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 number is not risk-adjusted.
APR-DRG: stands for All Patient Refined Diagnosis Related Group, 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 (minor, moderate, major and extreme). This report uses APR-DRG version 20.0 for the expected rate, because AHRQ uses this version to determine expected rate and risk-adjusted rate in the Inpatient Quality Indicators. Some other Utah Department of Health reports based on hospital administrative data -through 2004 that include average charges - use APR-DRG version 15.0. Read more…
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 the actual payment that the hospital receives. For this report, cases with a high outlier (unusually high) charge and cases with a high outlier length of stay were excluded from each hospital’s average charge. A high outlier is over 2.5 standard deviations higher than the state mean for each of four levels of patient severity per APR-DRG.
Birth Injuries: injuries that happen to the newborn baby during birth. These 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 baby 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 non-preventable. For example, 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.
Also, 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.
Cesarean Delivery (APR-DRG 540, Version 20.0 other names: cesarean section, cesarean section delivery, c-section) 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 delieveries 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.
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.
Expected Rate: the number of patients expected per 100 or 1,000 patients with a certain condition or procedure if the hospital performed the same as other hospitals in the nation with similar patients in the Health Care Cost and Utilization Project (HCUP) State Inpatient Databases for 2003. Expected rate adjusts for the hospital’s case mix (patients’ age, gender and how ill the patients are). Read more…
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 cesarean. 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.
Inpatient Quality Indicators (IQI): were developed by the Agency for Health Care 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 rates for the conditions in this report. AHRQ IQI limitations include possible differences in hospital coding practices and possible inadequacy of the risk adjustment method for expected percentage. The AHRQ IQIs and APR-DRGs in Utah Hospital Comparison reports are similar but not identical. Read more at: www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf, pages 4, 15-18, 60-61, 82, and www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml
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.
Level of Illness: Utah Hospital Comparison
reports use two levels of illness based on the APR-DRG’s four subclasses
for severity of illness (SOI), which we collapse into minor/moderate and
major/severe. Read more at:http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml
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.
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.
Outlier Charge: a charge by a specified hospital that is more than 2.5 standard deviations higher than the state average by APR-DRG for each of the four severity of illness levels (which we have collapsed into minor/moderate and major/extreme).This report excludes patients with outlier charges from its hospital average charge.
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). 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 and see the Maternity Technical Document.
Star Rating System: Utah Hospital Comparison reports use a star rating based on a test of statistical significance, the exact 95% confidence interval. This test shows whether the difference between a hospital’s actual rate and expected rate 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 rate for each indicator. If the expected rate is between the lower and higher limits for the actual rate, then we are 95% confident that the actual rate and the expected rate are essentially the same. If the higher limit for the actual rate is lower than the expected rate, then we are 95% confident that the actual rate at that hospital is really lower than the expected rate. Hospitals with an actual rate that is significantly lower than the expected rate receive a three-star rating. If the lower limit for the actual rate is higher than the expected rate, then we are 95% confident that the actual rate at that hospital is really higher than the expected rate. Hospitals with an actual rate that is significantly higher than the expected rate receive a one-star rating. Keep in mind, however, that many factors affect the hospital’s rates of these events. For example, a hospital that cares for a lot of high-risk pregnancies may have a higher rate for a safety indicator, but that does not mean that the hospital delivers poor quality care. Read more…
State Inpatient Databases (SID) 2003: a national sample that represents about 90% of all inpatients from 38 participating states in 2003. The Health Care Cost and Utilization Project (HCUP) collects these data every year. For this report, the expected rate for the quality indicators is determined using the SID 2003. Read more…
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). Read more…
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.
Utah Overall: for each specified condition or procedure and illness level, all cases treated at all Utah hospitals. Utah overall average charge is the sum of all reported hospital charges billed to all patients treated at Utah hospitals divided by the number of Utah cases overall. The quality tables include only Utah residents. The hospital average charges (APR-DRGs) tables include Utah resident and non-resident patients.
Vaginal Birth After C-Section (VBAC): a vaginal delivery for a woman who has had a previous cesarean section delivery. Since a VBAC does have a risk of complications, it is important that a hospital have the right staff available for the delivery. Some hospitals do not offer VBAC as an option because the staff needed in an emergency (such as a ruptured uterus) are not available 24 hours a day, seven days a week. Details on professional practice guidelines for VBAC from the American College of Obstetricians and Gynecologists (ACOG) can be found here.
Vaginal Delivery (APR-DRG 560 Version 20.0): deliveries that had no complications and did not involve any operating room procedures (e.g., tubal ligation or dilation and curettage). This is the largest category of deliveries and accounted for 69% of deliveries in Utah in 2005.
Note: Indicator terms, such as expected rate, are based on Agency for Health Care Research and Quality and APR-DRG technical documents.