• 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

This measure is used to assess the number of provider-level bilateral cardiac catheterizations per 100 discharges with procedure code of heart catheterization.

Outpatient procedures may result in selection bias for this indicator and should be examined. In addition, as a utilization indicator, the construct validity relies on the actual inappropriate use of procedures in hospitals with high rates, which should be investigated further.

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.

Right-side coronary catheterization incidental to left-side catheterization has little additional benefit for patients without clinical indications for right-side catheterization. Bilateral catheterization is contraindicated in most patients without proper indications. As such, lower rates represent better quality.

*The following caveats were identified from the literature review for the "Bilateral Cardiac Catheterization Rate" indicator:

• Selection bias^a: This results when a substantial percentage of care for a condition is provided in the outpatient setting, so the subset of inpatient cases may be unrepresentative. Examination of outpatient care or emergency care data may help to reduce this in these cases.
• Unclear construct^a: There is uncertainty or poor correlation with widely accepted process measures.

Refer to the original measure documentation for further details.

Note:

a - The concern is theoretical or suggested, but no specific evidence was found in the literature.

Coronary artery disease; bilateral cardiac catheterization

All discharges, age 18 years and older, with heart catheterization in any procedure field. Include only coronary artery disease.

Exclude cases:

• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• MDC 15 (newborns and other neonates)

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

Number of simultaneous right and left heart catheterizations (in any procedure field) among cases meeting the inclusion and exclusion rules for the denominator

Exclude cases:

• With valid indications for right-sided catheterization in any diagnosis field

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

• 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

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

This measure should be estimable with reasonable precision, given that more than 1.2 million inpatient cardiac catheterizations were performed in the United States in 1998.

• Hall M, Popovic J. 1998 summary: National Hospital Discharge survey. Adv Data 2000;(316):Various pagings.

Unspecified

Unspecified

Unspecified

Unspecified

Getting Better

Effectiveness

Users of care only

Discharges, age 18 years and older, with coronary artery disease (CAD) who had a heart catheterization (see the "Denominator Inclusions/Exclusions" field)

Patients associated with provider

Inclusions
All discharges, age 18 years and older, with heart catheterization in any procedure field. Include only coronary artery disease.

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

Exclusions
Exclude cases:

• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• MDC 15 (newborns and other neonates)

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

Clinical Condition
Diagnostic Evaluation
Institutionalization

Time window is a single point in time

Inclusions
Number of simultaneous right and left heart catheterizations (in any procedure field) among cases meeting the inclusion and exclusion rules for the denominator

Exclusions
Exclude cases:

• With valid indications for right-sided catheterization in any diagnosis field

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

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

Individual Case

Unspecified

Rate

Better quality is associated with a lower score

Analysis by subgroup (stratification on patient factors, geographic factors, etc.)
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.

Bilateral cardiac catheterization rate (IQI 25).

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

National Quality Forum

Measure was not adapted from another source.

2002 Jun

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 December 4, 2002. The information was verified by the Agency for Healthcare Research and Quality on December 26, 2002. This NQMC summary was updated by ECRI on April 7, 2004, August 19, 2004, and 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.

No copyright restrictions apply.