Utah Hospital Comparison Reports - Glossary of Terms

General Terms

Actual death percentage:
the actual number of deaths per 100 patients with a certain condition or procedure. Actual death percentage does not adjust for the hospital’s/facility's case mix. Other name: observed death rate per 100 patients. Some measures exclude transfer patients.
Actual Rate:
The actual rate is the number of events that occurred for every 100 patients for some indicators and for every 1,000 patients for other indicators. This rate is not risk-adjusted.
Agency for HealthCare Research and Quality (AHRQ):
a federal agency that develops indicators of patient safety and quality of care and engages in other related activities.
Allergic reaction:
swollen glands, trouble breathing and other body reactions that can be life threatening.
APR-DRG:
stands for All Patient Refined Diagnosis Related Group, which is software widely used in health services research. The APR-DRG software organizes about 20,000 clinical diagnoses and procedures into about 300 groups. Each APR-DRG has four levels for severity of illness. This report combines the Minor and Moderate levels and combines the Major and Extreme levels for the average hospital/facility charge tables. This report uses APR-DRG version 20.0. Read more at http://solutions.3m.com/wps/portal/3M/en_US/3MHIS/HealthInformationSystems/products-services/product-list/apr-drg-classification
Average charge:
the average dollars for hospital services for which patients were billed at a particular hospital. The charge does not include physicians’ professional fees or patient personal costs. The charge may differ from actual payment that the hospital receives. High outlier charges were excluded from each hospital’s/facility's average charge. A high outlier (unusually high) charge is over 2.5 standard deviations higher than the state mean for each of four subclasses of severity of illness per APR-DRG.
CAH or “Critical Access Hospital":
a nonprofit, profit or public hospital that is enrolled as a Medicaid provider and qualifies as a Critical Access Hospital under 42 CFR, Section 485, Subpart F. For more information, see http://www.rules.utah.gov/publicat/code/r432/r432-106.htm#T3
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr485_main_02.tpl
Expected death percentage:
the number of deaths expected per 100 patients with a certain condition or procedure based on similar patients nationwide in the Health Care Cost and Utilization Project (HCUP) State Inpatient Databases for 2005. Expected death percentage adjusts for the hospital’s case mix (patients’ age, gender and how ill the patients are). Read more at www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf.
Expected Rate:
the number of patients expected for every 100 patients for some indicators and for every 1,000 patients for other indicators with a certain condition or procedure based on similar patients nationwide in the Health Care Cost and Utilization Project (HCUP) State Inpatient Databases for 2005. Expected rate adjusts for the hospital’s/facility's case mix (patients’ age, gender and how ill the patients are). Read more at www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf.
Facility or Facilities:
hospitals that treat outpatients and inpatients and ambulatory surgery centers that treat outpatients.
Inpatient Quality Indicators (IQI):
were developed by the Agency for Healthcare Research and Quality (AHRQ), a federal agency, to be used on inpatient hospital discharge data.  AHRQ IQI definitions and methods were used to calculate the actual and expected deaths rates conditions and procedures in this report. AHRQ IQI limitations include possible differences in hospital coding practices and possible inadequacy of the risk adjustment method for expected death percentage.  In some reports AHRQ IQIs and APR-DRGs in Utah Hospital Comparison reports are similar but not identical. See the report specific technical document, so the number of patients may not be the same. See the report specific technical document.   Read more at
www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf
Outlier charge:
a charge by a specified hospital/facility that is more than 2.5 standard deviations higher than the state average by APR-DRG and severity of illness level. This report excludes outlier charge cases. For more information see this reports Technical Document.
Patient Safety Indicators (PSIs):
Patient safety is quality improvement of health care to reduce medical injuries (e.g., injuries to patients in a health care setting such as a hospital/facility). The Agency for Healthcare Research and Quality (AHRQ), a federal agency, has developed a set of indicators of patient safety based on the inpatient hospital discharge data. Although hospital discharge data do have some limitations, research shows that PSIs may serve as proxies for patient safety-related performance. AHRQ PSI definitions and analytical methods were used to calculate the three indicators. Read more at www.qualityindicators.ahrq.gov/
Severity of illness:
Utah Hospital Comparison reports use two levels of illness for inpatients based on the APR-DRG’s four subclasses for severity of illness (SOI): Minor/Moderate and Major/Severe. For more information see the report specific Technical Document.
Star rating system:
Utah Hospital Comparison reports use "star" ratings based on a test of statistical significance, the exact 95% confidence interval. For the Heart Surgeries and Conditions Report and the Hip and Knee Surgeries and Conditions Report, this test shows whether the difference between a hospital’s actual death percentage and expected death percentage is real (statistically significant, p < 0.05) or just due to chance. We calculated the upper and lower exact 95% confidence interval limits for each hospital’s actual death rate for each indicator. If the expected death percentage is between the lower and higher limits for the actual death percentage, then we are 95% confident that the actual death rate and the expected death rate are essentially the same. If the higher limit for the actual death percentage is lower than the expected death percentage, then we are 95% confident that the actual death percentage is really lower than the expected death rate. If the lower limit for the actual death percentage is higher than the expected death percentage, then we are 95% confident that the actual death rate is really higher than the expected death rate.For more information see the report specific Technical Document.
State Inpatient Databases (SID) 2005:
a national sample that represents about 90% of all inpatients from 37 participating states in 2005. The Health Care Cost and Utilization Project (HCUP) collects these data every year. For this report, the percentage of expected deaths for the quality indicators is adjusted using the SID 2005. Read more at www.hcup-us.ahrq.gov/sidoverview.jsp#What.
Statistically significant difference: the star ratings in the AHRQ IQI tables use exact 95% confidence intervals to show whether differences are statistically significant (p < 0.05).For more information see the report specific Technical Document.
Utah overall:
for each specified condition or procedure and severity of illness group (Minor/Moderate or Major/Extreme), all cases treated at all Utah hospitals/facilities, except some specialty hospitals such as Primary Children’s Medical Center. Utah overall average charge is the sum of all reported hospital/facility charges billed to all patients treated at Utah hospitals/facilities divided by the number of Utah overall cases except the Veterans Administration. The AHRQ IQI tables include only Utah residents. The APR-DRGs tables include Utah resident and non-resident patients.

Gallbladder Related Terms

Bile:
a substance made up of mostly of salts and cholesterol excreted from the liver and stored in the gallbladder. Bile is sent to the small intestine to help digest fatty foods.
Cholangiogram, percutaneous transhepatic cholangiogram:
an x-ray of the bile ducts inside and outside the liver. The x-ray is taken after contrast medium (dye) is injected. Though the medical community is divided, some surgeons perform an x-ray (cholangiogram) to be sure the bile ducts are intact.
Cholangitis:
an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines.
Cholecystitis:
inflammation of the gallbladder, often causing abdominal pain which can be severe.
Cholelithiasis:
see gallstones.
Common bile duct injury:
a rare but serious complication of gallbladder removal. Among laparoscopic gallbladder removals, it occurs in fewer than one in 200 patients.
Gallbladder:
an organ that stores bile excreted from the liver.
Gallbladder disease:
includes inflammation, infection, stones, or obstruction of the gallbladder.
Gallbladder removal:
surgery to remove the gallbladder.The surgery is usually done if the gallbladder is inflamed or blocked, if gallstones are causing inflammation of the pancreas, or if cancer is suspected.
Gallstones:
hard objects that form within the gallbladder and its ducts. Gallstones occur when bile gets too thick and forms stones resembling gravel, peas or even olives. These stones can cause blockages, infection, jaundice, stagnant bile and cholangitis, which may require hospitalization and surgery.
Laparoscopic gallbladder removal: the surgeon removes the gallbladder using small instruments, including a camera. The surgeon inserts these instruments into the abdomen through small puncture holes near the belly button and below the ribs. The surgeon finds the gallbladder, cuts its vessels and tubes, and removes the gallbladder. Another minimally invasive procedure (called endoscopic retrograde cholangiopancreatography) removes the gallstones through through the mouth and stomach.
Laparoscopic gallbladder removal:
the surgeon removes the gallbladder using small instruments, including a camera.  The surgeon inserts these instruments into the abdomen through small punctures near the belly button and below the ribs.  The surgeon finds the gallbladder, cuts its vessels and tubes, and removes it.  Another minimally invasive procedure (called endoscopic retrograde cholangiopancreatography) removes the gallstones through the mouth and stomach.
 
Laparoscopic-to-open gallbladder removal:
sometimes the surgeon begins a laparoscopic gallbladder removal but must change to an open gallbladder removal. The change in plan may be due to how the patient’s organs are positioned, past abdominal surgeries, or other reasons.
Open gallbladder removal:
the surgeon removes the gallbladder through an incision (cut) four to eight inches long below the right ribs. Patients who have had previous abdominal surgery or certain medical conditions may need open rather than laparoscopic gallbladder removal.

Note:
Medical terms for gallbladder conditions and procedures are based on Healthfinder, http://www.healthfinder.gov/library/ and MedlinePlus, http://www.nlm.nih.gov/medlineplus/encyclopedia.html

Heart and Stroke related terms

Acute myocardial infarction, acute MI, AMI, myocardial infarction or MI:
see heart attack.
Angioplasty:
see balloon angioplasty.
Balloon angioplasty:
a balloon catheter is used to open narrowed or blocked blood vessels of the heart. The balloon catheter is a thin flexible tube with a tiny balloon near its end. The balloon is filled and emptied to open the artery so blood can flow through it. Other names: angioplasty; coronary angioplasty; coronary artery angioplasty; cardiac angioplasty; percutaneous coronary intervention (PCI); percutaneous transluminal coronary angioplasty (PTCA); heart artery dilation, heart angioplasty, heart artery angioplasty. For the definition of the indicators used, see the Technical Document for this heart report.
Cardiac catheterization, heart catheterization:
a doctor threads a catheter (thin flexible tube) from an artery or vein in the neck, arm or thigh into the heart arteries or inside the heart. For the definition of the indicators used, see the Technical Document for this heart report.
Cardiac valve procedure, heart valve procedure:
repair or replacement of diseased or damaged heart valves. For the definition of the indicators used, see the Technical Document for this heart report.
Cerebral:
of or related to the brain or cerebrum
Cholesterol:
a waxy fatty material that can build up in arteries and cause heart disease.
 
Clot:
lump of coagulated blood.
 
 
 
 
Coronary angioplasty, coronary artery angioplasty:
see balloon angioplasty.
Coronary artery bypass graft (CABG) surgery, coronary bypass surgery:
see heart bypass surgery.
Cranial:
of or related to the skull or cranium.
 
Diabetes:
a long-term disease marked by high levels of sugar in the blood. It can cause permanent damage throughout the body and result in death if not treated properly. People with diabetes are at higher risk for heart disease than people without diabetes.
Heart artery dilation:
See balloon angioplasty.
Heart attack:
blood clots, plaques (fat deposits) or artery spasms block a heart artery. This causes tissue damage or death to the heart muscle. Other names: myocardial infarction; MI; acute MI. For the definition of the indicators used, see the Technical Document for this heart report.
Heart bypass:
creates new routes around narrowed or blocked heart arteries. The doctor moves blood vessels from other parts of your body onto your heart. Other names: Other names: Heart artery bypass surgery, coronary artery bypass graft (CABG). For the definition of the indicators used, see the Technical Document for this heart report.
Heart failure:
the heart cannot pump enough blood. This causes fluid to build up in your legs, arms, digestive tract, lungs and liver. Heart failure is usually a chronic condition (develops over time). Other names: congestive heart failure, ischemic heart disease, ischemic cardiomyopathy. For the definition of the indicators used, see the Technical Document for this heart report.
Hemorrhage:
bleeding.
 
High blood pressure:
usually 140 systolic over 90 diastolic blood pressure or higher. Systolic is the pressure when the heart beats (squeezes blood into the body). Diastolic is the pressure between heart beats. Other name: hypertension.
Infarct:
an area of necrotic (dead) tissue caused by insufficient blood supply (not enough blood).
Infarction:
the process of forming an infarct.
Intracranial:
within the skull.
Ischemic:
the heart muscle does not get enough blood and oxygen.
 
Ischemic stroke:
stroke caused by blockage of a blood vessel carrying blood to the brain.  A blood clot that stays in place in the brain is called a cerebral thrombus.  A clot that forms some place other than the brain and which breaks loose and moves through the bloodstream to the brain is called a cerebral embolism.
Occlusion:
blockage.
 
 
Percutaneous cardiovascular procedure:
catheters threaded through arteries to the heart to look for and treat heart problems.
Percutaneous transluminal coronary angioplasty (PTCA):
see balloon angioplasty.
Precerebral:
before the brain, in front of the brain.
Stroke (brain attack, cerebral vascular disease, cerebrovascular disease, CVA, cerebral hemorrhage, ischemic stroke):
an interruption of the blood supply to any part of the brain.  A stroke can happen when a blood vessel carrying blood to the brain is blocked by a blood clot.  A stroke can also happen when a blood vessel in the brain breaks.  Interruption of the brain’s blood supply can cause a sudden lessening or loss of consciousness, feeling or voluntary movement.  Interruption of the brain’s blood supply, even for a short time, can result in brain damage, permanent disabilities and death.

Read more at http://www.nlm.nih.gov/medlineplus/ency/article/000726.htm#Definition.
Medical terms for stroke are based on the National Stroke Association, http://www.stroke.org.

Note:
Medical terms for the heart surgeries and conditions are based on Healthfinder, http://www.healthfinder.gov/library/ and MedlinePlus, http://www.nlm.nih.gov/medlineplus/encyclopedia.html

Maternity and Newborn Terms

Birth injury:

injuries that happen to the newborn during birth. Birth injuries could include a local infection, broken collar bone or a head injury. Most birth injuries are minor and heal without complications, but in rare cases some serious injuries can cause permanent harm or death. If an injured newborn is transferred to another hospital, that injury may be counted toward the receiving hospital’s injury rate. 

Some of the injuries that are included in “Birth Injuries – Injury to Newborn” (PSI 17)
are not preventable. For instance, some instances of eye damage are complications of a long or difficult labor. Injuries included in this category can also be unspecified. If the practitioner describes an injury that does not have a code, or does not specify what the injury was, it will also be included in this category.
The definition of this indicator changed in late 2003.  Prior to October 2003, “head molding” might have been included in the indicator.  “Newborn head molding” is an abnormal head shape that occurs from pressure on the baby’s head during delivery.  This is not a serious condition and the baby’s head often returns to its normal shape in a few days.  For the definition of the birth injury indicator used, see the Technical Document in the maternity and newborn report.
Cesarean delivery, cesarean section (APR-DRG 540, Version 20.0):
a procedure in which the newborn is delivered through a surgical cut in the mother’s abdomen. It can be a lifesaving procedure for mothers and babies when a vaginal delivery is not possible. For example, cesarean delivery can be effective when the baby is in distress or in the wrong position for birth. There is concern, however, that more cesarean deliveries are being performed than are medically necessary, which increases health care costs and puts the mother at higher risk for complications and involves a longer recovery time. For the definition of the indicators used, see the Technical Document for this maternity and newborn report.
Dilation and Curettage (D&C):
a procedure that is sometimes used to control unusually high amounts of bleeding after a delivery. In this procedure, the cervix (the opening to the uterus) is dilated (opened up) in order to remove any tissue that should have been delivered (e.g., the placenta). This is done using a curet or a suction curettage.
First-Time Cesarean Delivery:
a cesarean performed for a woman who has never had a cesarean delivery before. For some women, once they have had a cesarean delivery, they will need to have another one with their next baby. If the number of first time cesarean is reduced, then fewer women will need to have additional cesareans. This will result in lower health care costs and lower risk of complications. For this indicator, women with certain conditions (for example, women having twins) were excluded. For the definition of the indicator used, see the Technical Document for this maternity and newborn report.
Instruments [Used in Delivery]:
medical instruments that help to get the baby out of the birth canal. Forceps and vacuum extractors are two instruments that are used to gently grasp or pull the baby’s head to help in delivery. There are some increased risks of injury to the mother or the baby when using instruments during a delivery but they are typically only used when there is difficulty in getting the baby delivered. For the definition of the indicators used, see the Technical Document for this maternity and newborn report.
Normal Newborns (APR-DRG 640, Version 20.0):
babies in this category were born at full term (37 weeks of pregnancy or more, birth weight greater than 2499 grams or about 5.5 pounds). Most, but not all of these babies, do not have any significant health problems. This category accounted for approximately 85% of Utah newborns in 2005. Normal newborns usually stay in the hospital for two days, on average. Charges for a normal newborn only include those that are for the baby after he or she is born, and not any of the charges for the mother or the delivery. However, some hospitals offer a single charge for a mother and her newborn. For the definition of the indicators used, see the Technical Document for this maternity and newborn report.
Obstetric Injuries:
Lacerations, or tears, in the tissue of the vagina (birth canal), perineum (the tissue between the vagina and the rectum) and rectum (the anal opening) during a vaginal delivery. These tears are classified into different degrees depending on how serious they are. Lacerations classified as 3rd or 4th degree are tracked as patient safety indicators because they can cause long-term complications for women who have them. A third degree laceration is a tear that goes from the vagina and through the perineum to the outer edge of the rectum. A fourth degree laceration extends into the rectum and is the most severe. One factor that can increase the chance that a woman will have a laceration is the use of instruments to help get the baby out of the birth canal. Instruments like forceps and vacuum extractors are used when there is difficulty in getting the baby delivered. The AHRQ Patient Safety Indicators for these injuries includes some ICD-9-CM codes for repair of some injuries. For the definition of the indicators used, see the Technical Document for this maternity and newborn report.
Tubal Ligation:
a surgical operation that is used when a woman does not want to have any more children. During the operation, the fallopian tubes are cut which stops an egg from traveling from the ovaries to the uterus.

Note: Medical terms for maternity and newborn conditions and procedures are based on Healthfinder http://www.healthfinder.gov/library/ , MedlinePlus http://www.nlm.nih.gov/medlineplus/encyclopedia.html and the American College of Obstetricians and Gynecologists http://www.acog.com.

Hip and Knee related Terms

Femur:
Thigh bone.
Fracture of femur:
includes fractures (breaks) of the thigh bone at its neck (upper end), bottom (near the knee) and shaft (along its length). For the definition of the indicators used, see the Technical Document for this hip and knee report.
Hip fracture:
A hip fracture usually is a break of the neck of the femur, just below where it fits into the pelvis, the bones in the lower part of the body. For the definition of the indicators used, see the Technical Document for this hip and knee report. Read more at http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=229&topcategory=Hip
Hip replacement or hip joint replacement:
in the Utah Hospital Comparison report includes total, partial and revised hip joint replacement. For the definition of the indicators used, see the Technical Document for this hip and knee report. Read more at http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=504&topcategory=Hip
Knee replacement or knee joint replacement:
in the Utah Hospital Comparison report includes total and revised hip joint replacement. For the definition of the indicators used, see the Technical Document for this hip and knee report. Read more at http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee

Medical terms for the hip and knee surgeries and conditions are based on the American Academy of Orthopedic Surgeons, http://orthoinfo.aaos.org/category.cfm?topcategory=hip

Pneumonia related terms

Influenza:
a contagious disease that is caused by a virus. When influenza attacks the lungs, the lining of the respiratory tract is damaged. The tissues temporarily become swollen and inflamed but usually heal within two or more weeks. Influenza is often complicated by pneumonia, especially in the elderly.  Influenza, especially with pneumonia, can be life threatening.  Other name: flu.  Read more at http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=67283
Pneumonia:
an inflammation of the lung caused by infection with bacteria, viruses, and other organisms. Pneumonia is often a complication of a pre-existing condition/infection and triggered when a patient's defense system is weakened, most often by a simple viral upper respiratory tract infection or a case of influenza, especially in the elderly.  This report includes some but not all kinds of pneumonia among adult hospital inpatients (age 18 years and older).  The average hospital charge in this report is for patients in the All Patient Refined Diagnosis Related Group 139 (APR-DRG 139) Other Pneumonia.  “Other Pneumonia” includes some of the more common kinds of bacterial, viral and mycoplasma pneumonia as well as influenza with pneumonia.  It does not include respiratory syncytial viral (RSV) pneumonia, which is more common among children, or many of the rarer kinds of bacterial, viral and fungal pneumonias such as those associated with tuberculosis and cystic fibrosis.  The indicator for in-hospital deaths among adult pneumonia patients is more inclusive.  For a complete list of the kinds of pneumonia included in these indicators, see the Technical Document in the pneumonia report.

Medical terms for pneumonia are based on American Lung Association definitions at http://www.lungusa.org.

Indicator terms, such as expected rate, are based on Agency for Healthcare Research and Quality technical specifications documents. s.