Quality Indicator Definitions


CareChex® provides a comprehensive evaluation of hospital quality performance using a variety of process of care, outcomes of care, and patient satisfaction measures identified below.

Process of Care Measures

  1. Heart Attack (for Cardiac Care, Overall Medical Care, Overall Hospital Care)

    Percent of Heart Attack Patients Given Aspirin at Arrival Aspirin can help keep blood clots from forming and dissolve blood clots that can cause heart attacks.
    Percent of Heart Attack Patients Given Aspirin at Discharge Taking aspirin may help prevent further heart attacks.
    Percent of Heart Attack Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD) ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat heart attacks, heart failure, or a decreased function of the heart.
    Percent of Heart Attack Patients Given Smoking Cessation Advice/Counseling Smoking is linked to heart attacks. Quitting may help prevent another heart attack.
    Percent of Heart Attack Patients Given Beta Blocker at Discharge Beta blockers are a type of medicine used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack.
    Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival Blood clots can cause heart attacks. Doctors may give this medicine, or perform a procedure to open the blockage, and in some cases, may do both.
    Percent of Heart Attack Patients Given PCI Within 90 Minutes Of Arrival The procedures called Percutaneous Coronary Interventions (PCI) are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both.
    Source: CMS Hospital Compare

  2. Heart Failure (for Cardiac Care, Overall Medical Care, Overall Hospital Care)

    Percent of Heart Failure Patients Given Discharge Instructions The staff at the hospital should provide you with information to help you manage your heart failure symptoms when you are discharged.
    Percent of Heart Failure Patients Given an Evaluation of Left Ventricular Systolic (LVS) Function An evaluation of the LVS function checks how the left chamber of the heart is pumping.
    Percent of Heart Failure Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD) ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat heart attacks, heart failure, or a decreased function of the heart.
    Percent of Heart Failure Patients Given Smoking Cessation Advice/Counseling Smoking is linked to heart failure. Quitting may help improve your condition.
    Source: CMS Hospital Compare

  3. Pneumonia (for Respiratory Care, Overall Medical Care, Overall Hospital Care)

    Percent of Pneumonia Patients Given Oxygenation Assessment Having enough oxygen in your blood is important to your health.
    Percent of Pneumonia Patients Assessed and Given Pneumococcal Vaccination A pneumonia (pneumococcal) shot can help prevent pneumonia in the future, even for patients who have been hospitalized for pneumonia.
    Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics A blood culture tells what kind of medicine will work best to treat your pneumonia.
    Percent of Pneumonia Patients Given Smoking Cessation Advice/Counseling Smoking is linked to pneumonia. Quitting may help prevent you from getting pneumonia again.
    Percent of Pneumonia Patients Given Initial Antibiotic(s) within 6 Hours After Arrival Timely use of antibiotics can improve the treatment of pneumonia caused by bacteria.
    Percent of Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s) Antibiotics are medicines that treat infection, and each one is different. Hospitals should choose the antibiotics that best treat the infection type for each pneumonia patient.
    Percent of Pneumonia Patients Assessed and Given Influenza Vaccination An influenza shot can help prevent influenza in the future, even for patients who have been hospitalized for pneumonia.
    Source: CMS Hospital Compare

  4. Surgical Care (for Overall Hospital Care, Overall Surgical Care)

    Percent of Surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries Certain types of surgery can increase patients’ risk of having blood clots after surgery. For these types of surgery, this measure tells how often treatment to help prevent blood clots was ordered by the doctor.
    Percent of Patients who got treatment at the right time (within 24 hours before or after their surgery) to help prevent blood clots after certain types of surgery This measure tells how often patients having certain types of surgery received treatment to prevent blood clots in the period from 24 hours before surgery to 24 hours after surgery.
    Percent of Surgery patients whose preventive antibiotics were stopped at the right time (within 24 hours after surgery) Taking preventive antibiotics for more than 24 hours after routine surgery is usually not necessary. This measure shows how often hospitals stopped giving antibiotics to surgery patients when they were no longer needed to prevent surgical infection.
    Percent of all heart surgery patients whose blood sugar (blood glucose) is kept under good control in the days right after surgery All heart surgery patients get their blood sugar checked after surgery. Any patient who has high blood sugar after heart surgery has a greater chance of getting an infection. This measure tells how often the blood sugar of heart surgery patients was kept under good control in the days right after their surgery.
    Percent of Surgery patients needing hair removed from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream – not a razor) For those patients who needed to have hair removed to prepare for surgery, this measure tells how often one of the safer methods was used (electric clippers or hair removal cream).
    Percent of Surgery patients who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection Getting an antibiotic within one hour before surgery reduces the risk of wound infections. This measure shows how often hospital staff make sure surgery patients get antibiotics at the right time.
    Percent of Surgery patients who were given the right kind of antibiotic to help prevent infection Some antibiotics work better than others to prevent wound infections for certain types of surgery. This measure shows how often hospital staff make sure patients get the right kind of preventive antibiotic medication for their surgery.
    Source: CMS Hospital Compare

Outcomes of Care Measures

  1. Overall Mortality (for all diagnoses/procedures in the clinical category)
  2. Overall Complications (for all diagnoses/procedures in the clinical category)
  3. Inpatient Quality Indicators (for select clinical categories) which include specific mortality rates for:
    • Acute myocardial infarction (for Cardiac Care)
    • AMI, Without Transfer Cases (for Cardiac Care)
    • Congestive heart failure (for Cardiac Care)
    • Stroke (for Neurological Care)
    • Gastrointestinal hemorrhage (for Overall Medical Care)
    • Hip fracture (for Major Orthopedic Surgery)
    • Pneumonia (for Respiratory Care)
    • Esophageal resection (for Overall Surgical Care)
    • Pancreatic resection (for General Surgery)
    • Abdominal aortic aneurysm repair (for Overall Surgical Care)
    • Coronary artery bypass graft (for Major Cardiac Surgery)
    • Percutaneous transluminal coronary angioplasty (for Cardiac Care)
    • Carotid endarterectomy (for Major Neuro-Surgery)
    • Craniotomy (for Major Neuro-Surgery)
    • Hip replacement (for Major Orthopedic Surgery)
  4. Patient Safety Indicators (relevant indicators screened for each clinical category)
    • Failure to rescue (failed to diagnose and treat in time)
    • Decubitus ulcer (bed sores)
    • Foreign body left in during procedure
    • Iatrogenic pneumothorax (punctured lung as a result of hospital care)
    • Selected infections due to medical care
    • Postoperative hip fracture
    • Postoperative hemorrhage or hematoma
    • Postoperative physiologic and metabolic derangements
    • Postoperative respiratory failure
    • Postoperative pulmonary embolism or deep vein thrombosis (blood clots)
    • Postoperative sepsis (blood poisoning)
    • Postoperative wound dehiscence in abdominopelvic surgical patients (wound opens, or comes apart, after it was surgically closed)

Patient Satisfaction Measures*

  1. Overall Hospital Rating
    • Hospital rating on a scale of 1 to 10 (with "10" being the best)
    • Would recommend hospital to a friend or family member
  2. Doctor Communication
  3. Nurse Communication
  4. Staff Responsiveness
  5. Medication Explanation
  6. Pain Control
  7. Hospital Environment
    • Quietness (Use % of Patients Responding "Always Quiet at Night")
    • Cleanliness (Use % of Patients Responding "Room was Always Clean")
  8. Given Post-Discharge Information

* Evaluated for clinical categories of Overall Hospital Care, Overall Medical Care, and Overall Surgical Care