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Measure Summary
Title
Postoperative hemorrhage or hematoma (area-level): rate per 100,000 population.
Source(s)
AHRQ QI. Patient safety indicators #27: technical specifications. Postoperative hemorrhage or hematoma rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 2 p.

Measure Domain

Primary Measure Domain
Population Health Quality Measures: Population Outcome

Brief Abstract

Description

Please note: This measure summary will be fully specified once the updated AHRQ User Guide is released in early 2013.

Rationale

This indicator measures how often hospitalized patients bled too much either within their body or outside their body (hemorrhage) or developed a large clot (hematoma) following a surgical procedure. These complications were important enough to involve another operation to stop the bleeding or remove the blood clots. This event is considered preventable when proper guidelines and procedures are followed.

This indicator is reported as a count or as a population-based rate. About 38,835 of these events (3.38 per 100,000 United States [U.S.] residents) are estimated to have presented to or occurred in US community hospitals in 2008.

For additional information about the impact of these events, see the "Rationale" section under Patient Safety Indicator (PSI) 9, which is the hospital-level version of the indicator.

Primary Health Components

Unspecified

Denominator Description

Discharges in the numerator are assigned to the denominator based on the Metro Area or county of the patient residence, not the Metro Area or county of the hospital where the discharge occurred (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Discharges 18 years and older with the following:

  • International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for postoperative hemorrhage or postoperative hematoma in any diagnosis field (principal or secondary)

    AND

  • ICD-9-CM code for postoperative control of hemorrhage or for drainage of hematoma in any procedure code field

See the related "Numerator Inclusions/Exclusions" field.

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use of the Measure

State of Use
Current routine use
Current Use
Unspecified

Application of the Measure in its Current Use

Measurement Setting
Unspecified
Professionals Involved in Delivery of Health Services
Unspecified
Least Aggregated Level of Services Delivery Addressed
Unspecified
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age

Unspecified

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Healthy People/Healthy Communities

Data Collection for the Measure

Case Finding Period

Unspecified

Denominator Sampling Frame
Unspecified
Denominator Time Window
Unspecified
Denominator Inclusions/Exclusions

Inclusions
Discharges in the numerator are assigned to the denominator based on the Metro Area1 or county of the patient residence, not the Metro Area or county of the hospital where the discharge occurred

1 The term "metropolitan area" (MA) was adopted by the U.S. Census in 1990 and referred collectively to metropolitan statistical areas (MSAs), consolidated metropolitan statistical areas (CMSAs) and primary metropolitan statistical areas (PMSAs). In addition, "area" could refer to either 1) Federal Information Processing Standard (FIPS) county, 2) modified FIPS county, 3) 1999 Office of Management and Budget (OMB) Metropolitan Statistical Area or 3) 2003 OMB Metropolitan Statistical Area. Micropolitan Statistical Areas are not used in the Quality Indicator (QI) software.

Exclusions
Unspecified

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Discharges 18 years and older with the following:

  • International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for postoperative hemorrhage or postoperative hematoma in any diagnosis field (principal or secondary)

    AND

  • ICD-9-CM code for postoperative control of hemorrhage or for drainage of hematoma in any procedure code field

Exclusions
Exclude cases:

  • Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and the puerperium)
  • With missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), or principal diagnosis (DX1=missing), county (PSTCO=missing)

Note: Refer to the Technical Specifications document specific ICD-9-CM codes.

Numerator Search Strategy
Unspecified
Data Source
Administrative clinical data
Instruments Used and/or Associated with the Measure

Unspecified

Computation of the Measure

Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Unspecified

Identifying Information

Original Title

PSI #27 postoperative hemorrhage or hematoma rate (area-level indicator).

Measure Set Name
Submitter
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
Developer
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
Funding Source(s)

Agency for Healthcare Research and Quality (AHRQ)

Composition of the Group that Developed the Measure

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators are in the public domain and the specifications come from multiple sources, including the published and unpublished literature, users, researchers, and other organizations. AHRQ as an agency is responsible for the content of the indicators.

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

Unspecified

Date of Most Current Version in NQMC
2012 Mar
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: AHRQ quality indicators. Patient safety indicators: technical specifications [version 4.2]. PSI #27 postoperative hemorrhage or hematoma (area-level indicator). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 2 p.

Please note: This measure summary will be fully specified once the updated AHRQ User Guide is released in early 2013.

Source(s)
AHRQ QI. Patient safety indicators #27: technical specifications. Postoperative hemorrhage or hematoma rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 2 p.
Measure Availability

The individual measure, "PSI #27 Postoperative Hemorrhage or Hematoma Rate (Area-Level Indicator)," is published in the "AHRQ Quality Indicators. Patient Safety Indicators: Technical Specifications." This document is available in Portable Document Format (PDF) from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Web site External Web Site Policy.

For more information, please contact the QI Support Team at support@qualityindicators.ahrq.gov.

Companion Documents

The following are available:

  • AHRQ quality indicators. Patient safety indicator comparative data: based on the 2009 Nationwide Inpatient Sample (NIS) [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Aug. 21 p. This document is available in PDF from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Patient safety indicators (PSI) risk adjustment coefficients for the PSI [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 79 p. This document is available in PDF from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Patient safety quality indicators composite measure workgroup. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Mar. various p. This document is available in PDF from the AHRQ Quality Indicators Web site External Web Site Policy.
  • HCUPnet: a tool for identifying, tracking, and analyzing national hospital statistics. [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [accessed 2010 Jan 4]. HCUPnet is available from the AHRQ Web site External Web Site Policy. See the related QualityTools External Web Site Policy summary.
NQMC Status

This NQMC summary was completed by ECRI on April 24, 2006. The information was verified by the measure developer on July 31, 2006. This NQMC summary was updated by ECRI Institute on June 12, 2007, November 10, 2008 and again on June 21, 2010. This NQMC summary was retrofitted into the new template on July 18, 2011. This NQMC summary was updated again by ECRI Institute on January 2, 2013.

Copyright Statement

No copyright restrictions apply.

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