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Outcome Measures

Background

In the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare & Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality measures for acute myocardial infarction (AMI) and heart failure (HF) in June 2007 and for pneumonia (PN) in June 2008. CMS has since expanded the publicly reported outcome measures to include 30-day readmission for these conditions, as well as in-hospital adverse events and mortality. Publicly reporting these measures increases the transparency of hospital care, provides useful information for consumers choosing care, and assists hospitals in their quality improvement efforts. CMS annually calculates the following categories of outcome measures based on claims and administrative data for public reporting:

30-day risk-standardized mortality measures

  • Acute Myocardial Infarction
  • Heart Failure
  • Pneumonia

30-day risk-standardized readmission measures

  • Acute Myocardial Infarction
  • Heart Failure
  • Pneumonia

AHRQ Patient Safety Indicators (PSIs)

  • PSI 04 - Death among surgical inpatients with serious treatable complications
  • PSI 06 - Iatrogenic pneumothorax
  • PSI 11 – Postoperative respiratory failure
  • PSI 12 – Postoperative PE or DVT
  • PSI 14 - Postoperative wound dehiscence
  • PSI 15 - Accidental puncture or laceration
  • PSI Composite - Complication/patient safety for selected indicators

AHRQ Inpatient Quality Indicators (IQIs)

  • IQI 11 - Abdominal aortic aneurysm (AAA) repair mortality
  • IQI 19 - Hip fracture mortality rate
  • IQI Composite #2 - Mortality for selected medical conditions

Hospital Acquired Condition Measures (HACs)

  • Foreign object retained after surgery
  • Air embolism
  • Blood incompatibility
  • Pressure ulcer stages III and IV
  • Falls and trauma
  • Vascular catheter-associated infection
  • Catheter-associated urinary tract infection
  • Manifestations of poor glycemic control

Additional Analyses

In addition to calculating the above measures for public reporting, CMS also conducts annual analyses of its hospital outcome measures to provide greater insight into measure trends and variation. These additional analyses use calculations reported annually on Hospital Compare and are compiled in the reports provided below.

Hospital Performance Reports: Chartbook Series

The CMS Hospital Performance Reports present analyses that provide insight into hospital performance on publicly reported outcomes measures for patients with acute myocardial infarction, heart failure and pneumonia. CMS publicly reports 30-day risk-standardized mortality and readmission measures for these conditions on this Web site. These Chartbooks provides new information about recent trends and variation in outcomes by location, hospital characteristics, patient disparities, and cost. The chartbooks:

  • Display national trends and distributions of hospital performance on outcomes measures
  • Highlight regional variation in performance on outcomes measures
  • Compare the performance of teaching and non-teaching hospitals
  • Examine the performance of safety-net hospitals, hospitals with high proportions of African-American patients, and hospitals with high proportions of low income patients
  • Assess trends in hospitalization rates, length of stay and rates of discharge to skilled nursing facilities
  • Report variation in Medicare payments for treatment for acute myocardial infarction