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 Overall Medical Care & Overall Hospital Care)

    Percent of Heart Attack Patients Given Aspirin at Discharge Taking aspirin may help prevent further heart attacks.
    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.
    Percent of Heart Attack Patients Given a Prescription for a Statin at Discharge For patients who have had one or more heart attacks and have high cholesterol, taking Statins can lower the chance that they’ll have another heart attack or die.
    Source: CMS Hospital Compare
  2. Children's Asthma Care (for Overall Hospital Care & Overall Medical Care)

    Percent of Children Who Received Reliever Medication While Hospitalized for Asthma There is evidence that established guidelines for therapy are not being consistently followed. Using the appropriate medications will lower the risk of severe illness and/or death.
    Percent of Children Who Received Systemic Corticosteroid Medication (Oral and IV Medication that Reduces Inflammation and Controls Symptoms) While Hospitalized for Asthma Oral or IV steroid medications work in the body as a whole, rather than just on the lungs. They help reduce inflammation and control allergic reactions.
    Percentage of Children and their caregivers who received a home management plan of care document while hospitalized for asthma There is evidence that self-management of asthma by the patient or caregiver leads to more positive outcomes. Appropriate self-management is completely reliant upon patient education. Patient education is more effective when it aims at training self-management skills that will alter behavior.
    Source: CMS Hospital Compare
  3. Heart Failure (for 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.
    Source: CMS Hospital Compare
  4. Outpatient (for Overall Hospital Care & Overall Medical Care)

    Percent of Outpatients with Chest Pain or Possible Heart Attack who got Aspirin Within 24 Hours of Arrival Blood clots can cause heart attacks. For many patients having a heart attack, taking aspirin soon after symptoms of a heart attack begin may help break up a clot and make the heart attack less severe. If patients have not taken aspirin themselves before going to the hospital, they should get aspirin when they arrive.
    Percent of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival People who suffer from strokes need to receive treatment immediately to lessen the amount of brain damage that occurs with any stroke. Before treatment can be provided, a scan of the brain must be taken to determine the type and severity of the stroke. Long waits may be a sign that the emergency department is understaffed or overcrowded and can lead to delayed diagnosis and treatment.
    Source: CMS Hospital Compare
  5. Outpatient (for Overall Hospital Care & Overall Surgical Care)

    Percent of Outpatients Having Surgery who got an Antibiotic at the Right Time - Within One Hour Before Surgery Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections.
    Percent of Outpatients having Surgery Who got the Right Kind of Antibiotic Hospitals can prevent surgical wound infections. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery
    Source: CMS Hospital Compare
  6. Perinatal Care (for Overall Hospital Care & Overall Surgical Care)

    Percent of mothers whose deliveries were scheduled too early (1-2 weeks early), when a scheduled delivery was not medically necessary Most elective deliveries are performed for convenience and result in significant short term neonatal morbidity.
    Source: CMS Hospital Compare
  7. Pneumonia (for Overall Medical Care & Overall Hospital Care)

    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.
    Source: CMS Hospital Compare
  8. Preventative Care (for Overall Hospital Care & Overall Medical Care)

    Percent of patients assessed and given influenza vaccination There are over 200,000 hospitalizations from the flu on average every year. An average of 36,000 Americans die annually due to the flu and its complications. The best way to prevent the flu is to get a flu shot each year during the Fall season.
    Source: CMS Hospital Compare
  9. Stroke (for Overall Hospital Care & Overall Surgical Care)

    Ischemic or hemorrhagic stroke patients who received treatment to keep blood clots from forming anywhere in the body within 2 days of hospital admission Stroke patients are at increased risk of developing venous thromboembolism (VTE). Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines.
    Ischemic stroke patients who received a prescription for medicine known to prevent complications caused by blood clots at discharge Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.
    Ischemic stroke patients with a type of irregular heartbeat who were given a prescription for a blood thinner at discharge The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.
    Ischemic stroke patients who got medicine to break up a blood clot within 3 hours after symptoms started The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.
    Ischemic stroke patients who received medicine known to prevent complications caused by blood clots within 2 days of hospital admission Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.
    Ischemic stroke patients needing medicine to lower bad cholesterol, who were given a prescription for this medicine at discharge The administration of intensive lipid lowering therapy using statin medication was associated with a dramatic reduction in the rate of recurrent ischemic stroke and major coronary events.
    Ischemic or hemorrhagic stroke patients or caregivers who received written educational materials about stroke care and prevention during the hospital stay Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services.
    Ischemic or hemorrhagic stroke patients who were evaluated for rehabilitation services A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services.
    Source: CMS Hospital Compare
  10. Surgical Care (for Overall Hospital Care & Overall Surgical Care)

    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 Surgery Patients Who were Given the Right Kind of Antibiotic to Help Prevent Infection Surgical wound infections can be prevented. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery.
    Percent of Surgery Patients Whose Urinary Catheters were Removed on the First or Second Day after Surgery. Surgery patients can develop infections when urinary catheters are left in place too long after surgery. Infections are dangerous for patients, cause longer hospital stays, and increase costs.
    Percent of Surgery Patients Who were Actively Warmed in the Operating Room or Whose Body Temperature was Near Normal by the End of Surgery. Hospitals can prevent surgical wound infections and other complications by keeping the patient’s body temperature near normal during surgery. Medical research has shown that patients whose body temperatures drop during surgery have a greater risk of infection and their wounds may not heal as quickly.
    Source: CMS Hospital Compare
  11. Venous Thromboembolism (for Overall Hospital Care)

    Patients who got treatment to prevent blood clots on the day of or day after hospital admission or surgery Updated “safe practices” recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis.
    Patients who got treatment to prevent blood clots on the day of or day after being admitted to the intensive care unit (ICU) It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors.
    Patients with blood clots who got the recommended treatment, which includes using two different blood thinner medicines at the same time The current recommendation for treatment of confirmed VTE to begin with oral warfarin therapy, with combination of initial anticoagulation therapy for a minimum of 5 days and until the INR is >2.0 for at least 24 hours, and then a recommended target rate.
    Patients with blood clots who were treated with an intravenous blood thinner, and then were checked to determine if the blood thinner caused unplanned complications Prompt recognition of Heparin-induced thrombocytopenia is important so that heparin can be discontinued and the risk of venous and arterial thrombosis minimized.
    Patients with blood clots who were discharged on a blood thinner medicine and received written instructions about that medicine Anticoagulation therapy poses risks to patients due to complex dosing, requisite follow-up monitoring and inconsistent patient compliance. The use of standardized practices for anticoagulation therapy that includes patient/caregiver involvement may reduce the risk of adverse drug events.
    Patients who developed a blood clot while in the hospital who did not get treatment that could have prevented it Preventable VTE is defined as “objectively diagnosed Deep Vein Thrombosis (DVT) or Pulmonary Emboli (PE) that occurred in a setting in which thromboprophylaxis was indicated but was either administered inadequately or not administered at all.”
    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 (relevant indicators screened for each clinical category)
    • Acute myocardial infarction
    • AMI, Without Transfer Cases
    • Congestive heart failure
    • Stroke
    • Gastrointestinal hemorrhage
    • Hip fracture
    • Pneumonia
    • Esophageal resection
    • Pancreatic resection
    • Abdominal aortic aneurysm repair
    • Coronary artery bypass graft
    • Percutaneous transluminal coronary angioplasty
    • Carotid endarterectomy
    • Craniotomy
    • Hip replacement
  4. Patient Safety Indicators (relevant indicators screened for each clinical category)
    • Pressure 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 respiratory failure
    • Postoperative pulmonary embolism or deep vein thrombosis (blood clots)
    • Postoperative sepsis (blood poisoning)

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
  9. Care Transition

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