Adding Clinical Data to Administrative Data

Transcription

1 Virginia Health Information VHI AHRQ Pilot Project Adding Clinical Data to Administrative Data Results (1Q and 2Q 2008 discharges)

2 Summary Thanks to your hard work, VHI is pleased to report on two full quarters of Present on Admission (POA) enhanced hospital discharge data collected for the VHI AHRQ Pilot Project called Adding Clinical Data to Administrative Data. Since the project began, VHI has collected POA indicators on more than 300,000 hospital discharges from 27 hospitals in Virginia. The current report, covering 1Q and 2Q 2008 discharges, contains updates to several tables included in last quarter s version: Tables 1/3: Tables 2/4: Tables 5/6: Tables 7/8: These tables can be used for examining the overall distribution of POA reporting in the principal/secondary diagnoses fields. These tables can be used for looking at the distribution of principal/secondary diagnoses that should have been coded as Exempt but were not and which POA codes, if any, were found in lieu of a 1 or E. Ranks the Top 50 diagnoses Not Present on Admission (N) in the primary and secondary diagnoses fields. Ranks the Top 50 diagnoses Exempt from POA Reporting (1 or E) in the primary/secondary diagnoses fields. Table 9 gives a POA indicator breakdown of the potential Hospital Acquired Conditions as defined by CMS. Please note that this quarter s report reflects changes to the list of potential HACs made by CMS in October 2008 and now includes an new page specific to your hospital(s). For more information on these conditions, please see In addition, VHI has added several new tables to the report. As promised, we have generated an aggregate report of the AHRQ Patient Safety Indicators (PSIs, Table 10) showing the impact to the numerator, denominator, and observed rates in these indicators when POA data is made available. The same table (Table 11), using information specific to your hospital(s), is also available. You can use these tables to get a sense of how your hospital(s) compares to the others in the pilot project. These tables were created by joining the 17 diagnoses fields and POA indicators submitted for the pilot with the other necessary data elements found in each hospitals administrative data submission. These tables are not risk adjusted because the populations used for comparison by the software are different when POA indicators are included. I hope that you will find Table 12 useful. It compares PSI rates in Virginia to the National Inpatient Sample (2006) and a Veteran s Administration Sample ( ). Although Virginia s data is not risk adjusted, the values will give you some sense of how PSI rates in Virginia compare to other sources. These rates will, of course, become more reliable as we continue to receive more data.

3 Similarly, we have also included an aggregate (Table 13) and hospital level report (Table 14) for the AHRQ Inpatient Quality Indicators (IQIs). POA testing showed almost no impact to the IQIs so a pre POA and post POA comparison is not provided. These reports were generated using your pilot data. VHI continues to receive and process the laboratory files. Data collection for this phase of the project is not yet as complete as the POA component. As we move into the last six months of this project, VHI remains committed to providing you with useful information from the data that you have submitted. Please let me know if you would like to see modifications or additions to the information found in this report. As always, I will continue to work with you one on one as needed and thank you for your ongoing commitment to this project! Chris Delcher

4 VHI-AHRQ Pilot Project POA Distribution by Hospital, for PRINCIPAL DIAGNOSIS ONLY, NON-EXEMPT CONDITIONS Participating Hospital Discharges (1Q and 2Q 2008) Table 1. All A. Present on Admission ("Y") B. Not present on Admission ("N") C. Insufficient ("U") D. Clinically Undetermined ("W") HOSPITAL KEY n % n % n % n % N Hospital 1 13, ,297 Hospital 2 5, ,306 Hospital 3 2, ,760 Hospital 4 14, ,921 Hospital 5 1, ,612 Hospital 6 2, ,645 Hospital 7 1, ,215 Hospital 8 6, ,726 Hospital 9 10, ,856 Hospital 10 5, ,655 Hospital 11 8, ,612 Hospital 12 13, ,212 Hospital 13 1, ,802 Hospital 14 4, ,055 Hospital 15 4, ,407 Hospital 16 6, ,795 Hospital 17 7, ,839 Hospital 18 2, ,840 Hospital 19 3, ,671 Hospital 20 1, ,422 Hospital 21 4, ,273 Hospital 22 2, ,331 Hospital 23 11, ,906 Hospital 24 6, ,050 Hospital 25 10, ,174 Hospital 26 1, ,161 Hospital 27 5, ,122 All 161, , ,665

5 A. Exempt (1 or E) VHI-AHRQ Pilot Project POA Distribution by Hospital, PRINCIPAL DIAGNOSIS ONLY, Exempt/Missing Conditions Participating Hospital Discharges (1Q and 2Q 2008) B. Exempt(but missing POA) C. Exempt(but coded "N") Table 2. D. Exempt(but coded "Y") E. Exempt(but coded "W") F. Exempt(but coded "U") G. Missing HOSPITAL KEY n % n % n % n % n % n % n % N Hospital 1 1, ,632 Hospital 2 1, ,037 Hospital Hospital 4 1, ,498 Hospital Hospital Hospital Hospital 8.. 1, ,867 Hospital 9 1, ,563 Hospital Hospital 11 1, ,861 Hospital 12 1, ,999 Hospital Hospital ,153 Hospital 15 1, ,573 Hospital ,049 Hospital , , ,149 Hospital Hospital Hospital Hospital Hospital Hospital , ,992 Hospital Hospital 25 8, ,599 Hospital Hospital All 22, , , ,593 Column A: For this project, VHI accepts the use of the 1 or the E to indicate "Exempt" from POA reporting. Column B-F: Describes diagnoses that should have be coded as "Exempt" (with details on the actual indicator found) according to "ICD-9-CM Official Guidelines for Coding and Reporting". These columns are not Column G: Missing can mean that either the entire diagnosis (ICD9 code) is missing or just the POA indicator is missing. % shown are calcualted by row All

6 VHI-AHRQ Pilot Project POA Distribution by Hospital, Secondary Diagnoses (2 thru 9), Non-Exempt Conditions Participating Hospital Discharges (1Q and 2Q 2008) Table 3. All A. Present on Admission B. Not present on Admission C. Insufficient D. Clinically Undetermined ("Y") ("N") ("U") ("W") HOSPITAL KEY n % n % n % n % N Hospital 1 68, , ,042 Hospital 2 32, , ,620 Hospital 3 14, , ,603 Hospital 4 64, , ,213 Hospital 5 6, ,917 Hospital 6 13, , ,004 Hospital 7 7, ,311 Hospital 8 36, , ,126 Hospital 9 47, , ,132 Hospital 10 27, , ,125 Hospital 11 40, , ,767 Hospital 12 60, , ,523 Hospital 13 10, ,431 Hospital 14 35, , ,873 Hospital 15 22, , ,876 Hospital 16 35, , ,848 Hospital 17 51, , ,227 Hospital 18 16, , ,945 Hospital 19 18, , ,103 Hospital 20 8, ,028 Hospital 21 20, , ,852 Hospital 22 10, , ,928 Hospital 23 62, , ,755 Hospital 24 35, , ,873 Hospital 25 56, , ,892 Hospital 26 1, ,144 Hospital 27 25, , ,158 All 832, , , ,316

7 A. Exempt (1 or E) VHI-AHRQ Pilot Project POA Distribution by Hospital, Secondary Diagnoses (2 thru 9), Exempt/Missing Conditions Participating Hospital Discharges (1Q and 2Q 2008) B. Exempt(but missing POA) C. Exempt(but coded "N") Table 4. D. Exempt(but coded "Y") E. Exempt(but coded "W") F. Exempt(but coded "U") G. Missing HOSPITAL KEY n % n % n % n % n % n % n % N Hospital 1 18, , ,390 Hospital 2 9, , ,124 Hospital 3 1, , ,557 Hospital 4 11, , ,139 Hospital 5 1, , ,003 Hospital 6 2, , ,836 Hospital , ,313 Hospital 8.. 4, , ,618 Hospital 9 15, , ,220 Hospital , , ,963 Hospital 11 8, , ,017 Hospital 12 11, , ,165 Hospital 13 1, , ,481 Hospital 14 9, , ,791 Hospital 15 5, , ,964 Hospital , , ,904 Hospital , , , ,677 Hospital , , ,119 Hospital , , ,353 Hospital , ,388 Hospital 21 6, , ,676 Hospital 22 2, , ,800 Hospital , , ,429 Hospital 24 7, , ,303 Hospital 25 46, , ,292 Hospital , ,144 Hospital , , ,082 All 161, , , , ,748 Column A: For this project, VHI accepts the use of the 1 or the E to indicate "Exempt" from POA reporting. Column B-F: Describes diagnoses that should have be coded as "Exempt" (with details on the actual indicator found) according to "ICD-9-CM Official Guidelines for Coding and Reporting". These columns are not necessarily errors but may reflect diffences in coding conventions. For the this project, VHI is requesting that "Exempt" ICD9 be coded with "1 or E" to avoid confusion. Column G: Missing can mean that either the entire diagnosis (ICD9 code) is missing or just the POA indicator is missing. % shown are calcualted by row All

8 VHI-AHRQ Pilot Project Top 50 Diagnoses NOT PRESENT ON ADMISSION Participating Hospital Discharges (1Q and 2Q 2008) Table 5. Top 50 Diagnoses NOT PRESENT ON ADMISSION in the principal diagnosis Table 6. Top 50 Diagnoses NOT PRESENT ON ADMISSION in the secondary diagnoses (2 thru 9) Rank ICD-9 Code Description Count Rank ICD-9 Code Description Count DEL W 2 DEG LACERAT-DEL AC POSTHEMORRHAG ANEMIA DEL W 1 DEG LACERAT-DEL URIN TRACT INFECTION NOS ABN FTL HRT RATE/RHY-DEL ACUTE RENAL FAILURE NOS CORD ENTANGLE NEC-DELIV FETAL/NEONATAL JAUND NOS SEC UTERINE INERT-DELIV HYPOPOTASSEMIA DEL W 3 DEG LACERAT-DEL ACUTE RESPIRATRY FAILURE PRIM UTERINE INERT-DELIV PULMONARY COLLAPSE OB PERINEAL TRAU NEC-DEL ANEMIA NOS UTERINE INERT NEC-DELIV PNEUMONIA FORCEP DELIV NOS-DELIVER PARALYTIC ILEUS HIGH VAGINAL LACER-DELIV HYPOSMOLALITY SHOULDER DYSTOCIA-DELIV CORD ENTANGLE NEC-DELIV PRECIPITATE LABOR-DELIV DEL W 2 DEG LACERAT-DEL CORD AROUND NECK-DELIVER ACIDOSIS COMP LAB/DELIV NEC-DELIV ABN FTL HRT RATE/RHY-DEL FETOPELV DISPROPOR-DELIV* POST TRAUM PULM INSUFFIC FAIL INDUCTION NOS-DELIV HYPOTENSION NOS FET/PLAC PROB NEC-DELIV DEL W 1 DEG LACERAT-DEL PREV C-DELIVERY-DELIVRD PLEURAL EFFUSION NOS OBSTRUC/FET MALPOS-DELIV SEPTICEMIA NOS DEL W 4 DEG LACERAT-DEL CONSTIPATION NOS CORD COMPRESS NEC-DELIV PAROX VENTRIC TACHYCARD BONY PELV OBSTRUCT-DELIV* PROTEIN-CAL MALNUTR NOS FETAL DISTRESS-DELIVERED FOOD/VOMIT PNEUMONITIS HIGH HEAD AT TERM-DELIV* CARDIAC DYSRHYTHMIAS NEC PROLONG 2ND STAGE-DELIV HYPEROSMOLALITY PREM SEPAR PLACEN-DELIV SURG COMP-DIGESTV SYSTEM EARLY ONSET DELIVERY-DEL THRUSH PERSIST OCCIPTPOST-DELIV* ATRIAL FIBRILLATION CORD PROLAPSE-DELIVERED ANEMIA-DELIVERED W P/P POSTPA HEM NEC-DEL W P/P DIS MAGNESIUM METABOLISM ACUTE & CHRONC RESP FAIL* SEVERE SEPSIS ACUTE RESPIRATRY FAILURE* SURG COMPL-HEART ANEMIA-DELIVERED W P/P ACCIDENTAL OP LACERATION SEPTICEMIA NOS* SEPSIS SEVERE PREECLAMP-DELIVER RETENTION URINE NOS BREECH PRESENTAT-DELIVER IATROGENC HYPOTNSION NEC DMII OTH UNCNTRLD HEMORRHAGE COMPLIC PROC CRNRY ATHRSCL NATVE VSSL* SUBENDO INFARCT POST TERM PREG-DEL* NEONAT JAUND PRETERM DEL RH ISOIMMUNIZAT-DELIVER SURG COMPLIC-RESPIR SYST PYREXIA IN LABOR-DELIVER HEMATOMA COMPLIC PROC DMII NEURO UNCNTRLD THROMBOCYTOPENIA NOS MALPOSITION NEC-DELIVER TACHYCARDIA NOS SUBENDO INFARCT* INT INF CLSTRDIUM DFCILE OTH CURR COND-DELIVERED* FEVER ELDERLY MULTIGRAVIDA-DEL NAUSEA ALONE ANEMIA-DELIVERED HYPOXEMIA ACUTE RENAL FAILURE NOS* DEHYDRATION OB PERINEAL LAC NOS-DEL ATRIAL FLUTTER 394 * This condition may be inconsistent with the definition of a principal diagnosis or POA coding guidelines.

9 VHI-AHRQ Pilot Project Top 50 Diagnoses EXEMPT FROM POA REPORTING Participating Hospital Discharges (1Q and 2Q 2008) Table 7. Top 50 Diagnoses EXEMPT FROM POA REPORTING in the principal diagnosis Table 8. Top 50 Diagnoses EXEMPT FROM POA REPORTING in secondary diagnoses (2 thru 9) Rank ICD-9 Code Description Count Rank ICD-9 Code Description Count 1 V3000 SINGLE LB IN-HOSP W/O CS 8,420 1 V270 DELIVER-SINGLE LIVEBORN 14,239 2 V3001 SINGLE LB IN-HOSP W CS 4,580 2 V053 NEED PRPHYL VC VRL HEPAT 8,417 3 V5789 REHABILITATION PROC NEC 1,020 3 V1582 HISTORY OF TOBACCO USE 6, NORMAL DELIVERY OLD MYOCARDIAL INFARCT 4,122 5 V5811 ANTINEOPLASTIC CHEMO ENC V140 HX-PENICILLIN ALLERGY 4,058 6 V3101 TWIN-MATE LB-IN HOS W CS V4581 AORTOCORONARY BYPASS 3, CRNRY ATHRSCL NATVE VSSL V5867 LONG-TERM USE OF INSULIN 3, PREV C-DELIVERY-DELIVRD V5866 LONG-TERM USE OF ASPIRIN 3, DEL W 1 DEG LACERAT-DEL V4582 STATUS-POST PTCA 2, CHEST PAIN NEC V7219 EXAM EARS & HEARING NEC 2, SUBENDO INFARCT V0251 GROUP B STREPTOC CARRIER 2, V571 PHYSICAL THERAPY NEC V1254 HX TIA/STROKE W/O RESID 2, V3100 TWIN-MATE LB-HOSP W/O CS V5861 LONG-TERM USE ANTICOAGUL 2, V553 ATTEN TO COLOSTOMY V6284 SUICIDAL IDEATION 2, ABN FTL HRT RATE/RHY-DEL V173 FAM HX-ISCHEM HEART DIS 2, DEL W 2 DEG LACERAT-DEL V142 HX-SULFONAMIDES ALLERGY 1, PNEUMONIA V145 HX-NARCOTIC ALLERGY 1, EARLY ONSET DELIVERY-DEL V148 HX-DRUG ALLERGY NEC 1, LOC OSTEOARTH NOS-L/LEG V1581 HX OF PAST NONCOMPLIANCE 1, CORD ENTANGLE NEC-DELIV V290 NB OBSRV SUSPCT INFECT 1, OTH CURR COND-DELIVERED V1251 HX-VEN THROMBOSIS/EMBOLS 1, RECURR DEPR PSYCHOS-UNSP V667 ENCOUNTR PALLIATIVE CARE 1, THRT PREM LABOR-ANTEPART V4365 JOINT REPLACED KNEE 1, V552 ATTEN TO ILEOSTOMY V4589 POST-PROC STATES NEC 1, DMI KETOACD UNCONTROLD HYPERTENSION NOS 1, AMI INFERIOR WALL V103 HX OF BREAST MALIGNANCY 1, MORBID OBESITY V146 HX-ANALGESIC ALLERGY 1, AMI ANTERIOR WALL V4577 ACQ ABSNCE GENITAL ORGAN 1, LATE EFFECT CV DIS NEC LATE EF-HEMPLGA SIDE NOS 1, CRBL ART OCL NOS W INFRC TOBACCO USE DISORDER 1, RECUR DEPR PSYCH-SEVERE V4579 ACQ ABSENCE OF ORGAN NEC 1, ATRIAL FIBRILLATION V4501 STATUS CARDIAC PACEMAKER 1, ACUTE PANCREATITIS V0382 ND VAC STRPTCS PNEUMNI B 1, SYNCOPE AND COLLAPSE V4364 JOINT REPLACED HIP 1, ASTHMA NOS W (AC) EXAC V1749 FAM HX-CARDIOVAS DIS NEC 1, OBS CHR BRONC W(AC) EXAC V854 BMI 40 AND OVER 1, POST TERM PREG-DEL V180 FAM HX-DIABETES MELLITUS 1, LOC OSTEOARTH NOS-PELVIS V462 DEPEND-SUPPLEMENT OXYGEN 1, DEHYDRATION V141 HX-ANTIBIOT ALLERGY NEC BIPOL I CUR DEPRES NOS V1046 HX-PROSTATIC MALIGNANCY ABN GLUCOSE TOLER-DELIV V252 STERILIZATION ELDERLY MULTIGRAVIDA-DEL V143 HX-ANTI-INFECT ALLERGY DRUG-INDUCED MOOD DISORD E8490 ACCIDENT IN HOME LUMBAR DISC DISPLACEMENT V1005 HX OF COLONIC MALIGNANCY ACUTE APPENDICITIS NOS V4586 BARIATRIC SURGERY STATUS OCL CRTD ART WO INFRCT HYPERLIPIDEMIA NEC/NOS ACUTE RESPIRATRY FAILURE V1301 PRSNL HST URNR DSRD CALC SEVERE PREECLAMP-DELIVER V237 INSUFFICNT PRENATAL CARE TOBACCO USE DISOR-DELLIV V433 HEART VALVE REPLAC NEC DEPRESSIVE DISORDER NEC V451 RENAL DIALYSIS STATUS 610 The full list of ICD9 codes exempt from POA reporting can be found in "ICD-9-CM Official Guidelines for Coding and Reporting"

10 Table 9. Potentially Hospital Acquired Conditions (HACs) All Diagnoses (1 thru 17) All Parcipating Hospital Discharges (1Q and 2Q 2008) N (Not Present on Admission) POA INDICATOR U (Insufficient Documentation) All HAC Category ICD9 Code ICD9 DESCRIPTION Count Count N DMII KETOACD UNCONTROLD DMI KETOACD UNCONTROLD Manifestations of Poor Glycemic Control DMII HPRSM NT ST UNCNTRL DMII HPROSMLR UNCONTROLD HYPOGLYCEMIC COMA CLOS SKULL BASE FRACTURE CL SKL BASE FX/MENIN HEM NASAL BONE FX CLOSED FX C4 VERTEBRA CLOSED FX C5 VERTEBRA CLOSED FX DORSAL VERTEBRA CLOSE FX LUMBAR VERTEBRA CLOSE FX SACRUM/COCCYX CLOSED T7 T12 FX CL/CRD INJ NOS FRACTURE ONE RIB CLOSED FRACTURE TWO RIBS CLOSED FX MULT RIBS NOS CLOSED FRACTURE ACETABULUM CLOS FRACTURE OF PUBIS CLOSED PELVIC FRACTURE NOS CLOS FX CLAVICLE NOS CLOSED FX CLAVICL FX UP END HUMERUS NOS CL FX SURG NCK HUMERUS CLOS FX GR TUBEROS HUMERUS CL FX HUMERUS NOS CLOSED 1. 1 Falls and Trauma Fracture FX HUMERUS SHAFT CLOSED FX LOWER HUMERUS NOS CL FX OLECRAN PROC ULNA CL FX DISTAL RADIUS NEC CL FX LOW RADIUS W ULNA CL FX CARPAL BONE NOS CLOSE FX 1ST METACARP BASE CL FX DIST PHALANX FX FEMUR INTRCAPS NEC CLCL TROCHANTERIC FX NOS CLOS INTERTROCHANTERIC FX CL FX NECK OF FEMUR NOS CL FX FEMUR NOS CLOSED FX FEMUR SHAFT CLOSED FX LOW END FEMUR NOS CL FX FEMORAL CONDYLE CLOSE FX LOW END FEMUR NEC CL FRACTURE PATELLA CLOSED FX UPPER END TIBIA CLOSE FX LATERAL MALLEOLUS CL FX ANKLE NOS CLOSED FX METATARSAL CLOSED FX PHALANX DISLOCATION JAW CLOSED DISLOC ACROMIOCLAVIC CL DISL FINGER NOS CLOSED DISLOCAT HIP NOS CLOSED 1. 1 Falls and Trauma Dislocation POSTERIOR DISLOC HIP CL TEAR MED MENISC KNEE CUR TEAR LAT MENISC KNEE CUR TEAR MENISCUS NEC CURREN DISLOCAT SACRUM CLOSED CONCUS BRIEF COMA <31 MN BRAIN LACER NEC W/O COMA BRAIN LAC NEC DEEP COMA TRAUM SUBARACHNOID HEM 2. 2 Falls and Trauma Intracranial Injury SUBARACHNOID HEM NO COMA TRAUMATIC SUBDURAL HEM SUBDURAL HEM W/O COMA SUBDURAL HEMORR COMA NOS BRAIN HEM NEC W/O COMA ST DEG BURN ABDOMN WALL ND DEG BURN BREAST ND DEG BURN GENITALIA 1. 1 Falls and Trauma Burn ST DEG BURN FOREARM ND DEG BURN HAND NOS ND DEG BURN FOOT BDY BRN < 10%/3D DEG NOS HYPOTHERMIA Falls and Trauma Electric Shock 9946 MOTION SICKNESS ASPHYXIATION/STRANGULAT 1. 1 Catheter Associated Urinary Tract Infection (UTI) REACT INDWELL URIN CATH Foreign Object Retained After Surgery 9984 FB LEFT DURING PROCEDURE 5. 5 Air Embolism 9991 AIR EMBOL COMP MED CARE 2. 2 Vascular Catheter Associated Infection INFECT D/T CENT VEN CATH Blood Incompatibility 9996 ABO INCOMPATIBILITY REAC 1. 1 All

11 Indicator Pre-POA* Post-POA** Number Indicator Name Count Count Min Max AHRQ - Hospital Patient Safety Indicators (PSI) Printing Date 4/3/2009 1Q08 and 2Q08 Aggregated Data of 27 Pilot Hospitals Numerator Denominator Rate Pre-POA Post-POA Count Count Min Max Pre-POA Post-POA Rate Rate Min Max 1 Complications of anesthesia , Death in low mortality DRGs , Decubitus ulcer , Death among surgical inpatients w/serious treatable comp. 5 Foreign body left in during , procedure, secondary DX field 6 Iatrogenic pneumothorax, secondary , DX field 7 Selected infections due to medical , care, secondary DX field 8 Post-operative hip fracture , Post-operative hemorrhage or , hematoma 10 Post-operative physiologic and , metabolic derangements 11 Post-operative respiratory failure , Post-operative pulmonary embolism , or deep vein thrombosis 13 Post-operative sepsis , Post-operative wound dehiscence , Accidental puncture or laceration, , secondary DX field 16 Transfusion reaction, secondary DX , field 17 Birth trauma- Injury to Neonate , Obstetric trauma vaginal delivery , with instrument 19 Obstetric trauma - vaginal delivery , without instrument 20 Obstetric trauma - cesarean section , Rates are per 1000 eligible discharges. Quality Indicators Version 3.2a/apr (09/25/2008) * Pre-POA - Quality Indicator results that DO NOT utilize present on admission information. ** Post-POA - Quality Indicator results that DO utilize present on admission information. The Min and Max give the range of Post-POA values submitted/calculated for each hospital. VIRGINIA HEALTH INFORMATION 102 N. 5th Street - Richmond VA Phone FAX

12 Table.12 Patient Safety Indicators (PSI) Comparison (1Q and 2Q 2008 Aggregated Data for 27 Pilot Hospitals) Virginia PRE- POA Virginia POST-POA National Inpatient Sample (2006) Veterans Administration Sample ( ) Indicator Number Indicator Description Obs Rate Obs Rate Risk Adj Rate Obs Rate Risk Adj Rate 1* Complications of anesthesia Death in low mortality DRGs Decubitus Ulcer Death among surgical inpatients w/serious treatable comp * Foreign body left in during procedure, secondary DX field** Iatrogenic pneumothorax, secondary DX field Selected Infections due to medical care, secondary DX field * Post-operative hip fracture Post-operative hemorrhage or hematoma Post-operative physiologic and metabolic derangements Post-operative respiratory failure Post-operative pulmonary embolism or deep vein thrombosis Post-operative sepsis * Post-operative wound dehiscence Accidental puncture or laceration, secondary DX field * Transfusion reaction, secondary DX field Birth trauma-injury to Neonate OB Trauma-vaginal delivery with instrument OB Trauma-vaginal delivery without instrument OB Trauma-cesarean section Source: Virginia Health Information AHRQ Shimada et al 2008 * Virginia's numerator <=30 ** Currently, the numerator/denominator for PSI 5 is 1 resulting in a rate of 1,000. See the aggregrate PSI report for the number of PSI 5 events.

13 AHRQ - Hospital Inpatient Quality Indicators (IQI) Aggregated Data of 27 Pilot Hospitals 1Q and 2Q 2008 Data Indicator Number Indicator Name Volume Indicator AHRQ Volume Thresholds Surgery Volume 1 Esophageal resection volume 6 and 7 procedures Pancreatic resection volume 10 and 11 procedures Abdominal aortic aneurysm repair (AAA) volume 10 and 32 procedures Coronary artery bypass graft (CABG) volume 100 and 200 procedures. 1,672 6 Percutaneous transluminal coronary angioplasty (PTCA) volume 200 and 400 procedures. 4,494 7 Carotid endarterectomy (CEA) volume 50 and 101 procedures. 568 Indicator Number Indicator Name Observed Numerator Observed Denominator Observed Rate* Expected Rate* O-E Ratio** Risk Adjusted Rate* Mortality Pancreatic resection mortality rate AAA repair mortality rate CABG mortality rate 42 1, Craniotomy mortality rate Hip replacement mortality rate 5 1, Acute myocardial infarction (AMI) mortality rate 234 3, Congestive heart failure (CHF) mortality rate 185 5, Acute stroke mortality rate 172 2, Gastrointestinal (GI) hemorrhage mortality rate 69 2, Hip fracture mortality rate 47 1, Pneumonia mortality rate PTCA mortality rate 69 4, CEA mortality rate AMI mortality rate - without transfers 193 2, Obstetrics Cesarean section delivery rate 5,726 17, VBAC rate - uncomplicated 315 3, Primary cesarean section delivery rate 3,027 14, Vaginal birth after Cesarean (VBAC) rate - all 366 3, Procedure Utilizaton Rates Laparoscopic cholecystectomy rate 1,123 1, Incidental appendectomy among the elderly rate 38 1, Bilateral cardiac catheterization rate 311 7, *Rates are per 100 eligible discharges. ** O-E Ratios (Observed to expected ratios) less than.80 are colored green, greater than 1.20 are colored red. Colors are for information only and do not necessarily represent statistically significant differences. VIRGINIA HEALTH INFORMATION 102 N. 5th Street RICHMOND, VA Phone FAX Date of Report: 4/7/2009