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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Pediatric heart surgery mortality: number of in-hospital deaths in patients undergoing surgery for congenital heart disease per 1,000 patients.
Source(s)
AHRQ QI. Pediatric quality indicators #6: technical specifications. Pediatric heart surgery mortality rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 4 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

The Pediatric Quality Indicators (PDI) function appropriately in pediatric populations to identify adverse events. This Quality Indicator (QI) evidenced the greatest total charges of the QIs but did not show excess length of stay.

California data from 2005 to 2007, which was used because it included present on admission data and allowed for hospital specific calculations, were used to determine the percentage of hospitals with appropriate patient volumes to readily use the QI for performance measurement. Only a few of the California hospitals (6%) could readily use this QI. The authors noted that the hospitals most likely to perform this procedure were able to use the QI; however, they noted the need to address this caveat in public reporting requirements.

The evidence for the validity of this indicator comes from two sources. First, three studies (including one that used prospectively collected clinical data) have reported an association between hospital volume and mortality following pediatric cardiac surgery. Using a multivariate model that included age, complexity category, and four comorbidities, Hannan et al. found 8.26% risk-adjusted mortality at hospitals with fewer than 100 cases per year, versus 5.95% at higher volume hospitals (an effect limited to surgeons who performed at least 75 cases per year). Two other studies using hospital discharge data from California and Massachusetts found similar effects of hospital volume. The consistent association between volume and risk-adjusted mortality supports the validity of both measures of performance, and is consistent with the hypothesis that more experience leads to improved technical skills and better outcomes. Other studies from single centers have confirmed this hypothesis by demonstrating improvements in mortality over time for a variety of procedures. The second source of evidence is that cardiopulmonary bypass or aortic crossclamp time has been repeatedly associated with postoperative mortality, adjusting for a variety of patient characteristics. This relationship has been demonstrated not just for the Fontan procedure, but also for the Norwood procedure for hypoplastic left heart syndrome. Experienced surgeons and surgical teams should be able to reduce cardiopulmonary bypass or aortic cross-clamp time, thereby improving postoperative mortality. It should be noted that patient-level reduction in mortality does not necessarily correspond with provider-level mortality. It is unknown how implementing these processes of care would actually affect provider-level mortality rates.

Primary Health Components

Unspecified

Denominator Description

Discharges under age 18 with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes for congenital heart disease or non-specific heart surgery with ICD-9-CM diagnosis of congenital heart disease in any field (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of deaths among cases meeting the inclusion and exclusion rules for the denominator with a code of pediatric heart surgery with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of congenital heart disease in any 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
Discharges under age 18 with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes for congenital heart disease (1P) or non-specific heart surgery (2P) with ICD-9-CM diagnosis of congenital heart disease (2D) in any field

Exclusions
Exclude cases:

  • Major Diagnostic Category (MDC) 14 (pregnancy, childbirth and puerperium)
  • With transcatheter interventions (either 3AP, 3BP, 3CP, 3DP, PDA as the only cardiac procedure1, or 3FP) as single cardiac procedures, performed without bypass (5P) but with catheterization (6P)
  • With septal defects (4P) as single cardiac procedures without bypass (5P)
  • With any diagnosis code of atrial septal defect (ASD) or ventricular septal defect (VSD) (5D) with patent ductus arteriosus (PDA) as the only cardiac procedure1
  • Heart transplant (7P)
  • Any diagnosis code of premature infant (4D) with PDA as only cardiac procedure1
  • Age less than or equal to 30 days with PDA as only cardiac procedure1
  • With missing discharge gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), or principal diagnosis (DX1=missing)
  • Transferring to another short-term hospital (DISP=2)
  • Neonates with any diagnosis code of birth weight less than 500 grams (Birth Weight Category 1)

1PDA as the only cardiac procedure is defined as any diagnosis code of (3D) and no other diagnosis code of (2D), and a procedure code of (3EP) and no other procedure code of (1P).

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

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Number of deaths among cases meeting the inclusion and exclusion rules for the denominator with a code of pediatric heart surgery with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of congenital heart disease in any 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 #6 pediatric heart surgery mortality 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
0339
Date of Endorsement

2013 Apr 3

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 #6 pediatric heart surgery mortality. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 4 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 #6: technical specifications. Pediatric heart surgery mortality rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 4 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 #6 Pediatric Heart Surgery Mortality 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. The information was verified by the measure developer on March 31, 2008. 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.

Disclaimer

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The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

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