• 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 patients admitted for diabetes short-term complications (ketoacidosis, hyperosmolarity, coma) per 100,000 population.

This indicator is intended to identify hospitalizations for diabetic ketoacidosis, coma, and hyperosmolarity. With good disease management, these complications are avoidable.

Diabetes; short-term complications (ketoacidosis; hyperosmolarity; coma); hospital admission rates

Population ages 6 to 17 in Metro Area or county

All non-maternal discharges ages 6 to 17 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) principal diagnosis code for short-term complications (ketoacidosis, hyperosmolarity, coma)

Exclude cases:

• transfer from other institution
• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)

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 health state(s)

Current routine use

Monitoring health state(s)

Ambulatory Care
Community Health Care

Advanced Practice Nurses
Physician Assistants
Physicians
Public Health Professionals

Counties or Cities

Age greater than or equal to 6 years and less than 18 years

Either male or female

Unspecified

Unspecified

Access to care in relation to admissions has been explicitly studied and reported. Weissman found that uninsured patients had a higher risk of admission for DKA and coma than privately insured patients (age 0 to 64) (adjusted O.R. 2.18 – 2.77). Two studies of Ambulatory Care Sensitive Condition (ACSC) indicators reported validation work for diabetes independent of measure sets. Millman et al. reported that low-income zip codes had 4.1 times more diabetes hospitalizations per capita (age 0 to 64) than high income zip codes in 11 states in 1988. Billings et al. found that low-income zip codes in New York City (where at least 60% of households earned less than $15,000 in 1988, based on adjusted 1980 Census data) had 6.3 times more diabetes hospitalizations per capita (age 0 to 64) than high-income zip codes (where less than 17.5% of households earned less than $15,000). Household income explained 52% of the variation in short term diabetes complication hospitalization rates at the zip code level. These findings suggest that this indicator may be a marker for poor access to outpatient care.

Unspecified

See the "Association with Vulnerable Populations" field.

Unspecified

Living with Illness

Effectiveness
Timeliness

Both users and nonusers of care

Population ages 6 to 17 in Metro Area or county

Geographically defined

Inclusions
Population ages 6 to 17 in Metro Area or county

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
All non-maternal discharges ages 6 to 17 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) principal diagnosis code for short-term complication (ketoacidosis, hyperosmolarity, coma)

Exclusions
Exclude cases:

• transfer from other institution
• Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)

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

Adverse Health State

Unspecified

Rate

A lower score is desirable

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

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.

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]

Diabetes short-term complications admission rate (PDI 15).

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

This measure was adapted from the AHRQ Prevention Quality Indicators.

Diabetes Short-term Complications Admission Rate (PQI 1) (Agency for Healthcare Research and Quality [AHRQ])

2006 Feb

2008 Feb

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. The information was verified by the measure developer on March 31, 2008.

No copyright restrictions apply.