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Measure Summary
Title
Neonatal iatrogenic pneumothorax: hospital discharge rate.
Source(s)
AHRQ QI. Neonatal quality indicators #1: technical specifications. Neonatal iatrogenic pneumothorax rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 5 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

In children procedures like central line placement, thoracentesis, or Swan-Ganz catheter placement can be technically more complex than in older patients, due to their smaller anatomy (though they are more likely to be performed in a monitored setting). Also, in comparison to adults, iatrogenic pneumothoraces in neonates are primarily due to barotraumas, with the very smallest infants being at greatest risk (as shown by our preliminary empirical analyses). In an older pediatric population, while barotraumas can occur, the risks for iatrogenic pneumothoraces are more clinically similar to an adult population (e.g. at risk while receiving a central line, catheter, or undergoing thoracentesis procedures).

Primary Health Components

Unspecified

Denominator Description

All surgical and medical discharges of neonates with birth weight less than 2500 grams (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 for iatrogenic pneumothorax 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
  • 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 of neonates with birth weight less than 2500 grams

Exclusions
Exclude cases:

  • Neonates with birth weight less than 500 grams (Birth Weight Category 1)
  • With principal diagnosis of iatrogenic pneumothorax or secondary diagnosis present on admission1
  • With any diagnosis code of chest trauma or pleural effusion
  • With an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of thoracic surgery, lung or pleural biopsy, diaphragmatic surgery repair, OR cardiac surgery
  • Normal newborn
  • Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
  • With missing discharge gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), or principal diagnosis (DX1=missing)

1Only for cases that otherwise qualify for the numerator

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.

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
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 for iatrogenic pneumothorax 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

NQI #1 neonatal iatrogenic pneumothorax rate.

Measure Set Name
Measure Subset 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. Neonatal quality indicators: technical specifications [version 4.2]. NQI #1 iatrogenic pneumothorax in neonates. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 7 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. Neonatal quality indicators #1: technical specifications. Neonatal iatrogenic pneumothorax rate [version 4.4]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Mar. 5 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, "NQI #1 Neonatal Iatrogenic Pneumothorax Rate," is published in "AHRQ Quality Indicators. Neonatal 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 June 30, 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. NQMC summary was updated 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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