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

Measures

Postoperative sepsis per 1,000 elective surgical hospital discharges of 4 or more days
Hospitalized patients who develop catheter-associated urinary tract infections (CAUTIs)
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
 

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Measure Title

Postoperative septicemia 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)

Table Description

Geographic Representation

National, State

Years Available

State: 2008-2010

National: 2008-2012

Population Subgroups

Age, bed size (hospital), gender, health insurance, geographic location (hospital and residence), income, ownership of hospital, region, teaching status of hospital

Data Sources

State

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

National

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

Denominator

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

Numerator

Subset of the denominator with any secondary diagnosis of sepsis

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 multistate 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 37 States: AK, AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, IN, KS, KY, MA, MD, MI, MO, MS, NC, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, and WY.

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Measure Title

Hospitalized patients who develop catheter-associated urinary tract infections (CAUTIs)

Measure Source

The Medicare Patient Safety Monitoring System (MPSMS): 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).

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, MPSMS

Denominator

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

Numerator

A subset of the denominator with the diagnosis and treatment of a catheter-associated urinary tract infection

Comments

Beginning with the 2004 MPSMS data, the "Post-operative UTI" measure was discontinued, and the "Catheter-Associated Urinary Tract Infection" measure was implemented in its place.

MPSMS data are abstracted from the medical record for the index hospital stay. Beginning with the 2009 MPSMS data, Medicare Eligibility and National Claims History databases were no longer applicable or available for the MPSMS sample.

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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)

Table Description

Geographic Representation

National

Years Available

2008-2010

Population Subgroups

Age, bed size (hospital), gender, health insurance, geographic location (hospital and residence), income, ownership of hospital, region, teaching status of hospital

Data Source

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

Denominator

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

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).

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 multistate 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.

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