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Definitions of Quality Indicators, Version 1.3

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Definitions of Quality Indicators, Version 1.3 Definitions of Quality Indicators, Version 1.3 1 Outcomes Mortality Indicator In-hospital mortality following common elective procedures Relationship to quality All surgery entails some risk; however, mortality following common elective procedures for uncomplicated cases should rarely occur. By comparing mortality rates across institutions or regions and by observing trends in mortality rates for elective procedures, it may be possible to target areas requiring more indepth analysis or quality improvement efforts. Benchmark State, regional, and peer group average. Method: Quality measure Number of deaths per 100 patients receiving common elective procedures. (Outcome of interest ÷ population at risk) * 100 Outcome of interest In-hospital mortality among patients receiving common elective procedures in any procedure field. Population at risk All non-maternal/non-neonatal discharges age 18 years or older. Screen diagnoses and procedures (all fields) to limit risk population to uncomplicated cases: A. for hysterectomy (see page 34), exclude female genital cancer (see page 34) or pelvic trauma (see page 34), B. for laminectomy/spinal fusion (see page 34), include only simple intervertebral disc displacement (see page 35), C. for cholecystectomy (see page 35), include only non- acute, uncomplicated cholecystitis and/or cholelithiasis (see page 35), D. for transurethral prostatectomy (see page 35), include only prostatic hyperplasia (see page 35), E. for hip replacement (see page 35), include only osteoarthrosis of hip (see page 35), F. for knee replacement (see page 35), include only osteoarthrosis of knee (see page 35). Exclude cases transferred to another institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates). 2 Outcomes Coded Complications Indicator Obstetrical complications Relationship to quality Obstetrical complications contribute to maternal, fetal, and neonatal morbidity and mortality. In 1987, there were 22 hospitalizations for obstetrical complications prior to delivery per 100 deliveries.1 Such complications are considered largely preventable through routine prenatal care and appropriate obstetrical care. Benchmark Reduce severe complications of pregnancy to no more than 15 per 100 deliveries.1 Method: Quality measure Number of complications per 100 deliveries. (Outcome of interest ÷ population at risk) * 100 Outcome of interest Maternal discharges with C fourth degree laceration; C hemorrhage or transfusions; C pulmonary, cardiac, central nervous system, or anesthesia complications; C obstetric shock; C renal failure; C puerperal infection; C air embolism; C disruption of cesarean or perineal wound; C breast abscess; or C other obstetric complications in any diagnosis or procedure field (see page 35 for diagnoses and page 36 for procedures). Population at risk All women who deliver (see page 36). 3 Outcomes Coded Complications Indicator Wound infection Relationship to quality Surgical and traumatic wounds are often contaminated with bacteria; however, strict surgical aseptic technique and appropriate antibiotic therapy can minimize the incidence of wound infections. This indicator is part of the Complications Screening Program2,3 and identifies diagnoses or procedures that suggest a possible complication resulting from treatment in the hospital. Because these ICD-9-CM codes explicitly identify wound infections, all cases in the hospital are screened for these conditions. Benchmark State, regional, or peer group average. Method: Quality measure Number of wound infections per 100 discharges. (Outcome of interest ÷ population at risk) * 100 Outcome of interest Discharges with post-operative or post-traumatic wound infection in any secondary diagnosis (see page 36). Population at risk All discharges. 4 Outcomes Coded Complications Indicator Adverse effects and iatrogenic complications Relationship to quality This indicator combines a wide range of conditions and procedures that denote potentially substandard care and poor outcomes. These complications and adverse events are explicitly identified by ICD-9-CM codes; thus, all cases in the hospital are screened for these conditions. This indicator is part of the Complications Screening Program.2,3 Benchmark State, regional, or peer group average. Method: Quality measure Number of complications per 100 discharges. (Outcome of interest ÷ population at risk) * 100 Outcome of interest Discharges with C post-operative hemorrhage or hematoma diagnoses (see page 36); C procedures to control hemorrhage (see page 36); C miscellaneous post-operative complication diagnoses (persistent post-operative fistula, air embolism due to a procedure, transfusion reaction, and other coded complications of medical care [see page 36]); C iatrogenic complication diagnoses (surgical complication or late amputation complication [see page 36]); C shock due to anesthesia (see page 37); or C sentinel event diagnoses (accidental operative laceration, post-operative wound disruption, foreign body left during procedure, reaction to foreign substance accidentally left during procedure, or ABO or rh incompatibility [see page 37]) in any secondary diagnosis or procedure. Population at risk All discharges. 5 Outcomes Complications Among Surgical Patients Indicator Pulmonary compromise after major surgery Relationship to quality Although patients who receive general anesthesia are at risk for subsequent pulmonary complications, meticulous post- operative care should prevent most such occurrences. This indicator is part of the Complications Screening Program2,3 and identifies diagnoses or procedures that suggest a possible complication resulting from treatment in the hospital. It is presumed that patients with these cardiorespiratory conditions on admission will not receive surgery immediately after admission. Thus, if one of these conditions is coded and surgery occurs early in the hospitalization, it is very likely that the condition occurred as a complication of treatment. Benchmark State, regional, or peer group average. Method: Quality measure Number of complications per 100 procedures. Standardized rate. Outcome of interest Post-operative discharges with pulmonary congestion, lung edema, or respiratory insufficiency or failure in any secondary diagnosis (see page 37). Population at risk All non-maternal/non-neonatal discharges age 18 years or older with major surgery (see page 50, 52) on day 1 or 2 of admission. Exclude discharges in MDC 4 (respiratory) or MDC 5 (cardiovascular). Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates). 6 Outcomes Complications Among Surgical Patients Indicator Acute myocardial infarction after major surgery Relationship to quality The risk of surgery-related myocardial infarction increases for patients with existing cardiac conditions, age greater than 70 years, and poor medical condition.4 Myocardial infarction after surgery may indicate that patients were inadequately screened prior to surgery or that they experienced substandard care during or following surgery. This indicator is part of the Complications Screening Program2,3 and identifies diagnoses or procedures that suggest a possible complication resulting from treatment in the hospital. It is presumed that patients with these cardiorespiratory conditions on admission will not receive surgery immediately after admission. Thus, if one of these conditions is coded and surgery occurs early in the hospitalization, it is very likely that the condition occurred as a complication of treatment. Benchmark State, regional, or peer group average. Method: Quality measure Number of complications per 100 procedures. Standardized rate. Outcome of interest Post-operative discharges with acute myocardial infarction in any secondary diagnosis (see page 37). Population at risk All non-maternal/non-neonatal discharges age 18 years or older with major surgery (see page 50, 52) on day 1 or 2 of admission. Exclude discharges in MDC 5 (cardiovascular). Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates). 7 Outcomes Complications Among Surgical Patients Indicator Gastrointestinal hemorrhage or ulceration after major surgery Relationship to quality Irritation to the lining of the stomach or duodenum can occur in surgical patients as a result of medications, excessive secretion of gastric acid, and other factors. Gastrointestinal hemorrhage or ulceration can be prevented under most circumstances through prophylactic use of medication that coats the stomach lining or that inhibits the secretion of gastric acid. This indicator is part of the Complications Screening Program2,3 and identifies diagnoses or procedures that suggest a possible complication resulting from treatment in the hospital. Patients with hemorrhage or ulceration on admission normally will not receive surgery immediately after admission. Thus, if one of these conditions is coded and surgery occurs early in the hospitalization, it is very likely that the condition occurred as a complication of treatment. Benchmark State, regional, or peer group average. Method: Quality measure Number of complications per 100 procedures. Standardized rate. Outcome of interest Post-operative discharges with gastrointestinal hemorrhage or ulceration in any secondary diagnosis (see page 37). Population at risk All non-maternal/non-neonatal discharges age 18 years or older with major surgery (see page 50, 52) on day 1 or 2 of admission. Exclude discharges in
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