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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Accidental puncture or laceration: rate per 1,000 eligible discharges.
Source(s)
AHRQ QI. Pediatric quality indicators #1: technical specifications. Accidental puncture or laceration rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 2 p.

AHRQ quality indicators. Pediatric quality indicators: technical specifications [version 4.4]. Appendices. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 61 p.

Measure Domain

Primary Measure Domain
Clinical Quality Measures: 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

Using data from 19 states from 2006 to 2008 over five million pediatric hospitalizations were examined. Pediatric patients who experienced an adverse event had a 6.15% mortality rate and excess cost of $1.3 billion. This quality indicator (QI) was one of the highest volume events. The trend in this QI worsened over time and was one of the most variable across the hospitals studied.

More recently, data from the Healthcare Cost and Utilization Project from 2000 to 2007 were used to examine trends in pediatric care. Accidental puncture and laceration increased 25.6% from 2000 to 2007, with the largest increase for children between the ages of 5 and 14 years. However, the authors did caution that present on admission data were not used and the sample of hospitals varied over the years.

Pediatric Quality Indicator 1 (PDI 1) functions appropriately in pediatric populations to identify adverse events that are associated with excess length of stay and total charges. Using the Nationwide Inpatient Sample from 1998-2005 and the Kid's Inpatient Database (KID) from 1997, 2000, and 2003, Camp and colleagues identified 6,459 unique records flagged by PDI 1, and matched them with 19,377 control records with the same age, race, gender, and hospital identification code. Multiple regression analyses were performed for inpatient mortality, length of stay and total hospital charges (controlling for procedure category, admission type, and insurance status in the matched case-control data set). Adjusted for procedure category, admission type, and insurance status, patients with PDI 1 were more likely to die (odds ratio [OR]: 1.9., P < 0.001), had a 4.81 day longer length of stay (95% confidence interval [CI]: 4.26-5.36, P < 0.001), and had $36,291 higher total hospital charges (95% CI: $32,583-$40,000, P < 0.001) compared with patients without PDI 1.

In a similar study using nearest-neighbor propensity score matching in the Pediatric Health Information System database from 2006 (an administrative database with data from 38 academic, nonprofit pediatric hospitals affiliated with the Child Health Corporation of America), Kronman and colleagues reported mean excess length of stay of 2.77 days and mean excess total charges of $34,884 for each PDI 1 case, relative to matched controls. The excess charges came from all hospital cost centers, including pharmacy ($7,705), supplies ($1,718), laboratory ($7,622), imaging ($1,956), and other clinical activities ($4,827).

Primary Health Components

Unspecified

Denominator Description

All surgical and medical discharges under age 18 defined by specific Diagnosis-Related Groups (DRGs) or Medicare Severity DRGs (MS-DRGs) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Discharges among cases meeting the inclusion and exclusion rules for the denominator with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code denoting accidental cut, puncture, perforation or laceration during a procedure in any secondary diagnosis field (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
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
Better Care

Data Collection for the Measure

Case Finding Period

Unspecified

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

Inclusions
All surgical and medical discharges under age 18 defined by specific Diagnosis-Related Groups (DRGs) or Medicare Severity DRGs (MS-DRGs)

Exclusions
Exclude cases:

  • With principal diagnosis denoting accidental cut, puncture, perforation, or laceration, or secondary diagnosis present on admission1
  • Normal newborn
  • Neonate with birth weight less than 500 grams (Birth Weight Category 1)
  • Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
  • With International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for spine surgery
  • With missing discharge gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), or principal diagnosis (DX1=missing)

Note: Refer to the Technical Specifications document for specific ICD-9-CM codes. See also the Pediatric Quality Indicators Appendices for DRGs and MS-DRGs.

1Only for cases that otherwise qualify for the numerator

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Discharges among cases meeting the inclusion and exclusion rules from the denominator with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code denoting accidental cut, puncture, perforation or laceration during a procedure in any secondary diagnosis field

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

Exclusions
Unspecified

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

PDI #1 accidental puncture or laceration rate.

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

Endorser
National Quality Forum
NQF Number
0344
Date of Endorsement

2012 Aug 9

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. Pediatric quality indicators: technical specifications [version 4.2]. PDI #1 accidental puncture or laceration. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 3 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. Pediatric quality indicators #1: technical specifications. Accidental puncture or laceration rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 2 p.

AHRQ quality indicators. Pediatric quality indicators: technical specifications [version 4.4]. Appendices. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 61 p.
Measure Availability

The individual measure, "PDI #1 Accidental Puncture or Laceration Rate," is published in "AHRQ Quality Indicators. Pediatric Quality 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. Pediatric quality 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. 19 p. This document is available in PDF from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Pediatric quality indicators (PDI) risk adjustment coefficients for the PDI [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 73 p. This document is available in PDF from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Pediatric 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 Institute on December 28, 2007. This NQMC summary was updated by ECRI Institute on June 25, 2010. This NQMC summary was reviewed and edited by ECRI Institute on July 15, 2011. This NQMC summary was retrofitted into the new template on July 19, 2011. This NQMC summary was updated again by ECRI Institute on February 28, 2013.

Copyright Statement

No copyright restrictions apply.

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