Methods Applying AHRQ Quality Indicators to Healthcare ... - HCUP

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"clinical grouper" makes it easier to quickly understand patterns of diagnoses andprocedures. The target CCS for CHF was 108; the target CCS for asthma was128; the target CCS for asthma/COPD was 127 or 128; the target for pneumoniawas 122; and the target for AMI was 100.Discharged alive.Not a combined transfer record.For the CHF analysis, there was a fourth criterion that excluded records with hearttransplant procedures (any ICD-9-CM procedure code in the range 37.51-37.54).All discharges with non-missing patient discharge status were retained for the selectedpatients. A patient was allowed to have multiple index admissions, if they occurred morethan 30 days apart.5. Readmissions: This analysis considered readmissions within 30 days of an indexadmission (defined above). The 30-day window was defined from the end of the firstevent (discharge date) to the beginning of the second event (admission date). Thereadmission could occur at any hospital and was not limited to the hospital of the indexadmission. Readmissions may be discharged in January to December 2008, include apatient discharge status of “died”, and be combined transfer records. Three types ofreadmissions were evaluated for inclusion in the NHQR:Readmissions based on same principal diagnosis: If within 30 days of anindex admission, there was a discharge record for the same person with thesame principal diagnosis CCS, using the CCS categories noted above.Readmissions based on same diagnosis: If within 30 days of an indexadmission, there was a discharge record for the same person with the same CCSas a principal or secondary diagnosis. This type of readmission uses the sameCCS categories identified above.Readmissions for any diagnosis: If within 30 days of an index admission, therewas a discharge record for the same person, regardless of the principal orsecondary diagnosis.For the analysis we looked at both readmission rates and cost using the following methodology:Readmission Rates. Readmission rates were calculated as the percentage of index eventswith at least one readmission by reporting category: age (18-64, 65+), gender,race/ethnicity, and income quartile.Costs. The HCUP databases include information on total hospital charges. Using HCUPhospital-level cost-to-charge ratios based on hospital accounting reports from the Centersfor Medicare and Medicaid Services, 10 total charges are converted to costs. Costs will tendto reflect the actual costs of production, while charges represent what the hospital billed forthe stay. Hospital charges reflect the amount the hospital charged for the entire hospitalstay and does not include professional (physician) fees. The total and average cost was10 HCUP Cost-to-Charge Ratio Files (CCR). Healthcare Cost and Utilization Project (HCUP). August2011. U.S. Agency for Healthcare Research and Quality, Rockville, MD. www.hcupus.ahrq.gov/db/state/costtocharge.jsp.Methods for HCUP Data in 2011 NHQR and NHDR F-2December 9, 2011
calculated for the index events and readmissions by reporting category. The total andaverage cost for readmissions includes all readmissions within 30 days of the index event.Statistical Methods. No risk adjustment was made to the readmission rates or costs.Rates and costs are stratified by two age groups – 18-64 and 65 and older. Estimates wereincluded in this analysis if they reached a threshold defined by a relative standard error lessthan 30% and at least 10 cases in the denominator. Estimates that did not satisfy thesecriteria were set to missing.Methods for HCUP Data in 2011 NHQR and NHDR F-3December 9, 2011
Page 1: HCUP Methods Series
Page 6 and 7: Assign Additional Measures for Repo
Page 8 and 9: For the discharge-based PDIs, risk
Page 10 and 11: Data Elements for Exclusions: Three
Page 12 and 13: In a subsequent analysis, we invest
Page 17 and 18: QI No.IQI 22IQI 23IQI 24IQI 25IQI 2
Page 19 and 20: QI No.PSI 19PSI 21PSI 22PSI 23PSI 2
Page 21 and 22: Data Sources for the HCUP Nationwid
Page 23 and 24: Table 4. Use of Secondary Procedure
Page 25: Table 6. Number of Diagnosis and Pr
Page 28 and 29: APPENDICES
Page 30 and 31: HCUP Race DataHCUP coding includes
Page 32 and 33: Primary expected payer2008 Disparit
Page 34 and 35: Median income of Patient’s ZIP Co
Page 36 and 37: Typically, most States have no more
Page 38 and 39: . Standard error estimates for age/
Page 40 and 41: inpatient population distribution f
Page 42 and 43: IQI CompositeWeightNHQR/NHDRSummary
Page 44 and 45: APPENDIX E:COMPARISON OF INPATIENT
Page 46 and 47: Table E-1. List of PQIs and PDIs Us
Page 50 and 51: APPENDIX G:STATE-LEVEL BIVARIATE AN
Page 52 and 53: AHRQPreventionQualityIndicators(PQI
Page 54 and 55: AHRQPreventionQualityIndicators(PQI
Page 56 and 57: APPENDIX H:PATIENT SAFETY IN HOSPIT

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