Inpatient Safety Indicators

The IQIs are a set of measures that can be used with hospital inpatient discharge data to provide a perspective on quality and include the following:

· Volume indicators are proxy, or indirect, measures of quality. They are based on evidence suggesting that hospitals performing more of certain intensive, high-technology, or highly complex procedures may have better outcomes for those procedures. Volume indicators simply represent counts of admissions in which these procedures were performed.

· Mortality indicators for inpatient procedures include procedures for which mortality has been shown to vary across institutions and for which there is evidence that high mortality may be associated with poorer quality of care.

· Mortality indicators for inpatient conditions include conditions for which mortality has been shown to vary substantially across institutions and for which evidence suggests that high mortality may be associated with deficiencies in the quality of care.

· Utilization indicators examine procedures whose use varies significantly across hospitals and for which questions have been raised about overuse, underuse, or misuse. High or low rates for these indicators are likely to represent inappropriate or inefficient delivery of care.

Esophageal Resection Mortality Rate (IQI 8)

Esophageal cancer surgery is a rare procedure that requires technical proficiency; and errors in surgical technique or management may lead to clinically significant complications, such as sepsis, pneumonia, anastomotic breakdown, and death.

Relationship to Quality	Better processes of care may reduce mortality for esophageal resection, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 patients with discharge procedure code of esophageal resection.
Numerator	Number of deaths with a code of esophageal resection in any procedure field.
Denominator	Discharges with ICD-9-CM codes of 4240 through 4242 in any procedure field and a diagnosis code of esophageal cancer in any field. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 8.48 per 100 population at risk
Empirical Rating	8

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Pancreatic Resection Mortality Rate (IQI 9)

Pancreatic resection is a rare procedure that requires technical proficiency; and errors in surgical technique or management may lead to clinically significant complications, such as sepsis, anastomotic breakdown, and death.

Relationship to Quality	Better processes of care may reduce mortality for pancreatic resection, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 patients with discharge procedure code of pancreatic resection.
Numerator	Number of deaths with a code of pancreatic resection in any procedure field.
Denominator	Discharges with ICD-9-CM codes of 526 or 527 in any procedure field and a diagnosis code of pancreatic cancer in any field. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 6.91 per 100 population at risk
Empirical Rating	5

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Pediatric Heart Surgery Mortality Rate (IQI 10)

Pediatric heart surgery requires proficiency with the use of complex equipment; and technical errors may lead to clinically significant complications, such as arrhythmias, congestive heart failure, and death.

Relationship to Quality	Better processes of care may reduce mortality for pediatric heart surgery, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 patients with selected discharge procedure code of pediatric heart surgery.
Numerator	Number of deaths with a code of pediatric heart surgery in any procedure field with ICD-9-CM diagnosis of congenital heart disease in any field.
Denominator	Discharges with ICD-9-CM procedure codes for congenital heart disease (1P) in any field or non-specific heart surgery (2P) in any field with ICD-9-CM diagnosis of congenital heart disease (2D) in any field. Age less than 18 years old. Exclude MDC 14 (pregnancy, childbirth and pueperium); patients with transcatheter interventions (either 3AP, 3BP, 3CP, 3DP, 3EP with 3D, or 3FP) as single cardiac procedures, performed without bypass (5P) but with catheterization (6P); patients with septal defects (4P) as single cardiac procedures without bypass (5P); heart transplant (7P); premature infants (4D) with PDA closure (3D and 3EP) as only cardiac procedure; age less than 30 days with PDA closure as only cardiac procedure; missing discharge disposition (DISP=missing); and transferring to another short-term hospital (DISP=2). See Appendix A for detailed information on the exclusion categories.
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 4.97 per 100 discharges at risk
Empirical Rating	3

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Abdominal Aortic Aneurysm Repair Mortality Rate (IQI 11)

Abdominal aortic aneurysm (AAA) repair is a relatively rare procedure that requires proficiency with the use of complex equipment; and technical errors may lead to clinically significant complications, such as arrhythmias, acute myocardial infarction, colonic ischemia, and death.

Relationship to Quality	Better processes of care may reduce mortality for AAA repair, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with procedure code of AAA repair.
Numerator	Number of deaths with a code of AAA repair in any procedure field and a diagnosis of AAA in any field.
Denominator	Discharges with ICD-9-CM codes of 3834, 3844, and 3864 in any procedure field and a diagnosis code of AAA in any field. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 11.30 per 100 discharges at risk
Empirical Rating	8

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Coronary Artery Bypass Graft Mortality Rate (IQI 12)

Coronary artery bypass graft (CABG) is a relatively common procedure that requires proficiency with the use of complex equipment; and technical errors may lead to clinically significant complications such as myocardial infarction, stroke, and death.

Relationship to Quality	Better processes of care may reduce mortality for CABG, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with procedure code of CABG.
Numerator	Number of deaths with a code of CABG in any procedure field.
Denominator	Discharges with ICD-9-CM codes of 3610 through 3619 in any procedure field. Age 40 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 3.54 per 100 discharges at risk
Empirical Rating	5

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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PTCA Mortality Rate (IQI 30)

Relationship to Quality	Better processes of care may reduce short-term mortality, which represents better quality.
Definition	Number of deaths per 100 PTCAs.
Numerator	Number of deaths with a code of PTCA in any procedure field.
Denominator	Discharges with ICD-9-CM codes 3601, 3602, 3605, or 3606 in any procedure field. Age 40 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator – Recommended for use only with the corresponding volume indicator above.
Empirical Performance	Population Rate: 1.46 per 100 discharges at risk
Empirical Rating	Not available.

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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CEA Mortality Rate (IQI 31)

Relationship to Quality	Better processes of care may reduce short-term mortality, which represents better quality.
Definition	Number of deaths per 100 CEAs.
Numerator	Number of deaths with a code of CEA in any procedure field.
Denominator	Discharges with ICD-9-CM codes of 3812 in any procedure field. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator – Recommended for use only with the corresponding volume indicator above.
Empirical Performance	Population Rate: 0.76 per 100 discharges at risk
Empirical Rating	Not available.

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Craniotomy Mortality Rate (IQI 13)

Craniotomy for the treatment of subarachnoid hemorrhage or cerebral aneurysm entails substantially high post-operative mortality rates.

Relationship to Quality	Better processes of care may reduce mortality for craniotomy, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with DRG code for craniotomy (DRG 001, 002, 528, 529, and 530), with and without comorbidities and complications.
Numerator	Number of deaths with DRG code for craniotomy (DRG 001, 002, 528, 529, and 530), Age >17, with and without comorbidities and complications.
Denominator	All discharges with DRG code for craniotomy (DRG 001, 002, 528, 529, and 530), with and without comorbidities and complications. Age 18 years or older. Exclude patients with a principle diagnosis of head trauma, missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 7.59 per 100 discharges at risk
Empirical Rating	6

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Hip Replacement Mortality Rate (IQI 14)

Total hip arthroplasty (without hip fracture) is an elective procedure performed to improve function and relieve pain among patients with chronic osteoarthritis, rheumatoid arthritis, or other degenerative processes involving the hip joint.

Relationship to Quality	Better processes of care may reduce mortality for hip replacement, which represents better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 patients with discharge procedure code of partial or full hip replacement.
Numerator	Number of deaths with a code of partial or full hip replacement in any procedure field.
Denominator	All discharges with procedure code of partial or full hip replacement in any field. Include only discharges with uncomplicated cases: diagnosis codes for osteoarthrosis of hip in any field. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Procedures
Empirical Performance	Population Rate: 0.25 per 100 discharges at risk
Empirical Rating	3

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Acute Myocardial Infarction Mortality Rate (IQI 15)

Timely and effective treatments for acute myocardial infarction (AMI), which are essential for patient survival, include appropriate use of thrombolytic therapy and revascularization.

Relationship to Quality	Better processes of care may reduce mortality for AMI, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with a principal diagnosis code of AMI.
Numerator	Number of deaths with a principal diagnosis code of AMI.
Denominator	All discharges with a principal diagnosis code of AMI. Age 18 years and older. Exclude patients with missing discharge disposition (DISP=missing) or transferring to another short-term hospital (DISP=2).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 10.24 per 100 discharges at risk
Empirical Rating	5

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Acute Myocardial Infarction Mortality Rate, Without Transfer Cases (IQI 32)

Relationship to Quality	Better processes of care may reduce mortality for AMI, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with a principal diagnosis code of AMI.
Numerator	Number of deaths with a principal diagnosis code of AMI.
Denominator	All discharges with a principal diagnosis code of AMI. Age 18 years and older. Exclude patients with missing discharge disposition (DISP = missing), transferring to another short-term hospital (DISP = 2), with missing admission source (ASOURCE = missing) or transferring from another short-term hospital (ASOURCE = 2).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 11.21 per 100 discharges at risk
Empirical Rating	Not available

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Congestive Heart Failure Mortality Rate (IQI 16)

Congestive heart failure (CHF) is a progressive, chronic disease with substantial short-term mortality, which varies from provider to provider.

Relationship to Quality	Better processes of care may reduce short-term mortality, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with principal diagnosis code of CHF.
Numerator	Number of deaths with a principal diagnosis code of CHF.
Denominator	All discharges with a principal diagnosis code of CHF. Age 18 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 4.88 per 100 discharges at risk
Empirical Rating	6

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Acute Stroke Mortality Rate (IQI 17)

Quality treatment for acute stroke must be timely and efficient to prevent potentially fatal brain tissue death, and patients may not present until after the fragile window of time has passed.

Relationship to Quality	Better processes of care may reduce short-term mortality, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with principal diagnosis code of stroke.
Numerator	Number of deaths with a principal diagnosis code of stroke.
Denominator	All discharges with a principal diagnosis code of stroke. Age 18 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 11.66 per 100 discharges at risk
Empirical Rating	10

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Gastrointestinal Hemorrhage Mortality Rate (IQI 18)

Gastrointestinal (GI) hemorrhage may lead to death when uncontrolled, and the ability to manage severely ill patients with comorbidities may influence the mortality rate.

Relationship to Quality	Better processes of care may reduce mortality for GI hemorrhage, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with principal diagnosis code of GI hemorrhage.
Numerator	Number of deaths with a principal diagnosis code of gastrointestinal hemorrhage.
Denominator	All discharges with principal diagnosis code for gastrointestinal hemorrhage. Age 18 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 3.41 per 100 discharges at risk
Empirical Rating	5

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Hip Fracture Mortality Rate (IQI 19)

Hip fractures, which are a common cause of morbidity and functional decline among elderly persons, are associated with a significant increase in the subsequent risk of mortality.

Relationship to Quality	Better processes of care may reduce mortality for hip fracture, which represents better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of deaths per 100 discharges with principal diagnosis code of hip fracture.
Numerator	Number of deaths with a principal diagnosis code of hip fracture.
Denominator	All discharges with a principal diagnosis code for hip fracture. Age 18 years and older. Exclude patients with missing discharge disposition, transferring to another short-term hospital, MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 3.07 per 100 discharges at risk
Empirical Rating	10

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Pneumonia Mortality Rate (IQI 20)

Treatment with appropriate antibiotics may reduce mortality from pneumonia, which is a leading cause of death in the United States.

Relationship to Quality	Inappropriate treatment for pneumonia may increase mortality.
Benchmark	State, regional, or peer group average.
Definition	Mortality in discharges with principal diagnosis code of pneumonia.
Numerator	Number of deaths with a principal diagnosis code of pneumonia.
Denominator	All discharges with principal diagnosis code of pneumonia. Age 18 years and older. Exclude patients with missing discharge disposition (DISP=missing), transferring to another short-term hospital (DISP=2), MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Mortality Indicator for Inpatient Conditions
Empirical Performance	Population Rate: 8.95 per 100 discharges at risk
Empirical Rating	7

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Cesarean Delivery Rate (IQI 21)

Cesarean delivery is the most common operative procedure performed in the United States and is associated with higher costs than vaginal delivery. Despite a recent decrease in the rate of Cesarean deliveries, many organizations have aimed to monitor and reduce the rate.

Relationship to Quality	Cesarean delivery has been identified as an overused procedure. As such, lower rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Provider-level number of Cesarean deliveries per 100 deliveries.
Numerator	Number of Cesarean deliveries, identified by DRG, or by ICD-9-CM procedure codes if they are reported without a 7491 hysterotomy procedure.
Denominator	All deliveries. Exclude patients with abnormal presentation, preterm, fetal death, multiple gestation diagnosis codes, or breech procedure codes.
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 19.88 per 100 discharges at risk
Empirical Rating	17

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Primary Cesarean Delivery Rate (IQI 33)

Relationship to Quality	Cesarean delivery has been identified as an overused procedure. As such, lower rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Provider-level number of Cesarean deliveries per 100 deliveries.
Numerator	Number of Cesarean deliveries, identified by DRG, or by ICD-9-CM procedure codes if they are reported without a 7491 hysterotomy procedure.
Denominator	All deliveries. Exclude patients with abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis codes, breech procedure codes, or a previous Cesarean delivery diagnosis in any diagnosis field.
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 12.67 per 100 discharges at risk
Empirical Rating	Not evaluated

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Vaginal Birth After Cesarean Rate, Uncomplicated (IQI 22)

The policy of recommending vaginal birth after Cesarean delivery (VBAC) represents to some degree a matter of opinion on the relative risks and benefits of a trial of labor in patients with previous Cesarean delivery.

Relationship to Quality	VBAC has been identified as a potentially underused procedure. As such, higher rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Provider-level vaginal births per 100 discharges with a diagnosis of previous Cesarean delivery.
Numerator	Number of vaginal births in women with a diagnosis of previous Cesarean delivery.
Denominator	All deliveries with a previous Cesarean delivery diagnosis in any diagnosis field. Exclude patients with abnormal presentation, preterm, fetal death, multiple gestation diagnosis codes or breech procedure codes.
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 28.45 per 100 discharges at risk
Empirical Rating	19

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Vaginal Birth After Cesarean Rate, All (IQI 34)

Relationship to Quality	VBAC has been identified as a potentially underused procedure. As such, higher rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Provider-level vaginal births per 100 discharges with a diagnosis of previous Cesarean delivery.
Numerator	Number of vaginal births in women with a diagnosis of previous Cesarean delivery.
Denominator	All deliveries with a previous Cesarean delivery diagnosis in any diagnosis field.
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 27.32 per 100 discharges at risk
Empirical Rating	Not evaluated

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Laparoscopic Cholecystectomy Rate (IQI 23)

Surgical removal of the gall bladder (cholecystectomy) performed with a laparoscope has been identified as an underused procedure. Laparoscopic cholecystectomy is associated with less morbidity in less severe cases.

Relationship to Quality	Laparoscopic cholecystectomy is a new technology with lower risks than open cholecystectomy (removal of the gall bladder). Higher rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Number of laparoscopic cholecystectomies per 100 cholecystectomies.
Numerator	Number of laparoscopic cholecystectomies (any procedure field).
Denominator	All discharges with any procedure code of cholecystectomy in any procedure field. Include only discharges with uncomplicated cases: cholecystitis or cholelithiasis in any diagnosis field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 75.09 per 100 discharges at risk
Empirical Rating	20

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Incidental Appendectomy in the Elderly Rate (IQI 24)

Removal of the appendix incidental to other abdominal surgery—such as urological, gynecological, or gastrointestinal surgeries—is intended to eliminate the risk of future appendicitis and to simplify any future differential diagnoses of abdominal pain.

Relationship to Quality	Incidental appendectomy among the elderly is contraindicated. As such, lower rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Number of incidental appendectomies per 100 elderly with intra-abdominal procedure.
Numerator	Number of incidental appendectomies (any procedure field).
Denominator	All discharges age 65 years and older with intra-abdominal procedure (based on DRGs). Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 2.43 per 100 discharges at risk
Empirical Rating	13

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Bilateral Cardiac Catheterization Rate (IQI 25)

Right-side coronary catheterization incidental to left-side catheterization has little additional benefit for patients without clinical indications for right-side catheterization.

Relationship to Quality	Bilateral catheterization is contraindicated in most patients without proper indications. As such, lower rates represent better quality.
Benchmark	State, regional, or peer-group average.
Definition	Provider level bilateral cardiac catheterizations per 100 discharges with procedure code of heart catheterization.
Numerator	Number of simultaneous right and left heart catheterizations (in any procedure field). Include only coronary artery disease. Exclude valid indications for right-sided catheterization in any diagnosis field, MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Denominator	All heart catheterizations in any procedure field. Include only coronary artery disease. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Type of Indicator	Provider Level, Procedure Utilization Indicator
Empirical Performance	Population Rate: 9.93 per 100 discharges at risk
Empirical Rating	25

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Coronary Artery Bypass Graft Area Rate (IQI 26)

Coronary artery bypass graft (CABG) is performed on patients with coronary artery disease. No ideal rate for CABG has been established.

Relationship to Quality	CABG is an elective procedure that may be overused; therefore, more average rates would represent better quality.
Benchmark	State, regional, or peer group average.
Definition	Number of CABGs per 100,000 population.
Numerator	Number of CABGs in any procedure field. All discharges age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Denominator	Population in MSA or county, age 40 years or older.
Type of Indicator	Area Level, Utilization Indicator
Empirical Performance	Population Rate: 315.03 per 100,000 population at risk
Empirical Rating	19

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Percutaneous Transluminal Coronary Angioplasty Area Rate (IQI 27)

Percutaneous transluminal coronary angioplasty (PTCA) is performed on patients with coronary artery disease. No ideal rate for PTCA has been established.

Relationship to Quality	PTCA has been identified as a potentially overused procedure; therefore, more average rates represent better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of PTCA procedures per 100,000 population.
Numerator	Number of PTCA procedures in any procedure field. All discharges age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Denominator	Population in MSA or county, age 40 years and older.
Type of Indicator	Area Level, Utilization Indicator
Empirical Performance	Population Rate: 528.16 per 100,000 population at risk
Empirical Rating	19

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Hysterectomy Area Rate (IQI 28)

Hysterectomy is performed on patients with a number of indications, such as recurrent uterine bleeding, chronic pelvic pain, or menopause, usually in some combination. No ideal rate for hysterectomy has been established.

Relationship to Quality	Hysterectomy has been identified as a potentially overused procedure; therefore, more average rates represent better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of hysterectomies per 100,000 population.
Numerator	Number of hysterectomies in any procedure field. All discharges of females age 18 years and older. Exclude discharges with genital cancer or pelvic or lower abdominal trauma in any diagnosis field, MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates).
Denominator	Female population in MSA or county age 18 years or older.
Type of Indicator	Area Level, Utilization Indicator
Empirical Performance	Population Rate: 488.29 per 100,000 population at risk
Empirical Rating	22

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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Laminectomy or Spinal Fusion Area Rate (IQI 29)

Laminectomy is performed on patients with a herniated disc or spinal stenosis. No ideal rate for laminectomy has been established.

Relationship to Quality	Laminectomy has been identified as a potentially overused procedure; therefore, more average rates represent better quality care.
Benchmark	State, regional, or peer group average.
Definition	Number of laminectomies or spinal fusions per 100,000 population.
Numerator	Number of laminectomies or spinal fusions in any procedure field. All discharges age 18 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).
Denominator	Population in MSA or county, age 18 years or older.
Type of Indicator	Area Level, Utilization Indicator
Empirical Performance	Population Rate: 250.98 per 100,000 population at risk
Empirical Rating	20

For full documentation on this indicator, see the Guide to the Inpatient Quality Indicators.

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