Title
Abdominal aortic aneurysm (AAA) repair: volume.
Source(s)
| AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p. |
| AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 4.2]. IQI #4 abdominal aortic aneurysm (AAA) repair volume. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 1 p. |
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Primary Measure Domain
Clinical Quality Measures: Structure
Secondary Measure Domain
Clinical Quality Measure: Outcome
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Description
This measure is used to assess the raw volume of provider-level abdominal aortic aneurysm (AAA) repair (surgical procedure).
As a volume indicator, AAA repair is a proxy measure for quality and should be used with other indicators.
Rationale
About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.
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. Higher volumes have been associated with better outcomes, which represent better quality.
Note:
The following caveats were identified from the literature review for the "Abdominal Aortic Aneurysm Repair Volume" indicator:
- Proxyb: Indicator does not directly measure patient outcomes but an aspect of care that is associated with the outcome; thus, it is best used with other indicators that measure similar aspects of care.
- Easily manipulateda: Use of the indicator may create perverse incentives to improve performance on the indicator without truly improving quality of care.
Refer to the original measure documentation for further details.
a - The concern is theoretical or suggested, but no specific evidence was found in the literature.
b - Indicates that the concern has been demonstrated in the literature.
Evidence for Rationale
| AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p. |
Primary Health Components
Abdominal aortic aneurysm (AAA) repair; procedure volume
Denominator Description
This measure applies to providers of abdominal aortic aneurysm (AAA) repair (one provider at a time).
Numerator Description
Discharges, age 18 years and older, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for abdominal aortic aneurysm (AAA) repair procedure and a primary or secondary diagnosis of AAA in any field
Exclude cases:
- Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
Note: Refer to the Technical Specifications document for specific ICD-9-CM codes.
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Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
- Abdominal aortic aneurysm (AAA) repair is an uncommon cardiovascular procedure--only 48,600 were performed in the United States in 1997.
Evidence for Additional Information Supporting Need for the Measure
| HCUPnet. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2004 [accessed 2007 May 21]. [Various pagings]. |
Extent of Measure Testing
Each potential quality indicator was evaluated against the following six criteria, which were considered essential for determining the reliability and validity of a quality indicator: face validity, precision, minimum bias, construct validity, fosters real quality improvement, and application. The project team searched Medline for articles relating to each of these six areas of evaluation. Additionally, extensive empirical testing of all potential indicators was conducted using the 1995-97 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and Nationwide Inpatient Sample (NIS) to determine precision, bias, and construct validity. Table 2 in the original measure documentation summarizes the results of the literature review and empirical evaluations on the Inpatient Quality Indicators. Refer to the original measure documentation for details.
Evidence for Extent of Measure Testing
| AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p. |
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State of Use of the Measure
State of Use
Current routine use
Current Use
External oversight/State government program
Internal quality improvement
Quality of care research
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Application of the Measure in its Current Use
Measurement Setting
Hospitals
Professionals Involved in Delivery of Health Services
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Does not apply to this measure
Target Population Age
Does not apply to this measure
Target Population Gender
Does not apply to this measure
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National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
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Institute of Medicine (IOM) National Health Care Quality Report Categories
IOM Care Need
Not within an IOM Care Need
IOM Domain
Not within an IOM Domain
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Data Collection for the Measure
Case Finding Period
Does not apply to this measure
Denominator Sampling Frame
Health care or public health organization
Denominator (Index) Event or Characteristic
Health Care/Public Health Organization Characteristic
Denominator Inclusions/Exclusions
Inclusions
This measure applies to providers of abdominal aortic aneurysm (AAA) repair (one provider at a time).
Exclusions
Unspecified
Exclusions/Exceptions
Does not apply to this measure
Numerator Inclusions/Exclusions
Inclusions
Discharges, age 18 years and older, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for abdominal aortic aneurysm (AAA) repair procedure and a primary or secondary diagnosis of AAA in any field
Note: Refer to the Technical Specifications document for specific ICD-9-CM codes.
Exclusions
Exclude cases:
- Major Diagnostic Category (MDC) 14 (pregnancy, childbirth, and puerperium)
Numerator Search Strategy
Institutionalization
Data Source
Administrative clinical data
Type of Health State
Proxy for Outcome
Instruments Used and/or Associated with the Measure
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Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Does not apply to this measure
Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison
Prescriptive standard
Prescriptive Standard
Benchmark:
- Threshold 1: 10 or more procedures per year
- Threshold 2: 32 or more procedures per year
Evidence for Prescriptive Standard
Hannan EL, Kilburn H Jr, O'Donnell JF, Bernard HR, Shields EP, Lindsey ML, Yazici A. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed. Health Serv Res 1992 Oct;27(4):517-42. PubMed  |
| Kazmers A, Jacobs L, Perkins A, Lindenauer SM, Bates E. Abdominal aortic aneurysm repair in Veterans Affairs medical centers. J Vasc Surg 1996 Feb;23(2):191-200. PubMed |
| Nationwide inpatient sample and state inpatient databases. Healthcare Cost and Utilization Project (HCUP). [database]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 1995-1997. [Various pagings]. |
| Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, Lipsett PA, Bass E. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery . JAMA 1999 Apr 14;281(14):1310-7. |
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Original Title
IQI 4 abdominal aortic aneurysm (AAA) repair volume.
Submitter
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
Developer
Agency for Healthcare Research and Quality - Federal Government Agency [U.S.]
Funding Source(s)
Agency for Healthcare Research and Quality (AHRQ)
Composition of the Group that Developed the Measure
The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators are in the public domain and the specifications come from multiple sources, including the published and unpublished literature, users, researchers, and other organizations. AHRQ as an agency is responsible for the content of the indicators.
Financial Disclosures/Other Potential Conflicts of Interest
Endorser
National Quality Forum
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2010 Sep
Date of Next Anticipated Revision
Measure Status
Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.
Source(s)
| AHRQ quality indicators. Guide to inpatient quality indicators: quality of care in hospitals - volume, mortality, and utilization [version 3.1]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Mar 12. 91 p. |
| AHRQ quality indicators. Inpatient quality indicators: technical specifications [version 4.2]. IQI #4 abdominal aortic aneurysm (AAA) repair volume. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2010 Sep. 1 p. |
Measure Availability
The individual measure, "Abdominal Aortic Aneurysm (AAA) Repair Volume (IQI 4)," is published in "AHRQ Quality Indicators. Guide to Inpatient Quality Indicators: Quality of Care in Hospitals -- Volume, Mortality, and Utilization" and "AHRQ Quality Indicators. Inpatient Quality Indicators: Technical Specifications." Updated versions of these documents are available in Portable Document Format (PDF) from the Inpatient Quality Indicators Resources page at the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Web site.
For more information, please contact the QI Support Team at support@qualityindicators.ahrq.gov.
NQMC Status
This NQMC summary was completed by ECRI on August 19, 2004. The information was verified by the measure developer on October 13, 2004. This NQMC summary was updated by ECRI on March 4, 2005. The information was verified by the measure developer on April 22, 2005. This NQMC summary was updated by ECRI Institute on August 17, 2006, on May 29, 2007, on October 20, 2008 and again on August 27, 2010. This NQMC summary was reviewed and edited by ECRI on July 13, 2011. This NQMC summary was retrofitted into the new template on July 14, 2011.
Copyright Statement
No copyright restrictions apply.
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