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  • Measure Summary
  • NQMC:011029
  • Mar 2016

Esophageal resection mortality: percentage of in-hospital deaths per 1,000 discharges with esophageal resection for cancer, ages 18 years and older.

AHRQ Quality Indicators™ (AHRQ QI™) ICD-9-CM and ICD-10-CM/PCS specification version 6.0. Inpatient Quality Indicator 08 (IQI 08) esophageal resection mortality rate. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2016 Mar. 25 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: AHRQ QI research version 5.0. Inpatient quality indicator 8 technical specifications: esophageal resection mortality rate. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2015 Mar. 2 p.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of in-hospital deaths per 1,000 discharges with esophageal resection for cancer, ages 18 years and older.

Rationale

Esophageal resection is a complex cancer surgery. In 1996, 265 hospitals (19.7 percent of providers) performed at least 1 procedure. Of these hospitals, the mean number of procedures was 2; the median was 1; and the 90th and 95th percentiles were 4 and 6, respectively. In general, there are a moderate number of hospitals with lower volumes and a few hospitals with much higher volumes. Overall procedure volume was stable over the 2008 time period.

Several studies have noted that providers with higher volumes have lower mortality rates for the procedure than providers with lower volumes. This suggests that perhaps providers with higher volumes have some characteristics, either structurally or with regard to processes that influence mortality after this procedure. However, if these characteristics do indeed exist, what they are is unclear.

Note: The following caveats affect the validity of the indicator:

  • Confounding Bias: Patient characteristics may substantially affect the performance of the indicator; risk adjustment is recommended. The concern is theoretical or suggested, but no specific evidence was found in the literature.
  • Unclear Construct: There is uncertainty or poor correlation with widely accepted process measures. The concern is theoretical or suggested, but no specific evidence was found in the literature.

Evidence for Rationale

Davies GM, Geppert J, McClellan M, et al, UCSF-Stanford Evidence-based Practice Center. Refinement of the HCUP quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2001 May.  (Technical review; no. 4). 

Desoto M. (Center for Delivery, Organization, and Markets [CDOM]. Agency for Healthcare Research and Quality [AHRQ]. Rockville, MD). Personal communication. 2017 Feb 16.  1 p.

Primary Health Components

Esophageal cancer; gastrointestinal-related cancer; esophageal resection; total gastrectomy; death

Denominator Description

Discharges, for patients ages 18 years and older, with either:

  • Any-listed International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) procedure codes for esophageal resection and any-listed ICD-9-CM or International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for esophageal cancer; or
  • Any-listed ICD-9-CM or ICD-10-PCS procedure codes for esophageal resection and any-listed ICD-9-CM or ICD-10-CM diagnosis codes for gastrointestinal-related cancer; or
  • Any-listed ICD-9-CM or ICD-10-PCS procedure codes for total gastrectomy and any-listed ICD-9-CM or ICD-10-CM diagnosis codes for esophageal cancer

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

Number of deaths (DISP=20) among cases meeting the inclusion and exclusion rules for the denominator

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Refer to Refinement of the HCUP Quality Indicators for measure testing information.

Evidence for Extent of Measure Testing

Davies GM, Geppert J, McClellan M, et al, UCSF-Stanford Evidence-based Practice Center. Refinement of the HCUP quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2001 May.  (Technical review; no. 4). 

State of Use

Current routine use

Current Use

Internal quality improvement

Public reporting

Measurement Setting

Hospital Inpatient

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

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Safety

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Discharges, for patients ages 18 years and older, with either

  • Any-listed International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) procedure codes for esophageal resection and any-listed ICD-9-CM or International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for esophageal cancer; or
  • Any-listed ICD-9-CM or ICD-10-PCS procedure codes for esophageal resection and any-listed ICD-9-CM or ICD-10-CM diagnosis codes for gastrointestinal-related cancer; or
  • Any-listed ICD-9-CM or ICD-10-PCS procedure codes for total gastrectomy and any-listed ICD-9-CM or ICD-10-CM diagnosis codes for esophageal cancer

Note: Refer to the original measure documentation for ICD-9-CM, ICD-10-PCS, and ICD-10-CM codes.

Exclusions
Exclude cases:

  • Transferring to another short-term hospital (DISP=2)
  • Major Diagnostic Categories (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)

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of deaths (DISP=20) among cases meeting the inclusion and exclusion rules for the denominator

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Type of Health State

Death

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

The predicted value for each case is computed using Generalized Estimating Equation (GEE) logistic regression and covariates for age (in 5-year age groups), All Patient Refined-Diagnosis Related Groups (APR-DRG) and Major Diagnostic Categories (MDC). The expected rate is computed as the sum of the predicted value for each case divided by the number of cases for the unit of analysis of interest (i.e., county or state). The risk adjusted rate is computed using indirect standardization as the observed rate divided by the expected rate, multiplied by the reference population rate. The Smoothed Rate is the risk-adjusted rate shrunken to the volume specific rate and the prior year smoothed rate.

Refer to Inpatient Quality Indicators (IQI) Parameter Estimates ICD-9-CM Version 6.0 in the "Companion Documents" field for additional information.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

IQI 8: esophageal resection mortality rate.

Measure Collection Name

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators

Measure Set Name

Inpatient Quality Indicators

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 Indicator (QI) measures are developed by a team of clinical and measurement experts in collaboration with AHRQ. The AHRQ QIs are continually updated as a result of new research evidence and validation efforts, user feedback, guidance from the National Quality Forum (NQF), and general advances in the science of quality measurement.

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Mar

Measure Maintenance

Measure is reviewed and updated on a yearly basis

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: AHRQ QI research version 5.0. Inpatient quality indicator 8 technical specifications: esophageal resection mortality rate. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2015 Mar. 2 p.

Source(s)

AHRQ Quality Indicators™ (AHRQ QI™) ICD-9-CM and ICD-10-CM/PCS specification version 6.0. Inpatient Quality Indicator 08 (IQI 08) esophageal resection mortality rate. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2016 Mar. 25 p.

Measure Availability

Source available from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) Web site External Web Site Policy.

For more information, contact the AHRQ QI Support Team at 5600 Fishers Lane, Rockville, MD 20857; E-mail: QIsupport@ahrq.hhs.gov; Phone: 301-427-1949.

Companion Documents

The following are available:

  • Davies GM, Geppert J, McClellan M, et al, UCSF-Stanford Evidence-based Practice Center. Refinement of the HCUP quality indicators. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2001 May. (Technical review; no.4). This document is available from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Inpatient quality indicators (IQI) parameter estimates ICD-9-CM version 6.0. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2017 Mar. 66 p. This document is available from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Inpatient quality indicators ICD-9-CM benchmark data tables version 6.0. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2017 Mar. 28 p. This document is available from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Inpatient quality indicators (IQI) log of ICD-9-CM, ICD-10-CM/PC, and DRG coding updates and revisions to IQI documentation and software version 6.0. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2017 Mar. 48 p. This document is available from the AHRQ Quality Indicators Web site External Web Site Policy.
  • AHRQ quality indicators. Inpatient quality indicators composite measure workgroup. Final report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Mar. various p. This document is available from the AHRQ Quality Indicators Web site External Web Site Policy.
  • HCUPnet: a tool for identifying, tracking, and analyzing national hospital statistics. [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [accessed 2017 Mar 24]. HCUPnet is available from the AHRQ Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on December 4, 2002. The information was verified by the Agency for Healthcare Research and Quality on December 26, 2002.

This NQMC summary was updated by ECRI on April 7, 2004, August 19, 2004, and 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 on August 27, 2010.

This NQMC summary was reviewed and edited by ECRI Institute on July 13, 2011.

This NQMC summary was retrofitted into the new template on July 14, 2011.

This NQMC summary was updated by ECRI Institute on March 25, 2013 and December 9, 2015. The information was verified by the measure developer on February 16, 2016.

This NQMC summary was updated again by ECRI Institute on April 10, 2017. The information was verified by the measure developer on May 3, 2017.

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