• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

Does not apply to this measure

About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.

Timely and effective treatments for acute myocardial infarction (AMI), which are essential for patient survival, include appropriate use of thrombolytic therapy and revascularization. Better processes of care may reduce mortality for AMI, which represents better quality.

This AMI indicator focuses on the outcomes of patients admitted directly to a hospital who stay in that hospital for their entire episode of care.

Acute myocardial infarction (AMI); mortality

All discharges, age 18 years and older, with a principal diagnosis code of acute myocardial infarction (AMI)

Exclude cases:

• Missing discharge disposition
• Transferring to another short-term hospital
• Missing admission source
• Transferring from another short-term hospital

Note: Refer to the Technical Specifications document for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Number of deaths among cases meeting the inclusion and exclusion rules for the denominator

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Variation in quality for the performance measured

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.

Current routine use

External oversight/State government program
Internal quality improvement
Quality of care research

Hospitals

Physicians

Single Health Care Delivery Organizations

Age greater than or equal to 18 years

Either male or female

Unspecified

Acute myocardial infarction (AMI) affects 1.5 million people each year and approximately one-third die in the acute phase of the heart attack.

• American Heart Association (AHA). Heart attack and stroke facts: 1996 statistical supplement. Dallas (TX): American Heart Association (AHA); 1996. Various p.

Unspecified

See "Incidence/Prevalence" field.

Unspecified

Unspecified

Getting Better

Effectiveness

Users of care only

Discharges, age 18 years and older, with acute myocardial infarction (AMI) (see the "Denominator Inclusions/Exclusions" field)

Patients associated with provider

Inclusions
All discharges, age 18 years and older, with a principal diagnosis code of acute myocardial infarction (AMI)

Note: Refer to the Technical Specifications document for specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Exclusions
Exclude cases:

• Missing discharge disposition
• Transferring to another short-term hospital
• Missing admission source
• Transferring from another short-term hospital

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Institutionalization

Time window is a single point in time

Inclusions
Number of deaths among cases meeting the inclusion and exclusion rules for the denominator

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Institutionalization

Administrative data

Not Individual Case

Clinical Outcome

Unspecified

Rate

Better quality is associated with a lower score

Analysis by subgroup (stratification on patient factors, geographic factors, etc.)
Case-mix adjustment
Risk adjustment method widely or commercially available

External comparison at a point in time
External comparison of time trends
Internal time comparison

Each potential quality indicator was evaluated against the following six criteria, which were considered essential for determining the reliability and validity of a quality indicator: face validity, precision, minimum bias, construct validity, fosters real quality improvement, and application. The project team searched Medline for articles relating to each of these six areas of evaluation. Additionally, extensive empirical testing of all potential indicators was conducted using the 1995-97 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and Nationwide Inpatient Sample (NIS) to determine precision, bias, and construct validity. Table 2 in the original measure documentation summarizes the results of the literature review and empirical evaluations on the Inpatient Quality Indicators. Refer to the original measure documentation for details.

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.

Acute myocardial infarction (AMI) mortality rate, without transfer cases (IQI 32).

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality (AHRQ)

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.

None

Acute Myocardial Infarction Mortality Rate, Without Transfer Cases (IQI 32) is closely related to the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) indicator for AMI mortality. This indicator is NOT risk adjusted in the same manner as the JCAHO indicator and does not exclude hospice patients as the JCAHO indicator (due to inability to identify hospice patients in data).

(AMI-9) Inpatient mortality (Joint Commission on the Accreditation of Healthcare Organizations [JCAHO])

2004 Jul

2008 Feb

This is the current release of the measure.

This measure updates previous versions:

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals -- volume, mortality, and utilization [version 3.0]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Feb 20. 99 p.
• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 37 p.

• AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p.



• AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 3.2]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Feb 29. 37 p.

This NQMC summary was completed by ECRI on August 19, 2004. The information was verified by the measure developer on October 13, 2004. This NQMC summary was updated by ECRI on March 4, 2005. The information was verified by the measure developer on April 22, 2005. This NQMC summary was updated again by ECRI Institute on August 17, 2006, on May 29, 2007, and again on October 20, 2008.

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