/ethnicity, United States, 2009

3_3_1_8.4 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by income, United States, 2000-2009

National Data Source

AHRQ, CDOM, HCUP, Nationwide Inpatient Sample (NIS) and AHRQ Quality Indicators, modified version 4.1.

National Denominator

Hospital admissions among people age 18 and over or obstetric conditions, in low-mortality DRGs (defined as DRGs with less than a 0.5% mortality rate), excluding patients with trauma, immunocompromised state, or cancer.

National Numerator

Subset of the denominator with discharge disposition indicating death.

State Table

3_3_1_8.3 Deaths per 1,000 hospital admissions with expected low mortality, age 18 and over or obstetric admissions, by State, United States, 2000, 2004, 2007-2009

State Data Source

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

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Consistent with the AHRQ PSI software, admissions with expected low mortality are identified by Medicare Severity DRG or DRG, depending on the date of discharge. Exclusions include admissions with cancer, admissions in an immunocompromised state, and admissions involving a traumatic injury. Low-mortality DRGs are defined as DRGs with less than a 0.5% mortality rate, such as cesarean section without complications, major male pelvic procedures, and syncope and collapse.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, DRG, and transfers to the hospital. When reporting is by age, the adjustment is by gender, comorbidities, DRG, and transfers to the hospital; when reporting is by gender, the adjustment is by age, comorbidities, DRG, and transfers to the hospital. The AHRQ PSI software was modified to not use the present on admission (POA) indicators (or estimates of the likelihood of POA for secondary diagnosis).

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Complications of Medication

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_4_1_1.1 Hospital patients who received an anticoagulant who had an adverse drug event with warfarin, age 18 and over, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received warfarin during hospitalization and had a documented international normalized ratio (INR) result during the hospital stay.

National 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.
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, and INRs >1.5 and a blood transfusion (absent a surgical procedure) that occur the date of arrival are not counted.

The 2010 data include Medicare beneficiaries discharged from January to December, excluding Maryland, Puerto Rico, and the U.S. Virgin Islands, and the 2009 data include Medicare beneficiaries discharged from January to September.

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Complications of Medication

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_4_1_2.1 Hospital patients with an anticoagulant-related adverse drug event with IV heparin, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received heparin during hospitalization and had a documented partial thromboplastin time (PTT) result during the hospital stay.

National 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.
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, and PTTs >45 and a blood transfusion (absent a surgical procedure) that occur the date of arrival are not counted.

Data for 2010 include records for discharges that occurred from January to December, excluding Maryland, Puerto Rico, and the U.S. Virgin Islands, and 2009 data include Medicare beneficiaries discharged from January to September.

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Complications of Medication

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

National Table

3_4_1_3.1 Hospital patients with an anticoagulant-related adverse drug event with low-molecular-weight heparin or factor Xa, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National Denominator

All Medicare fee-for-service (FFS) discharges from the MPSMS sample who received LMWH or factor Xa during the hospital stay.

National Numerator

Subset of the denominator who experienced:

Abrupt cessation/hold of LMWH or factor Xa 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.
Blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

Abrupt cessation/holds of LMWH or factor Xa, 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.

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Complications of Medication

Measure Title

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

Measure Source

Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS)

National Table

3_4_1_4.1 Hospital patients with adverse drug events associated with hypoglycemic agents, including insulin, oral hypoglycemic, or combination of both, United States, 2009-2010

National Data Source

AHRQ and CMS, MPSMS.

National 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.

National 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 or sugar, anxiety, code blue (CPR), confusion, death, drowsiness, sweating, weakness, trembling, increased heart rate, irritability, seizure, stroke, transient ischemic attack, myocardial infarction, and coma/loss of consciousness.

Comments

MPSMS is a nationwide surveillance system designed to identify rates of specific adverse events within the hospitalized Medicare FFS population. An adverse event is defined as an unintended patient harm, injury, or loss more likely associated with the patient’s interaction with the health care delivery system than from diseases the patient may have.

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Other Complications

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), National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).

National Tables

3_4_1_5.1 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, 2007-2008, 2008-2009

3_4_1_5.2a Visits to physician offices, hospital outpatient departments, and hospital emergency departments for adverse effects of medical care per 1,000 population, by race, United States, 2008-2009

National Data Source

CDC, NCHS, NAMCS, NHAMCS.

National Denominator

U.S. civilian noninstitutionalized population.

National Numerator

Subset of the denominator with visits for treatment of adverse effects of medical or surgical care, or medicinal drugs.

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Page last reviewed June 2013

Internet Citation: 2012 National Healthcare Quality and Disparities Reports: Patient Safety . June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/nhqrdr/nhqrdr12/measurespec/patient_safety.html