Excluding transfers out and shock, renal functionality for analysing failure causes and determining Recommended change: workflow to address quality Exclude out of hospital arrest. issues. Modify risk adjustment criteria VLAD is updated on a monthly. A (see below) flag is initiated where the VLAD governing inclusion of line meets the lower or upper transferred patients in contiguous control limits. episodes. Current definition: Numerator: Exclusion criteria: Age greater QI software adjusts risk How reported: than or according to Acute myocardial In-hospital deaths per Current: Current: Reported as rate per 1000 equal to 18 groups infarction (AMI) 1,000 discharges. Number of deaths transferring to another short-term years mortality rate. discharges with acute (DISP=20) among (DISP=2) Interpretation: myocardial infarction Observed rates may be cases meeting the MDC 14 (pregnancy, childbirth, Better quality is associated with (AMI) as a principal risk adjusted by: inclusion and and puerperium) Year: 2013 a score. diagnosis for patients exclusion rules for the hospitals, with missing: ages 18 years and Public reporting: denominator. age groups, discharge disposition older. Excludes race/ethnicity The s include in-hospital (DISP=missing), Previous (2009): obstetric discharges categories, mortality for AMI. gender (SEX=missing), Number of deaths and transfers to sex and age (AGE=missing), among cases meeting Hospital reporting: another hospital. quarter (DQTR=missing), Payer categories. the inclusion and Yes, via website. Hospitals may Previous definition year (YEAR=missing) or exclusion rules for the also use the software to create (2009): principal diagnosis denominator (see own reports. (DX1=missing) Number of deaths per below). 100 discharges with Previous (2009): Denominator: principal diagnosis of missing discharge disposition AMI. Current: transferring to another Discharges, for hospital patients ages 18 years pregnancy, childbirth and and older, with a puerperium principal ICD-9-CM diagnosis code for AMI. Previous (2009): All discharges, age 18 years and older, with
Excluding transfers out Recommended change: Exclude out of hospital arrest. Modify risk adjustment criteria (see below) governing inclusion of transferred patients in contiguous episodes. and shock, renal failure functionality for analysing causes and determining workflow to address quality issues. VLAD is updated on a monthly. A flag is initiated where the VLAD line meets the lower or upper control limits. Acute myocardial infarction (AMI) mortality rate. Year: 2013 Current definition: In-hospital deaths per 1,000 discharges with acute myocardial infarction (AMI) as a principal diagnosis for patients ages 18 years and older. Excludes obstetric discharges and transfers to another hospital. Previous definition (2009): Number of deaths per 100 discharges with principal diagnosis of AMI. Numerator: Current: Number of deaths (DISP=20) among cases meeting the inclusion and exclusion rules for the denominator. Previous (2009): Number of deaths among cases meeting the inclusion and exclusion rules for the denominator (see below). Denominator: Current: Discharges, for patients ages 18 years and older, with a principal ICD-9-CM diagnosis code for AMI. Previous (2009): All discharges, age 18 years and older, with Exclusion criteria: Current: transferring to another short-term (DISP=2) MDC 14 (pregnancy, childbirth, and puerperium) with missing: discharge disposition (DISP=missing), gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing) or principal diagnosis (DX1=missing) Previous (2009): missing discharge disposition transferring to another hospital pregnancy, childbirth and puerperium Age greater than or equal to 18 years QI software adjusts risk according to groups Observed rates may be risk adjusted by: hospitals, age groups, race/ethnicity categories, sex and Payer categories. How reported: Reported as rate per 1000 discharges. Interpretation: Better quality is associated with a score. Public reporting: The s include in-hospital mortality for AMI. Hospital reporting: Yes, via website. Hospitals may also use the software to create own reports.