• 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 percutaneous transluminal coronary angioplasty (PTCA) procedures per 100,000 population.

Percutaneous transluminal coronary angioplasty (PTCA) is performed on patients with coronary artery disease. No ideal rate for PTCA has been established. PTCA is a potentially overused procedure, and rates vary widely and systematically between areas.

As an area utilization indicator*, PTCA is a proxy for actual quality problems. The indicator has unclear construct validity, as high utilization of PTCA has not been shown to necessarily be associated with higher rates of inappropriate utilization. A minor source of bias may be the small number of procedures performed on an outpatient basis. Caution should be maintained for PTCA rates that are drastically below or above the average or recommended rates.

*The following caveats were identified from the literature review for the "Percutaneous Transluminal Coronary Angioplasty Area Rate" indicator:

• Proxy^b: Indicator does not directly measure patient outcomes but an aspect of care that is associated with the outcome; thus, it is best used with other indicators that measure similar aspects of care.
• 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^b: There is uncertainty or poor correlation with widely accepted process measures.
• Unclear benchmark^b: The "correct rate" has not been established for the indicator; national, regional, or peer group averages may be the best benchmark available.

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.

b - Indicates that the concern has been demonstrated in the literature.

Coronary artery disease; percutaneous transluminal coronary angioplasty (PTCA)

Population in Metro Area or county, age 40 years and older

Discharges, age 40 years and older, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 0066, 3601, 3602, or 3605 in any procedure field

Exclude cases:

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

• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Monitoring and planning
Variation in use of service

• 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
Monitoring and planning

Hospitals

Physicians
Public Health Professionals

Counties or Cities

Age greater than or equal to 40 years

Either male or female

Unspecified

In a study of seven Swedish heart centers, 38.3% of all percutaneous transluminal coronary angioplasty (PTCA) procedures were performed for inappropriate indications and 30% for uncertain indications. In a follow-up study of a coronary angiography study conducted in New York, a panel of cardiologists found the rate for inappropriate indications was 12% and the rate of procedures performed for uncertain indications was 27%.

Unspecified

Unspecified

Unspecified

Unspecified

Not within an IOM Care Need

Not within an IOM Domain

Both users and nonusers of care

Population in Metro Area or county, age 40 years and older

Geographically defined

Inclusions
Population in Metro Area or county, age 40 years and older

Exclusions
Unspecified

All cases in the denominator are not equally eligible to appear in the numerator

Patient Characteristic

Time window is a single point in time

Inclusions
Discharges, age 40 years and older, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 0066, 3601, 3602, or 3605 in any procedure field

Exclusions
Exclude cases:

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

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

Does not apply to this measure

Unspecified

Rate

Undetermined

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

Observed (raw) rates may be stratified by areas (Metro Area or counties), age groups, race/ethnicity categories, and sex.

Risk adjustment of the data is recommended using, at minimum, age and sex.

Application of multivariate signal extraction (MSX) to smooth risk adjusted rates is also recommended.

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.

Percutaneous transluminal coronary angioplasty (PTCA) area rate (IQI 27).

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

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 February 3, 2006. The information was verified by the measure developer on March 6, 2006. This NQMC summary was updated by ECRI Institute on May 29, 2007 and again on October 20, 2008.

No copyright restrictions apply.