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



• McDonald K, Romano P, Davies S, Haberland C, Geppert J, Ku A, Choudhry K. Measures of pediatric health care quality based on hospital administrative data: the pediatric quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Sep. 130 p. [82 references]

Does not apply to this measure

This measure is used to assess the number of cases of technical difficulty (e.g., accidental cut or laceration during procedure) per 1,000 eligible discharges.

This indicator is intended to track injuries occurring during a procedure, specifically accidental cut, puncture, perforation, or laceration. These procedures may be prevented through proper technique during procedures.

Accidental cut; puncture; perforation; laceration

All surgical and medical discharges under age 18 defined by specific Diagnosis Related Groups (DRGs)

Exclude cases:

• with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code denoting technical difficulty (e.g., accidental cut, puncture, perforation, or laceration) in the principal diagnosis field
• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
• normal newborn (DRG 391)
• neonates with a birth weight less than 500 grams

Note: Refer to the original measure documentation for specific DRG and ICD-9-CM codes.

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 denoting accidental cut, puncture, perforation or laceration during a procedure in any secondary diagnosis field

Note: Refer to the original measure documentation for specific ICD-9-CM codes.

• A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences
• 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

Internal quality improvement
Quality of care research

Hospitals

Physicians

Single Health Care Delivery Organizations

Age less than 18 years

Either male or female

Stratify rates by low birth weight neonate (under 2000 grams) and other patients.

Surgeries in pediatric patients, because of their smaller anatomy, can be technically more complex and can carry a high risk of accidental puncture or laceration (e.g., 2.22 per 1,000 discharges at 0 to 17 years, 1.84 at 18 to 44 years, 2.82 at 45 to 64 years, and 3.47 at 65 or more years). This indicator was investigated by two groups, although the definition differed slightly from the definition proposed for this measure. Miller and colleagues analyzed Healthcare Cost and Utilization Project (HCUP) data in 2000, using a publicly released version of this indicator applied to a pediatric population, and found a significant incidence of accidental puncture or laceration in pediatric patients (1.0 per 1,000 in 2000 among 0 to 18 year old children). Additionally, Miller & Zhan found that this error resulted in increased mean length of stay (by 7.7 days) and charges per stay ($41,204 on average) in affected patients, with 2.7 times higher odds of in-hospital mortality (after adjusting for age, gender, expected payer, up to 30 comorbidities, and multiple hospital characteristics, including ownership, teaching status, nursing expertise, urban location, bed size, pediatric volume, coding intensity, intensive care unit (ICU) bed percentage, and surgical discharge percentage). Sedman et al. found observed rates varying from 1.7 per 1,000 in 1999 to 1.9 per 1,000 in 2002 in the National Association of Children's Hospitals and Related Institutions (NACHRI) database (i.e., a slight upward trend over time), when applying the publicly released Agency for Healthcare Research and Quality (AHRQ) Quality Indicator (QI) definition to a pediatric population.

See the "Incidence/Prevalence" field.

Unspecified

See the "Incidence/Prevalence" field.

See the "Incidence/Prevalence" field.

Getting Better

Effectiveness
Safety

Users of care only

All surgical and medical discharges under age 18 defined by specific Diagnosis Related Groups (DRGs) (see the "Denominator Inclusions/Exclusions" field)

Patients associated with provider

Inclusions
All surgical and medical discharges under age 18 defined by specific Diagnosis Related Groups (DRGs)

Exclusions
Exclude cases:

• with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code denoting technical difficulty (e.g., accidental cut, puncture, perforation, or laceration) in the principal diagnosis field
• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth and puerperium)
• normal newborn (DRG 391)
• neonates with a birth weight less than 500 grams

Note: Refer to the original measure documentation for specific DRG and ICD-9-CM codes.

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

Clinical Condition
Institutionalization
Therapeutic Intervention

Time window is a single point in time

Inclusions
Discharges among cases meeting the inclusion and exclusion rules from the denominator with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code denoting accidental cut, puncture, perforation or laceration during a procedure in any secondary diagnosis field

Note: Refer to the original measure documentation for specific ICD-9-CM codes.

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

Adverse Outcome

Unspecified

Rate

Better quality is associated with a lower score

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

Internal time comparison

The development of the Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators utilizes a four pronged approach: identification of candidate indicators, literature review, empirical analyses, and panel review. Candidate indicators were identified through both published literature and a brief survey of national organizations. Literature review provided descriptions and evaluations of some candidate indicators and the underlying relationship to quality of care. Empirical analyses were conducted to explore alternative definitions; to assess nationwide rates and hospital variation; and to develop appropriate methods to account for variation in risk. Clinical panel review helped to refine indicator definitions and risk groupings, and to establish face validity in light of the limited evidence from the literature for most pediatric indicators. Information from these sources was used to specify indicator definitions and make recommendations to AHRQ regarding the best indicators for inclusion in the pediatric indicator set.

A structured review of each indicator was undertaken to evaluate face validity (from a clinical perspective). This process mirrored that undertaken during the initial development of the Patient Safety Indicators. Specifically, the panel approach established consensual validity, which "extends face validity from one expert to a panel of experts who examine and rate the appropriateness of each item...." The methodology for the structured review was adapted from the RAND/UCLA Appropriateness Method and consisted of an initial independent assessment of each indicator by clinician panelists using an initial questionnaire, a conference call among all panelists, followed by a final independent assessment by clinician panelists using the same questionnaire. The panel process served to refine definitions of some indicators, add new measures, and dismiss indicators with major concerns from further consideration.

Empirical analyses were conducted to provide the clinical panels and peer review participants with additional information about the indicators. These analyses were also used by the development team to test the alternative specifications and the relative contribution of indicator components in the numerator and denominator. These analyses were not intended to inform issues of precision, bias and construct validity, which will be addressed separately. The data source used in the empirical analyses was the 2003 Kids' Inpatient Sample (KID).

Refer to the original measure documentation for additional details.

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA appropriateness method user's manual. Santa Monica (CA): RAND; 2001. 109 p.



• Green L, Lewis F. Measurement and evaluation in health education and health promotion. Mountain View (CA): Mayfield Publishing Company; 1998.



• McDonald K, Romano P, Davies S, Haberland C, Geppert J, Ku A, Choudhry K. Measures of pediatric health care quality based on hospital administrative data: the pediatric quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Sep. 130 p. [82 references]

Accidental puncture or laceration (PDI 1).

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

This measure was adapted from the AHRQ Patient Safety Quality Indicators.

Accidental Puncture or Laceration, Provider Level (PSI 15) (Agency for Healthcare Research and Quality [AHRQ])

2006 Feb

2007 Mar

This is the current release of the measure.

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



• McDonald K, Romano P, Davies S, Haberland C, Geppert J, Ku A, Choudhry K. Measures of pediatric health care quality based on hospital administrative data: the pediatric quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Sep. 130 p. [82 references]

This NQMC summary was completed by ECRI Institute on December 28, 2007.

No copyright restrictions apply.