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Focus on Inpatient Quality
By: Jill Miyamura, Ph.D.
3/9/2009
This section describes quality of care for hospitals compared to the U.S. The Inpatient Quality Indicators (IQIs) are a set of measures that provide a perspective on hospital quality of care using hospital administrative data. These indicators reflect quality of care inside hospitals and include inpatient mortality for certain procedures and medical conditions, and utilization of procedures for which there are questions of overuse, underuse, and misuse. The indicators were developed by investigators at Stanford University and the University of California, under a contract with the Agency of Healthcare Quality and Research (AHRQ).
 
The meter summarizes how Hawaii compares to the U.S. The performance meter score is based on up to 22 measures of quality of care and is reported only if at least 10 measures are available. A state receives a stronger performance meter score as the number of measures for which the state is doing better than the U.S. increases. A state receives a weaker performance meter score as the number of measures for which the state is doing worse than the U.S. increases.
 
The meter is determined by the underlying measure comparisons summarized below:
 

Category

Measure

Hawaii to U.S. Comparison

Mortality Rates for Medical Conditions Number of deaths per 1,000 discharges for acute myocardial infarction (AMI).

n

Number of deaths per 1,000 discharges for AMI, without transfer cases.

n

Number of deaths per 1,000 discharges for congestive heart failure (CHF).

p

Number of deaths per 1,000 discharges for stroke.

q

Number of deaths per 1,000 discharges for gastrointestinal (GI) hemorrhage.

n

Number of deaths per 1,000 discharges for hip fracture.

n

Number of deaths per 1,000 discharges for pneumonia.

n

     
Mortality Rates for Surgical Procedures Number of deaths per 1,000 esophageal resections for cancer.

n

Number of deaths per 1,000 pancreatic resections for cancer.

n

Number of deaths per 1,000 abdominal aortic aneurysm (AAA) repairs.

n

Number of deaths per 1,000 coronary artery bypass graft (CABG) procedures.

n

Number of deaths per 1,000 percutaneous transluminal coronary angioplasty (PTCAs)

n

Number of deaths per 1,000 carotid endarterectomy (CEAs).

n

Number of deaths per 1,000 craniotomies.

q

Number of deaths per 1,000 hip replacements.

n

     
Hospital-level Procedure Utilization Rates Number of Cesarean deliveries per 1,000 deliveries.

p

Number of Cesarean deliveries per 1,000 deliveries, in women with no history of previous Cesarean delivery.

n

Number of vaginal births per 1,000 deliveries in women with previous Cesarean (VBACs).

n

Number of vaginal births per 1,000 deliveries in women with history of previous Cesarean delivery (VBACs).

n

Number of laparoscopic cholecystectomies per 1,000 cholecystectomies.

p

Number of incidental appendectomies per 1,000 abdominal surgeries.

n

Number of bilateral catheterizations per 1,000 cardiac catheterizations.

p

     
* These Inpatient Quality Indicators reflect quality of care inside hospitals. With the exception of the following measures, a higher number rate signals poorer quality of care.  For the following utilization measures, a lower rate signals poorer quality of care: VBACs and laparoscopic cholecystectomies. Please refer to the accompanying data tables for specific rates.
     
State to U.S. Comparison of Disparity:
p indicates that the State/hospital is performing better than the U.S. (i.e., State/hospital rate is smaller than the U.S.); better is defined as statistically better than the U.S. comparison (p<0.05) for two of the three years represented in this study (CY 2005-CY2007).
n indicates that the State/hospital is performing similar to the U.S. (i.e., State/hospital rate is similar to the U.S.); this symbol reflects rates that are not statistically significant (compared to the US) for 2 of the past 3 years(CY 2005-CY2007).
q indicates that the State/hospital is performing worse than the U.S. (i.e., State/hospital is larger than in the U.S.); worse is defined as statistically worse than the U.S. comparison (p<0.05) for two of the three years represented in this study (CY 2005-CY2007).
     

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