National Healthcare Quality & National Healthcare Disparities Reports: Measure Specification Appendix, 2013

Measures

Hospitalized adult patients who have an adverse event associated with the anticoagulant warfarin
Hospitalized adult patients who have an adverse event associated with intravenous (IV) heparin
Hospitalized adult patients who have an adverse event associated with low-molecular-weight heparin (LMWH) or factor Xa inhibitor
Hospitalized adult patients who have an adverse event associated with a hypoglycemic agent
 

Measure Title

Hospitalized adult patients who have an adverse event associated with the anticoagulant warfarin

Measure Source

The Medicare Patient Safety Monitoring System (MPSMS)

Table Description

Geographic Representation

National

Years Available

2009-2011

Population Subgroups

Age, CHF/pulmonary edema, COPD, cerebrovascular disease, coronary artery disease, corticosteroids, diabetes, gender, obesity, race/ethnicity, renal disease, smoking

Data Sources

CMS Inpatient Quality Reporting (IQR) Program, formerly referred to as the CMS Reporting Hospital Quality Data for Annual Payment Update Program (RHQDAPU), MPSMS

Denominator

All patients from the MPSMS sample who received warfarin during hospitalization and had a documented international normalized ratio (INR) result during the index hospital stay

Numerator

A 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

Not included in this measure are the following:

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

MPSMS data are abstracted from the medical record for the index hospital stays. In 2009, the lead agency for MPSMS transitioned from the Centers for Medicare & Medicaid Services (CMS) to the Agency for Healthcare Research and Quality (AHRQ).

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Measure Title

Hospitalized adult patients who have an adverse event associated with intravenous (IV) heparin

Measure Source

The Medicare Patient Safety Monitoring System (MPSMS)

Table Description

Geographic Representation

National

Years Available

2009-2011

Population Subgroups

Age, CHF/pulmonary edema, COPD, cerebrovascular disease, coronary artery disease, corticosteroids, diabetes, gender, obesity, race/ethnicity, renal disease, smoking

Data Source

CMS Inpatient Quality Reporting (IQR) Program formerly referred to as the CMS Reporting Hospital Quality Data for Annual Payment Update Program (RHQDAPU), MPSMS

Denominator

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

Numerator

A 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

Not included are PTTs ≥100, PTTs >45, and an abrupt cessation/hold of IV heparin, 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.

MPSMS data are abstracted from the medical record for the index hospital stays. In 2009, the lead agency for MPSMS transitioned from the Centers for Medicare & Medicaid Services (CMS) to the Agency for Healthcare Research and Quality (AHRQ).

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Measure Title

Hospitalized adult patients who have an adverse event associated with low-molecular-weight heparin (LMWH) or factor Xa inhibitor

Measure Source

The Medicare Patient Safety Monitoring System (MPSMS)

Table Description

Geographic Representation

National

Years Available

2009-2011

Population Subgroups

Age, CHF/pulmonary edema, COPD, cerebrovascular disease, coronary artery disease, corticosteroids, diabetes, gender, obesity, race/ethnicity, renal disease, smoking

Data Source

CMS Inpatient Quality Reporting (IQR) Program, formerly referred to as the CMS Reporting Hospital Quality Data for Annual Payment Update Program (RHQDAPU), MPSMS

Denominator

All patients from the MPSMS sample who received LMWH or factor Xa inhibitor during the index hospital stay

Numerator:

A 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 three or more points more than forty eight hours after admission, intracranial bleeding (subdural hematoma), new hematoma, other types of bleeding, or pulmonary bleeding.
• Administration of vitamin K or fresh frozen plasma (FFP) with one or more of the above symptoms.
• Blood transfusion (absent a surgical procedure) with one or more of the above symptoms.

Comments

Not counted in this measure are abrupt cessation/holds of LMWH or factor Xa, administration of Vitamin K or FFP, and blood transfusions (absent a surgical procedure) that occur on the date of arrival.

MPSMS data are abstracted from the medical record for the index hospital stays.

In 2009, the lead agency for MPSMS transitioned from the Centers for Medicare & Medicaid Services (CMS) to the Agency for Healthcare Research and Quality (AHRQ).

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Measure Title

Hospitalized adult patients who have an adverse event associated with a hypoglycemic agent

Measure Source

The Medicare Patient Safety Monitoring System (MPSMS)

Table Description

Geographic Representation

National

Years Available

2009-2011

Population Subgroups

Age, CHF/pulmonary edema, COPD, cerebrovascular disease, coronary artery disease, corticosteroids, diabetes, gender, obesity, race/ethnicity, renal disease, smoking

Data Source

CMS Inpatient Quality Reporting (IQR) Program, formerly referred to as the CMS Reporting Hospital Quality Data for Annual Payment Update Program (RHQDAPU), MPSMS

Denominator

All patients from the MPSMS sample who received insulin, oral hypoglycemics, or both, and had glucose result during the hospital stay

Numerator

A 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 data are abstracted from the medical record for the index hospital stays.

In 2009, the lead agency for MPSMS transitioned from the Centers for Medicare & Medicaid Services (CMS) to the Agency for Healthcare Research and Quality (AHRQ).

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