Indicators
of Inpatient Care in Texas Hospitals Present on Admission (POA) 2016
Hospital Level Reports
VOLUME
& MORTALITY INDICATORS FOR INPATIENT PROCEDURES (bar charts and tables)
Medical articles and journals have suggested that, for some complex medical and
surgical procedures, outcomes for patients may be better in hospitals where
doctors perform such procedures regularly, rather than occasionally. Better
quality may be associated with greater volume, however, low-volume providers
may have excellent outcomes. Since volume alone is not an outcome (result)
measure, where possible, volume indicators should be evaluated along with
mortality indicators (outcome measures) for the same procedure. The volume
measures report the number of times the procedure is performed in the hospital.
The
mortality indicators report the percentage of patients who died at a hospital
after undergoing a specific type of surgery. Patients transferred to another
hospital or with incomplete discharge information are not included in the
mortality charts. Better quality may be associated with lower mortality rates.
Less frequently performed procedures have less comparative performance to
report. (PDF format)
Important Note: Starting 2015, a significant change in coding systems
occurred. Federal requirements necessitated the change in coding systems, from
the International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM) to the International Classification of Diseases, Tenth
Revision, Clinical Modification (ICD-10-CM) and International Classification of
Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). The change
occurred on October 1, 2015. The change will make the data difficult to utilize
and compare between 2016 data and between QI reports from previous years. 2016
measures are not risk-adjusted due to this being the first year of data using
the ICD-10-CM/PCS codes.
Esophageal Resection
The esophagus is the tube that carries food from the mouth to the stomach. It
sometimes has to be removed, usually due to cancer. Surgery on the esophagus
is difficult, and requires an experienced surgeon and
surgical team. The removal of the esophagus involves manipulation of vital
organs in both the chest and the abdomen, together with reconstruction of a way
to replace the function of the esophagus. This procedure is rarely done and few
hospitals do even one such operation in a year. Patients transferred to another
short-term hospital or with incomplete discharge information are excluded.
Because this surgery is not done often, caution should be used in comparing
hospital performance based on these rates.
Pancreatic
Resection
The
pancreas is an organ that lies deep in the abdomen and produces digestive
enzymes and important hormones such as insulin. If cancer develops in the
pancreas, removing the organ by surgery may be life saving. Surgical removal of
the pancreas is a demanding operation in which complications and death occur
even in the most experienced of hands. This may be the only treatment option
for those with cancer of the pancreas. This procedure is rarely done and few
hospitals do even one such operation in a year. Patients transferred to another
short-term hospital or with incomplete discharge information are excluded.
Caution should be used in comparing hospital performance based on these rates.
Abdominal
Aortic Aneurysm (AAA) Repair
An
aneurysm is a defect or swelling in the wall of a weak or damaged artery. The
abdominal aorta is the major blood vessel from the heart that supplies blood to
most of the major organs and the legs. Aneurysms can form in the aorta, the
main artery carrying blood from the heart. Aneurysms that occur in the part of
the aorta within the abdomen are called abdominal aortic aneurysms. When the
vessel swells to a certain size, it is likely to rupture, often causing death.
This may be prevented by repair of the swelling before it bursts. In some cases,
once the aneurysm has burst, the patient may be saved by emergency surgery to
repair the vessel. Patients requiring this procedure may have disease of other
major vessels as well, which may lead to stroke or heart attack during or after
the major surgery required to repair the abdominal aorta. This surgery usually
is performed by surgeons who specialize in repair of blood vessels, and at
hospitals where other specialists are available to deal with the expected
complications. The type of aneurysm and other patient-related factors greatly
affect the mortality rate for this procedure. Patients transferred to another
hospital or with incomplete discharge information are not included.
Coronary
Artery Bypass Graft (CABG)
A
coronary artery bypass graft (CABG) is a surgical procedure to reroute or
“bypass” blockages in the arteries that carry blood to the heart. A CABG may be
done to reduce chest pain, prevent heart attack or to treat other heart
problems caused by blockages in the coronary arteries. Studies have shown that
higher volumes may be associated with better patient outcomes. Thousands of
bypass surgeries are performed each year and the death rate is relatively low.
However, this relatively common procedure requires skill in the use of complex
equipment. Patients transferred to another hospital or with incomplete
discharge information are not included.
Percutaneous
Coronary Intervention (PCI)
This
procedure is a minimally invasive procedure done to open blockages in the
arteries that carry blood to the heart muscle. A thin tube is threaded through
a major blood vessel in the leg up to the heart, and a small balloon or other
device on the tip of the tube is used to reduce or eliminate the blockage. The
procedure may be done to reduce chest pain, prevent or treat heart attacks, or
to treat other heart problems caused by blockages in the coronary arteries. It
requires proficiency with the use of complex equipment, and technical errors
may lead to clinically significant complications. The procedure is frequently
done on an outpatient basis and this report is limited to the number of times
the procedure was performed on hospitalized patients only.
Carotid
Endarterectomy
The
carotid arteries are the major arteries in the neck, which carry blood from the
heart to the brain. If blockages develop in these arteries, stroke or other
brain problems can result. Carotid endarterectomy is a surgery to remove
blockages from these arteries and reduce the chance of stroke. It is a fairly
common procedure that requires proficiency with the use of complex equipment.
Complications can result in stroke, heart attack or death. Patients transferred
to another hospital or with incomplete discharge information are not included.
Craniotomy
Mortality
Craniotomy
is the surgical opening of part of the cranium, or skull, to gain access to the
underlying structures, the brain, the meninges (protective membranes covering
the brain), and the blood vessels. This surgery is performed to remove a brain
tumor, repair an aneurysm (ballooning of blood vessels), inspect the brain,
perform a biopsy (removal of tissue for microscopic examination to establish a
diagnosis), or relieve pressure inside the skull. It is a demanding operation
that is sometimes associated with high risk of disability or death. The
mortality rate for this operation may be high even in the hands of an extremely
experienced neurosurgeon and neurosurgical team. The adjustments used in this
report to equalize "risk" may not fully reflect the many types of
risk associated with this complex surgery, which often is performed on an
emergency basis.
Hip Replacement Mortality
Planned
replacement of a diseased hip joint with an artificial joint is a common
procedure to treat disabling pain or improve hip function. The mortality rate
is low for this procedure, as would be expected in a procedure designed to
improve function rather than extend life. The patients are often elderly, and
many have multiple medical conditions. The cases for this indicator are
undercounted, resulting in a higher than actual mortality rate. The results
should not be compared with earlier years.
MORTALITY INDICATORS FOR INPATIENT CONDITIONS (bar charts and tables)
This section reports the percentage of patients who died at a hospital while
being treated for each condition. Better quality may be associated with lower
mortality rates. (PDF format)
Acute Myocardial Infarction (AMI) Mortality
A heart
attack is called a myocardial infarction. Myocardial means heart muscle, and
infarction means an area of tissue death due to lack of blood supply. Heart
attacks occur when an artery to the heart (a coronary artery) becomes blocked.
A heart attack is a life-and-death emergency. According to the American Heart
Association, if a heart attack victim gets to an emergency room fast enough,
prompt care dramatically reduces heart damage. Detailed practice guidelines
covering all phases of heart attack management have resulted from research.
This report does not consider how quickly the patient began receiving medical
treatment. Patients transferred to or from another hospital are not included.
Heart Failure Mortality
Heart
Failure is one of the most common and severe heart diseases affecting
Americans, and one of the most common reasons for hospitalization. It is the
presence of an abnormal amount of fluid in the tissues, usually because of
limitations in the body’s ability to return the flow of blood from the arms or
legs to the heart and lungs. Though heart failure has many possible underlying
causes, the end result is an inability of the heart muscle to function well
enough to meet the demands of the rest of the body. Heart failure mortality is
influenced greatly by other medical problems, including lung disease, high
blood pressure, cancer and liver disease.
Acute Stroke Mortality
A
stroke is a disruption in the blood supply to the brain. A stroke occurs when a
blood vessel bringing oxygen and nutrients to the brain bursts, or is clogged
by a blood clot or some other particle. Because of this rupture or blockage,
part of the brain doesn’t get the flow of blood it needs, and the nerve cells
in the affected area of the brain cannot function. When nerve cells cannot
function, neither can the part of the body they control. The effects of stroke
often are permanent because dead brain cells are not replaced. Mortality rates
will vary based on the cause of the stroke, the severity of the stroke, other
patient illnesses and speed of arrival at the hospital. Some advanced
treatments may be helpful only in the first few minutes or hours following the
onset of the stroke, and this report does not consider that information.
Gastrointestinal (GI) Hemorrhage Mortality
GI
hemorrhage is the loss of blood from the gastrointestinal tract: the esophagus,
stomach, small intestine or colon. While many cases are relatively minor, some
are life threatening or fatal. The risk of death is primarily related to the
reason why the bleeding began, along with patient factors, such as age and
other illnesses. The evidence for substantial variance in mortality rates due
to provider performance is weak. This indicator should be interpreted with
caution.
Hip Fracture Mortality
Hip
fractures are a common cause of morbidity and functional decline among elderly
persons. Complications of hip fracture and other medical conditions can lead to
a relatively high mortality rate, and evidence suggests that some of these
complications are preventable. Elderly patients often have other medical
conditions and pre-fracture functional impairments. As a result, they are at
significant risk of postoperative complications, which—if not recognized and
effectively treated—can lead to life-threatening problems.
Pneumonia Mortality
Pneumonia
is a medical condition involving an infection in the lungs. An irritation to
the lining of the lungs causes fluid to collect, often making breathing
difficult. Pneumonia typically is treated with antibiotics, sometimes in an
outpatient setting. However, death may occur even when the patient is in the
hospital, especially in patients with weakened respiratory systems or other
chronic health problems. There is a significant impact from patient factors and
admitting practices (whether your doctor thinks you need to be in the hospital
or not).
UTILIZATION INDICATORS (bar charts and tables)
This section of indicators reflects the use of certain procedures about which
questions have been raised about overuse or underuse. While there is no
"correct" frequency for performing procedures included in this
section of the report, high or low rates may raise questions that should be
discussed with your doctor and hospital. (PDF format)
Primary
Cesarean Section Delivery Rate
Cesarean
section (C-section) is the surgical removal of the baby through the mother's abdomen.
Whether or not the procedure is necessary and appropriate depends largely on
each individual's clinical characteristics. The decision is usually a joint one
between the patient and her doctor. Babies in the breech (buttocks first)
position, prior C-section(s), the number of previous births, placental or
umbilical cord complications, infections and high or low birth weight are
factors that may cause a woman to have a C-section, according to the American
College of Obstetrics and Gynecology, but women with abnormal presentation,
preterm delivery, fetal death, more than one baby, or previous C-section are
not included in this calculation. Hospitals that serve as referral centers for
high risk pregnancies, those with intensive care units for very sick babies,
and those serving mothers who have not had the benefit of prenatal care can be
expected to have higher C-section rates.
Vaginal Birth After Cesarean (VBAC), Uncomplicated Rate
Just because
a woman has had one Cesarean section (C-section) delivery does not necessarily
mean she must deliver future babies by C-section. Many women have normal
deliveries even though they had a C-section in the past. This report provides
information on the proportion of vaginal births that occurred to mothers who
had delivered previously by C-section. Mothers with abnormal presentation,
pre-term delivery, fetal death, or more than one baby are not included in this
calculation. This indicator must be viewed with caution, as there is some
evidence that standards of care are changing in this complex area.
Hospital Characteristics
Indicators of Inpatient Care in Texas Hospitals, 2015
Indicators of Inpatient Care in Texas
Hospitals, 2014
Indicators of Inpatient Care in
Texas Hospitals, 2013
Indicators of Inpatient Care in
Texas Hospitals, 2012
Indicators of Inpatient Care in
Texas Hospitals, 2011
Indicators of Inpatient Care in
Texas Hospitals, 2010
Texas Health Data
Texas Health Data
Developed by THCIC using Inpatient Quality Indicators software, Version 7.0 Beta, released
September2017 by the Agency for Healthcare Research
and Quality.