1. Healthcare

NATIONAL PERINATAL
INFORMATION CENTER
QUALITY ANALYTIC SERVICES
225 Chapman Street, Suite 200
Providence, RI 02905
Phone: 401-274-0650
Fax: 401-455-0377
www.npic.org
January 12, 2015
Dear Colleague,
The National Perinatal Information Center/Quality Analytic Services (NPIC/QAS) is pleased to provide
you with Volume 14.2 of our 2014 Quarterly Reports. The report includes extensive tables and graphs
displaying utilization, outcome and quality trends for the period 2009-2014 (Q2). As a reminder, the
Trend Data Base is made up of only those hospitals that have been NPIC/QAS members for the entire
trend period. If your hospital has not been a member for all five years, your data will be displayed for
those years for which you have been a member.
Appendices D-K, which reference the calculation algorithms, are being sent as a separate
attachment to the report.
The V.14.2 Quarterly Report distribution also includes the new NPIC/QAS Perinatal Quality
Improvement Dashboard and a special report, Postpartum Hemorrhage, an analysis of risk factors,
incidence and complications of postpartum hemorrhage.
The Perinatal Quality Improvement Dashboard was introduced as a special report last quarter and the
response was overwhelmingly positive. We are now issuing this Report as a standard part of your
quarterly report distribution and look forward to your continuing comments and feedback. Last quarter,
there were a number of recommendations regarding other metrics to display. The format/display of the
V14.2 Dashboard is the same as last quarter; however, we are considering adding or retiring metrics as
this Report evolves.
NPIC/QAS QUARTERLY COMPARATIVE REPORT
WEBINAR UPDATE
The Webinars scheduled for January 27th and 29th will feature a
review of the Postpartum Hemorrhage special report and will include
a discussion of postpartum hemorrhage protocols and quality
improvement initiatives with participating hospitals.
Please see links on following page to register for one of the quarterly webinars.
The NPIC/QAS Member Webinar/Conference Calls for V14.2 will be held on Tuesday, January 27,
2015 at 3:00pm-4:15pm ET and Thursday, January 29, 2015 at 11:30am-12:45pm ET. There is one
Webinar/Conference Call scheduled each day. The registration links below differ for each meeting.
If you did not register for a webinar when you received the Save the Date notice, use the links below to
register for the webinar of your choice. You must complete a registration form in order to participate
in either of the webinar/conference calls.
January 27, 2015 at 3:00pm-4:15pm (ET)
https://cc.readytalk.com/r/usaafm8grvh3&eom
January 29, 2015 at 11:30am-12:45pm (ET)
https://cc.readytalk.com/r/327o08xmor6j&eom
Once you register, meeting details will be provided in your confirmation email. If you will not have access to
the internet, you are encouraged to participate in the audio portion. Call-in details are provided here:
Phone: 866-740-1260 Phone Access Code: 5041508
The webinars will be recorded and made available for access at a later date.
If you are not familiar with our quarterly reports, we are happy to arrange a separate call with
you and your colleagues to review the data for your hospital. Please contact [email protected]
for assistance with scheduling a call.
If you have any questions, please do not hesitate to call either one of us at 401-274-0650 or e-mail to the
addresses listed below.
Sincerely,
Janet H. Muri
President
[email protected]
Ext. 105
Sandra A. Boyle
Director of Membership Services
[email protected]
Ext. 108
NPIC/QAS
QUARTERLY REPORT PACKAGE
For V.14.2
Date Range 7/1/13-6/30/14
Comparative Reports
(Confidential)
"This report is proprietary and confidential and constitutes valuable information that must be held in strict confidence. These data are not to be reproduced for use in
publication or promotion and are for use solely within its own institution and for its own business purpose only unless written permission has been granted from the "National
Perinatal Information Center" - © 2015. NPIC/QAS and their respective agents and employees shall not be held responsible or liable for any error, inaccuracy or omission in
any report or analysis prepared in connection with the Quarterly Report Package or any damage (including but not limited to consequential damages) resulting therefrom or
resulting from the member's use or inability to use its Quarterly Report Package.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
TABLE OF CONTENTS
PAGE
INTRODUCTION .................................................................................................................................................................................................................. 1-2
SECTION I: V.14.2 QUARTERLY REPORT OVERVIEW............................................................................................................................................ 3-4
SECTION II: OBSTETRICAL CLINICAL REPORT ..................................................................................................................................................... 5-7
Table OB 1:
Comparative Facility, Subgroup and Database Overview ................................................................................................................... 8
Table OB 2:
APR-MDC 14 Pregnancy, Childbirth and the Puerperium .................................................................................................................. 9
Table OB 2a:
Deliveries by APR DRG Subclass ..................................................................................................................................................... 10
Table OB 3:
MDC 14 Cases by MS DRG ......................................................................................................................................................... 11-12
Table OB 4:
Delivery Analysis ............................................................................................................................................................................... 13
Graph OB 4a: Comparative C-Section Rates: ........................................................................................................................................................... 14
Table OB 5:
Obstetrical Trend Analysis 2009-2014 (Q2) ............................................................................................................................... 15-16
Graph OB 5a: C-Section Deliveries 2009-2014 (Q2) with Trendlines...................................................................................................................... 17
Graph OB 5b: Primary C-Section Deliveries 2009-2014 (Q2) with Trendlines ........................................................................................................ 18
Graph OB 5c: Repeat C-Section Deliveries 2009-2014 (Q2) with Trendlines ......................................................................................................... 19
Table OB 6:
Coded Reasons for C-Sections ........................................................................................................................................................... 20
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Table OB 7:
Distribution of Coded Reasons for Primary and Repeat C-Sections Trend Analysis 2009-2014 (Q2) ............................................. 21
Table OB 8:
Operative Vaginal Deliveries ............................................................................................................................................................. 22
Graph OB 8a: Operative Vaginal Deliveries 2009-2014 (Q2) with Trendlines ........................................................................................................ 23
Table OB 9:
Delivery Analysis by Day of Week .................................................................................................................................................... 24
Graph OB 9a: Induction Rates 2009-2014 (Q2) with Trendlines .............................................................................................................................. 25
SECTION III: NEONATAL CLINICAL REPORT ...................................................................................................................................................... 26-28
Table N 1:
Neonatal Overview (all cases age 0-28 days old at admission) .................................................................................................. 29-31
Graph N1a:
Inborn Twins Birth Analysis 2009-2014 (Q2) with Trendlines ......................................................................................................... 32
Graph N 1b:
Inborn Other Multiples Birth Analysis 2009-2014 (Q2) with Trendlines .......................................................................................... 33
Table N 2:
Inborn Neonatal Analysis by Birthweight Category .......................................................................................................................... 34
Table N 3:
Neonates Transferred In from another hospital 0-28 days old at admission by Birthweight Category ............................................. 35
Table N 4:
Neonatal Trend Analysis By Birthweight Category 2009-2014 (Q2) ................................................................................................ 36
Graph N 4a:
Neonatal Birthweight Analysis 2009-2014 (Q2) with Trendlines: Discharges 500-749 Grams at Admission .................................. 37
Graph N 4b:
Neonatal Birthweight Analysis 2009-2014 (Q2) with Trendlines: Discharges 750-1499 Grams at Admission ................................ 38
Table N 5:
MDC 15 Neonate Analysis by MS DRG ........................................................................................................................................... 39
Table N 6:
Inborns by APR DRG Subclass ......................................................................................................................................................... 40
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Table N 7:
Neonates Transferred In 0-28 days old at Admission by APR DRG Subclass .................................................................................. 41
Table N 8:
Mortality Analysis by Admission Status ............................................................................................................................................ 42
Graph N 8a:
NPIC/QAS Inborn Mortality Rate ≥ 500 Grams ................................................................................................................................ 43
Graph N 8b:
NPIC/QAS Transferred In Mortality Rate ......................................................................................................................................... 44
Table N 9:
Inborn Neonatal Trend Analysis: Deaths by Birthweight Category 2009-2014 (Q2) .................................................................. 45-46
Graph N 9a:
Inborn Neonatal Mortality Analysis (≥ 500 Grams) 2009-2014 (Q2) with Trendlines ..................................................................... 47
Table N 10:
Mortality Analysis by Birthweight Category & Admission Status ............................................................................................... 48-49
SECTION IV: NEONATAL SPECIAL CARE REPORT ............................................................................................................................................ 50-51
Table N 11:
Special Care Analysis......................................................................................................................................................................... 52
Table N 12:
Neonatal Special Care Trend Analysis 2009-2014 (Q2) .................................................................................................................... 53
Graph N 12a:
Special Care Discharges 2009-2014 (Q2) with Trendlines ................................................................................................................ 54
Table N 13:
Special Care Discharges by Birthweight Category ............................................................................................................................ 55
Table N 14:
Special Care Discharges by Discharge Status .................................................................................................................................... 56
Table N 15:
Special Care Analysis: Complications .............................................................................................................................................. 57
Table N 16:
Special Care Analysis: Complication Trends 2009-2014 (Q2) Neonates 500-1499 Grams ............................................................. 58
Graph N 16a:
Special Care Analysis 2009-2014 (Q2) with Trendlines: Proportion of BPD to RDS, Neonates 500-1499 Grams ......................... 59
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Graph N 16b:
Special Care Analysis 2009-2014 (Q2) with Trendlines: NEC Rate, Neonates 500-1499 Grams.................................................... 60
Graph N 16c:
Special Care Analysis 2009-2014 (Q2) with Trendlines: IVH (Grade III or IV) Rate, Neonates 500-1499 Grams......................... 61
SECTION V: PERINATAL QUALITY INDICATORS ............................................................................................................................................... 62-65
Table QM 1:
Maternal Indicators ............................................................................................................................................................................ 66
Table QM 2:
Coded Reasons for Postpartum Readmissions .................................................................................................................................... 67
Graph QM 1a: AHRQ Perinatal Patient Safety Indicator: Obstetric Trauma – Vaginal Deliveries with Instruments (PSI 18) ............................... 68
Graph QM 1b: AHRQ Perinatal Patient Safety Indicator: Obstetric Trauma – Vaginal Deliveries without Instruments (PSI 19) .......................... 69
Graph QM 1c: AHRQ Inpatient Quality Indicator: Cesarean Delivery Rate (IQI 21) .............................................................................................. 70
Graph QM 1d: AHRQ Inpatient Quality Indicator: VBAC Rate Uncomplicated (IQI 22) ....................................................................................... 71
Graph QM 1e: AHRQ Inpatient Quality Indicator: Primary Cesarean Delivery Rate (IQI 33) ................................................................................ 72
Graph QM 1f: AHRQ Inpatient Quality Indicator: VBAC Rate All (IQI 34) .......................................................................................................... 73
Graph QM 1g: NQF Incidence of Episiotomy ............................................................................................................................................................ 74
Graph QM 1h: NPIC/QAS Third & Fourth Degree Perineal Laceration Rate, with Forceps or Vacuum Extractions .............................................. 75
Graph QM 1i: NPIC/QAS Third & Fourth Degree Laceration Rate with Forceps or Vacuum Extraction 2009-2014 (Q2) with Trendlines .......... 76
Graph QM 1j: NPIC/QAS Third & Fourth Degree Perineal Laceration Rate, without Forceps or Vacuum Extractions ......................................... 77
Graph QM 1k: NPIC/QAS Third & Fourth Degree Laceration Rate without Forceps or Vacuum Extraction 2009-2014 (Q2) with Trendlines ..... 78
Graph QM 1l: NPIC/QAS Postpartum Readmission Rate......................................................................................................................................... 79
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Graph QM 1m: NPIC/QAS Postpartum Readmission Rate 2009-2014 (Q2) with Trendlines .................................................................................... 80
Graph QM 1n: NPIC/QAS Postpartum Hemorrhage Rate ......................................................................................................................................... 81
Graph QM 1o: NPIC/QAS Postpartum Hemorrhage Rate 2009-2014 (Q2) with Trendlines .................................................................................... 82
Graph QM 1p: NPIC/QAS Rate of Disruption or Infection of Obstetrical Wound .................................................................................................... 83
Graph QM 1q: NPIC/QAS Rate of Disruption or Infection of Obstetrical Wound 2009-2014 (Q2) with Trendlines ............................................... 84
Graph QM 1r: NPIC/QAS Rate of Vaginal Deliveries Coded with Shoulder Dystocia ............................................................................................ 85
Graph QM 1s: NPIC/QAS Rate of Inductions Resulting in Cesarean Delivery ........................................................................................................ 86
Table QN 1:
Neonatal Indicators ............................................................................................................................................................................ 87
Graph QN 1a: AHRQ Perinatal Patient Safety Indicator: Birth Trauma – Injury to Neonate (PSI 17).................................................................... 88
Graph QN 1b: AHRQ Neonatal Quality Indicator: Neonatal Mortality (NQI 02) ................................................................................................... 89
Graph QN 1c
AHRQ Neonatal Quality Indicator: Neonatal Bloodstream Infection (NQI 03) ............................................................................... 90
Graph QN 1d: The Joint Commission Perinatal Care: Health Care Associated Bloodstream Infections in Newborns (PC 04) .............................. 91
Table QN 2:
NQF Unexpected Newborn Complications (UNC) (NQF #716 “Healthy Term Newborn”) ............................................................ 92
Graph QN 2a: Comparative Unexpected Newborn Complication Rates ................................................................................................................... 93
Table QN 3:
Coded Reasons for Inborn Readmissions ........................................................................................................................................... 94
Graph QN3a:
NPIC/QAS Inborn Readmission Rate ................................................................................................................................................ 95
Table QN 4:
NPIC/QAS Total Inborn Birth Trauma Rate 2009-2014 (Q2) .......................................................................................................... 96
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Graph QN 4a: NPIC/QAS Total Inborn Birth Trauma Rate 2009-2014 (Q2) with Trendlines ................................................................................. 97
Table QL 1:
Linked Mother / Baby Indicators ....................................................................................................................................................... 98
Graph QL 1a: Vaginal Deliveries with Coded Shoulder Dystocia Linked to an Inborn ≥ 2500 Grams with Birth Trauma..................................... 99
Graph QL 1b: Coded Maternal Conditions with Neonatal Special Care Admission: Hypertension ...................................................................... 100
Graph QL 1c: Coded Maternal Conditions with Neonatal Special Care Admission: Diabetes Mellitus ............................................................... 101
Graph QL 1d: Coded Maternal Conditions with Neonatal Special Care Admission: Obesity ............................................................................... 102
Graph QL 1e: Coded Maternal Conditions with Neonatal Special Care Admission: Thyroid Dysfunction .......................................................... 103
Graph QL 1f:
Primary Cesarean Deliveries ≥ 37 Weeks with Neonatal Special Care Admission ......................................................................... 104
Graph QL 1g: Repeat Cesarean Deliveries ≥ 37 Weeks with Neonatal Special Care Admission ........................................................................... 105
APPENDICES A – C ................................................................................................................................................................................................ 106
A.
All Patient Refined DRGs V.31- Perinatal ................................................................................................................................................ 107-108
B.
Glossary of Terms and Definitions ............................................................................................................................................................ 109-110
C.
Data Screens ..................................................................................................................................................................................................... 111
=======NPIC/QAS ANALYTIC REPORT V.14.2
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Introduction
The National Perinatal Information Center is pleased to provide you with
Volume V14.2 of our 2014 Quarterly Reports. This Report presents data
from the 7/1/13-6/30/14. If we have not received or validated your 2014
data, your report will not show 2014 data. Your NPIC/QAS hospital
number and date range of data for your hospital and for the database are
displayed on every table in the report.
Vol.14.2 also contains tables and graphs displaying obstetrical and
neonatal trends for the time period 2009-2014 (Q2). Trendlines for the
time period are displayed on the graphs for your hospital and the
trend database. If your hospital has not submitted data for the
entire period, trendlines will only be displayed for the years that
data was submitted.
The NPIC/QAS MEMBER WEBINAR/CONFERENCE CALLS to
discuss the V.14.2 report have been scheduled for Tuesday,
January 27, 2015 from 3:00pm - 4:15pm ET and Thursday, January
29, 2015 from 11:30am - 12:45pm ET.
There is no limit to the number of callers that can be received from
any one hospital, so we hope you will encourage other key perinatal
staff to participate.
Use the following links to register for the webinar of your choice. You
must complete a registration form in order to participate in either of
the webinar/conference calls.
Please Note: The registration links below differ for each meeting.
Tuesday, January 27, 2015 at 3:00pm-4:15pm ET
https://cc.readytalk.com/r/usaafm8grvh3&eom
Thursday, January 29, 2015 at 11:30am – 12:45pm ET
https://cc.readytalk.com/r/327o08xmor6j&eom
If you have trouble registering for either webinar/conference call,
please e-mail [email protected] for assistance.
Once you register, the meeting details will be provided in your
confirmation email. If you will not have access to the internet, you
are encouraged to participate in the audio portion.
Call-in details are provided below:
Phone: 866-740-1260
Phone Access Code: 5041508
We strongly encourage you to login to the web meeting 5-10
minutes before the start time, in order to test your computer for
browser compatibility prior to the meeting.
http://test.readytalk.com
The webinar will also be recorded and made available for access at a
later date.
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Page 1
Janet H. Muri, MBA, President
Donna Caldwell, PhD, Vice President
Sandra A. Boyle, BS, Director of Membership Services
Tara Wilcox, BA, Data Coordinator/Hospital Liaison
Meghan Mimnaugh, BA, Data Coordinator/Hospital Liaison
Caleb Gardner, Programmer Analyst
John Roach, BA, Senior Programmer Analyst
John C. Pezzullo, PhD, Consulting Statistician
Carolyn Wood, PhD, RN, Clinical Nurse Consultant
January 2015
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SECTION I: V.14.2 QUARTERLY REPORT OVERVIEW
The NPIC/QAS Database consists of eighty-four member hospitals
offering special care perinatal services. The hospitals vary in number
of births, special care intermediate and intensive neonatal beds,
presence of perinatology services and number of full-time
neonatologists on staff or under contract.
Since we know that size of special care units and presence of certain
clinical services may affect patient population, NPIC/QAS attempts to
improve the value of the comparative data in our reports by doing two
things: we present case mix adjusted data as often as possible and
provide two levels of comparisons to your hospital’s data: a subgroup
and the entire Perinatal Center Database (PCDB).
Developing subgroups within the PCDB allows NPIC/QAS to account
for differences in perinatal practice patterns based on hospital size,
teaching status, and volume of perinatal care relative to the entire
hospital. Subgroup definitions are included in the Glossary – Appendix
B.
Most of the tables in the Obstetrical and Neonatal Clinical Report
sections include unadjusted and case mix adjusted length of stay and
charge data. Case mix adjusting is the most valid method for removing
the impact of variations in case mix across hospitals and comparing
lengths of stay and charges. Most clinicians and administrators are
familiar with the CMS DRG weights that are frequently used to case
mix adjust data. For the past ten years NPIC/QAS has been using the
All Patient Refined DRGs (APR-DRGs)1 to group cases.
The APR-DRG software is the fourth generation of grouping software
developed in response to concerns that the DRGs, used and refined for
reimbursement by CMS for Medicare cases, did not reflect adequately
the variability and case intensity of perinatal cases. The APR-DRGs
were developed in coordination with the National Association of
Children’s Hospitals and Related Institutions and are particularly well
suited for looking at perinatal care. Version 31 (for discharges
occurring 10/01/13 and later) includes 12 obstetrical APR-DRGs and
29 neonatal APR-DRGs sorted by birthweight category, inborn /
outborn status and presence of a major surgical procedure. A list of the
V.31 perinatal APR-DRGs appears in Appendix A. Each APR-DRG
has a subclass 1-4 designating minor, moderate, major or extreme
severity of illness and 3M develops case weights for all APR DRGs
and subclasses.
In the past NPIC/QAS has developed its own APR DRG case weights
since the original APR DRG software did not have case weights. That
has changed and using the 3M APR DRG weights insures consistency
in APR DRG case mix identification from other vendors or services of
comparative data for your hospital.
The APR DRG subclass grouping allows for the development of a case
mix index (CMI) that can be used to adjust length of stay and charge
data to make very refined cross hospital comparisons.
Part of this report was produced using 3M APRDRG proprietary computer
software created, owned and licensed by the 3M Company. All copyrights in created,
owned and licensed by the 3M Company. All copyrights in and to the 3M Software
(including the selection, coordination and arrangement of all codes) are owned by
3M. All rights reserved.
1
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The case mix index (CMI) is a measure of resource use and case
intensity. A “standard” or average case has a case mix of 1.000; cases
more complex have a case mix greater than 1.000 and less intense, less
than 1.000. A case mix index is assigned to each severity subclass of
every APR-DRG and the case mix of a cohort of patients is calculated
by summing the case mix indices of all the cases in the cohort and
dividing by the number of cases, in effect, determining an average case
mix. The case mix index can then be used to “adjust” length of stay and
charge data to remove or neutralize the impact of the case mix on the
measure.
For example, two groups of neonatal cases with birthweights between
500-1500 grams may in fact have very different lengths of stay. One
group may have cases clustering near the 500 gram mark and the other
have cases clustering more toward 1500 grams. Understandably their
lengths of stay and average charges are going to be very different.
Calculating a case mix index for each group and dividing that CMI into
the average length of stay and average charge removes that difference
and makes the measures more comparable.
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SECTION II: OBSTETRICAL CLINICAL REPORT
Table OB 1: – Comparative Facility, Subgroup and Database
Overview: This table presents data on all inpatient discharges for the
four quarter period 7/1/13-6/30/14 for the database, your subgroup
average (an explanation of the hospital subgroup assignments appears
in Appendix B) and for all the quarters of data received and processed
for your hospital. (If your hospital is new to NPIC/QAS and just
beginning to submit data your report may display no data on the
hospital line. Your data will be displayed in subsequent quarterly
reports as soon as it is submitted, processed and validated.)
Table OB 2: APR-MDC 14: Pregnancy, Childbirth and the
Pueperium is a utilization and charge analysis which displays the
average length of stay (ALOS), average charge, case mix index (CMI),
adjusted average length of stay and adjusted average charge for all
MDC 14 cases. The table also subdivides all MDC14 cases into the
number of deliveries, the number of antepartum and postpartum
discharges as a percentage of total MDC 14 cases for your hospital, the
subgroup average and the database average.
Table OB 2a: Deliveries by APR DRG Subclass displays ALOS,
average charge, CMI, adjusted ALOS, and adjusted average charge
broken down into one of four APR-DRG severity subclasses: .1 minor
complications, .2 moderate complications, .3 major and .4 extreme
complications. Every case is assigned a subclass based on
complications, co-morbidities, age or other extenuating circumstance.
(Cases not grouping to any subclass are listed as “ungroupable”.) The
distribution of your cases by subclass tracks to the acuity of your
population and will impact your overall case mix index for deliveries.
Table OB 3: MDC 14 Cases by MS DRG is a utilization and charge
analysis of all MDC 14 cases by MS DRG.
Table OB 4: Delivery Analysis displays vaginal and c-section
deliveries as a percent of total deliveries for your hospital compared to
your subgroup average and the database average. It also shows the
ALOS, average charge, case mix index, adjusted ALOS and adjusted
average charge for vaginal and c-sections deliveries.
This table also displays all c-section deliveries subdivided into primary
and repeat c-sections and shows each category as a percent of total csections. Primary c-sections are also displayed as a percent of cases
without a prior uterine scar (code 654.2) and repeat c-sections as a
percent of cases with a prior uterine scar. The table also includes
vaginal birth after c-section displayed as a percent of cases with a prior
uterine scar. A utilization and charge analysis is also included for these
cases.
Graph OB 4a: Comparative C-Section Rates displays your
hospital’s c-section rate with a 95% confidence interval (CI).
Horizontal lines display the average rate for your subgroup, the
database and the database top decile. If your rate with the CI passes
through any of the lines your rate is not significantly different from
the average(s). If it does not pass through, your rate is significantly
different- either above or below the average(s).
The Obstetrical Trend Analysis displays your hospital’s data for the
period 2009-2014 (Q2) compared to the NPIC/QAS Trend Database, a
subgroup of 59 hospitals that have participated in the NPIC/QAS
database for the same period. The obstetrical trend analysis consists of
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two tables and ten graphs. The tables display the data points for each
year as well as the percent change from 2009-2014 (Q2). Below each
graph is a table which includes all the data displayed for the trend
analysis period: the trend database average rate, the hospital’s rate with
upper and lower confidence intervals and the hospital’s count of
numerator and denominator cases for each year.
Trendlines for the time period are displayed on the graphs for your
hospital and the trend database. If your hospital has not submitted data
for the entire period, trendlines will only be displayed for the years that
data was submitted.
PLEASE NOTE: The graph presentation is displayed as annual
data points however the determination of the significance is based
upon quarterly data points. This provides improved granularity and a
higher level of confidence in the evaluations of trend significance.
Table OB 5: Obstetrical Trend Analysis 2009-2014 (Q2) displays
total deliveries for your hospital and the trend database subdivided into
vaginal and c-section deliveries. It also displays primary c-sections as
a percent of cases without a prior uterine scar and repeat c-sections as a
percent of cases with a prior uterine scar. Average length of stay, case
mix index and adjusted length of stay are displayed for all categories.
Graph OB 5a:
C-Section Deliveries 2009-2014 (Q2) with
Trendlines graphs the c-section rate for your hospital and the trend
database average rate.
Graph OB 5b: Primary C-Section Deliveries 2009-2014 (Q2) with
Trendlines graphs the rate of primary c-sections as a percent of total
cases without a prior uterine scar for your hospital and the trend
database.
Graph OB 5c: Repeat C-Section Deliveries 2009-2014 (Q2) with
Trendlines graphs the rate of repeat c-sections as a percent of cases
with a prior uterine scar for your hospital and the trend database.
Table OB 6: Coded Reasons for C-Sections displays the coded
reasons and percent of total for your primary c-section and repeat csection cases divided into dystocia, non-reassuring fetal tracing, repeat
as a principal diagnosis (for repeat c-sections only), non-vertex
presentation, hemorrhage, abruption, placenta previa, and all other
coded reasons compared to your subgroup and the database. The ICD9-CM codes used to group cases into these categories are identified in
the glossary in Appendix D.
Table OB 7: Distribution of Coded Reasons for Primary and
Repeat C- Sections Trend Analysis 2009-2014 (Q2) displays the
distribution of coded reasons for primary c-sections and repeat csections for your hospital and the trend database.
Table OB 8: Operative Vaginal Deliveries displays deliveries broken
down into forceps deliveries (procedure codes 72.0-72.4) and vacuum
extractions (procedure code 72.7) and other operative vaginal
deliveries (procedure codes 72.8-72.9). Operative vaginal deliveries are
shown as a percent of total vaginal deliveries and each procedure
category is displayed as a percent of total operative vaginal deliveries.
The table also displays ALOS, average charge, CMI, adjusted ALOS
and adjusted average charge. This data is provided for your hospital,
your subgroup average and the database average. The database top
decile average is also displayed.
Graph OB 8a: Operative Vaginal Deliveries with Trendlines 20092014 (Q2) graphs the rate of operative vaginal deliveries as a percent
of total vaginal deliveries for your hospital and the trend database.
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Table OB 9: Delivery Analysis by Day of the Week displays the total
deliveries with induction procedure codes 73.01, 73.1 or 73.4 and
divides these deliveries into vaginal, primary and repeat c-section
deliveries. The table displays each of these categories as a percent of
total deliveries and their distribution by day of the week for your
hospital compared to your subgroup average and the database average.
.
The table also displays the total repeat c-section deliveries as a percent
of total deliveries and their distribution by day of the week.
Graph OB 9a: Induction Rates 2009-2014 (Q2) with Trendlines
graphs the rate of inductions as a percent of total deliveries for your
hospital and the trend database.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 7
Table OB 1: Comparative Facility, Subgroup and Database Overview
Hospital
SAMPLE
5,135
19,136
3.7
$14,624
Subgroup
Average
33,651
172,904
5.3
$51,764
Database
Average
23,914
112,584
4.7
$37,325
APR DRG Case Mix Index - All Discharges
CMI-Adjusted Average Patient Days
CMI-Adjusted Average Charge per Case
Total Perinatal Discharges**
0.5786
6.4
$25,275
4,891
1.1809
4.5
$43,834
8,736
1.0070
4.6
$37,065
8,510
Total APR MDC 14 (APR DRGs 540-566)
APR MDC 14 Case Mix Index
Total Deliveries (APR DRGs 540-542 and 560)
C-Section Rate
Vaginal Birth After C-Section (VBAC) Rate
Non-Birth Admission Rate
2,491
0.4608
2,225
37.4%
8.6%
10.4%
4,455
0.4487
3,962
32.1%
17.3%
11.3%
4,376
0.4416
3,962
34.7%
12.7%
9.1%
46.9%
1.3%
30.8%
20.3%
0.4%
0.3%
35.2%
0.9%
35.0%
18.8%
0.7%
9.5%
36.6%
0.9%
34.9%
20.6%
1.9%
3.8%
2,400
0.6468
2,283
2,135
148
0
4,282
0.7147
4,046
3,836
202
8
4,135
0.5662
4,039
3,854
179
6
117
236
146
Total Hospital Discharges Submitted *
Total Discharge Days
Average Length of Stay
Average Charge per Case
MDC 14 Payer Mix
% Medicaid
% Medicare
% Commercial Insurance/TRICARE
% HMO
% Self-Pay/Free Care
% Other/Missing Payers
Total Neonatal Admissions (0-28 Days at Admission)
Neonatal Case Mix Index
Inborns
Inborns, Single Birth
Inborns, Multiple Gestation
Inborns, Unknown
Other Neonatal Admits (Readmits and Transfers in <= 28 days old)
* Subgroup and Database Averages exclude data from hospitals which only submit perinatal discharges.
** Total APR MDC14 and Total Neonatal discharges
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 8
Table OB 2: APR MDC 14 Pregnancy, Childbirth and the Puerperium
Hospital: SAMPLE
# of
Cases
% of
Total MDC
ALOS
Average
Charge
CMI
Adjusted
ALOS
Adjusted
Average
Charge
APR MDC 14 Total Cases
Hospital
Subgroup Average
Database Average
2491
4455
4376
100.0%
100.0%
100.0%
2.6
3.1
2.9
$12,478
$21,682
$17,783
0.4608
0.4487
0.4416
5.7
6.9
6.7
$27,081
$48,322
$40,270
Total Deliveries 1
Hospital
Subgroup Average
Database Average
2225
3962
3962
89.3%
88.4%
90.6%
2.6
3.1
2.9
$12,476
$21,694
$17,760
0.4541
0.4437
0.4378
5.7
7.0
6.7
$27,476
$48,890
$40,564
Total Antepartum Discharges 2
Hospital
Subgroup Average
Database Average
179
337
286
7.2%
7.9%
6.4%
3.6
3.5
3.4
$11,028
$18,586
$14,648
0.3923
0.3880
0.3724
9.0
9.0
9.0
$28,110
$47,906
$39,336
Total Postpartum Discharges 3
Hospital
Subgroup Average
Database Average
49
78
61
2.0%
1.9%
1.4%
2.6
2.8
2.7
$10,674
$19,838
$16,261
0.5204
0.4883
0.4858
5.0
5.6
5.6
$20,511
$40,630
$33,473
Total Other APR MDC 14 Discharges4
Hospital
Subgroup Average
Database Average
38
78
67
1.5%
1.8%
1.6%
2.6
3.0
2.9
$21,742
$35,281
$29,758
1.0977
0.9194
0.9057
2.4
3.2
3.2
$19,807
$38,375
$32,857
1
Delivery APR DRGs = 540,541, 542, 560
Antepartum APR DRGs = 563, 565, 566
3
Postpartum APR DRGs = 561
4
Other APR MDC 14 DRGs = 544, 545, 546, 564 or 950-956
2
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 9
Table OB 2a: Deliveries by APR DRG Subclass
CMI
Adjusted
ALOS
Adjusted
Average
Charge
$12,476
$21,694
$17,760
0.4541
0.4437
0.4378
5.7
7.0
6.7
$27,476
$48,890
$40,564
2.1
2.6
2.5
$11,008
$18,052
$15,479
0.3888
0.3792
0.3872
5.5
6.7
6.5
$28,310
$47,612
$39,973
33.4%
37.7%
34.2%
2.5
3.1
3.0
$12,505
$21,463
$17,995
0.4456
0.4326
0.4388
5.6
7.1
6.8
$28,063
$49,608
$41,014
230
417
346
10.3%
11.5%
8.5%
5.1
5.4
4.9
$18,889
$35,442
$28,534
0.7571
0.7191
0.7292
6.7
7.4
6.7
$24,949
$49,290
$39,129
Subclass .4 - Extreme Complications
Hospital
Subgroup Average
Database Average
7
9
8
0.3%
0.3%
0.2%
8.9
9.8
9.8
$60,008
$108,622
$98,640
3.0043
2.6686
2.6273
3.0
3.7
3.7
$19,974
$40,704
$37,545
Ungroupable
Hospital
Subgroup Average
Database Average
0
0
0
0.0%
0.0%
0.0%
0.0
0.0
0.0
$0
$0
$0
0.0000
0.0000
0.0000
0.0
0.0
0.0
$0
$0
$0
# of Cases
% of Total
Deliveries
ALOS
Average
Charge
Total Deliveries
Hospital
Subgroup Average
Database Average
2225
3962
3962
100.0%
100.0%
100.0%
2.6
3.1
2.9
Subclass .1 - Minor Complications
Hospital
Subgroup Average
Database Average
1245
2088
2247
56.0%
50.6%
57.1%
Subclass .2 - Moderate Complications
Hospital
743
Subgroup Average
1449
Database Average
1361
Subclass .3 - Major Complications
Hospital
Subgroup Average
Database Average
Hospital: SAMPLE
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 10
Table OB 3: MDC 14 by MS DRG
CMI*
Adjusted
ALOS
Adjusted
Average
Charge
$18,294
$35,156
$27,864
0.7324
0.7241
0.6963
5.6
7.0
6.5
$24,977
$48,554
$40,016
2.8
3.5
3.3
$14,534
$25,226
$20,806
0.5479
0.5491
0.5456
5.1
6.4
6.0
$26,525
$45,941
$38,133
MS DRG 774 - Vaginal delivery w complicating diagnoses
Hospital
228
9.2%
Subgroup Average
478
11.1%
Database Average
421
9.5%
2.5
3.1
2.9
$12,013
$21,449
$17,117
0.3974
0.4029
0.3933
6.4
7.6
7.4
$30,230
$53,234
$43,525
MS DRG 775 - Vaginal delivery w/o complicating diagnoses
Hospital
1146
46.0%
Subgroup Average
2127
47.3%
Database Average
2084
48.0%
2.0
2.4
2.3
$9,721
$16,340
$13,460
0.3273
0.3304
0.3268
6.0
7.2
7.0
$29,696
$49,454
$41,190
MS DRG 767 - Vaginal delivery w sterilization &/or D&C
Hospital
14
0.6%
Subgroup Average
78
1.7%
Database Average
72
1.6%
2.8
3.0
2.9
$13,729
$26,856
$23,321
0.6384
0.5879
0.5787
4.4
5.1
5.0
$21,507
$45,685
$40,299
MS DRG 768 - Vaginal delivery w O.R. proc except steril &/or D&C
Hospital
4
0.2%
2.8
Subgroup Average
3
0.1%
4.6
Database Average
2
0.1%
4.8
$23,245
$40,314
$45,067
1.5407
0.9160
0.9784
1.8
5.1
4.9
$15,087
$44,013
$46,063
MS DRG 776 - Postpartum & post abortion diagnoses w/o O.R. procedure
Hospital
49
2.0%
2.6
Subgroup Average
77
1.9%
2.7
Database Average
60
1.4%
2.7
$10,674
$19,455
$16,487
0.5204
0.4837
0.4889
5.0
5.6
5.5
$20,511
$40,222
$33,724
MS DRG 769 - Postpartum & post abortion diagnoses w O.R. procedure
Hospital
3
0.1%
2.7
Subgroup Average
12
0.3%
4.8
Database Average
10
0.2%
4.5
$20,322
$62,171
$50,699
1.0808
1.5899
1.4444
2.5
3.0
3.1
$18,804
$39,103
$35,100
# of
% of
Hospital: SAMPLE
Cases
Total MDC
MS DRG 765 - Cesarean section w CC/MCC
Hospital
396
15.9%
Subgroup Average
610
14.4%
Database Average
609
13.4%
ALOS
Average
Charge
4.1
5.1
4.5
MS DRG 766 - Cesarean section w/o CC/MCC
Hospital
437
17.5%
Subgroup Average
667
14.0%
Database Average
774
18.0%
* CMI is calculated using the APR DRGs
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 11
Table OB 3: MDC 14 by MS DRG
CMI*
Adjusted
ALOS
Adjusted
Average
Charge
$23,562
$32,145
$28,585
0.7823
0.7674
0.7897
2.4
2.8
2.7
$30,119
$41,886
$36,196
5.0
3.7
3.4
$10,919
$17,107
$14,074
0.3545
0.3630
0.3544
14.2
10.2
9.6
$30,805
$47,132
$39,710
1.5
1.6
1.8
$8,842
$14,250
$14,731
0.3234
0.3500
0.3511
4.5
4.6
5.0
$27,344
$40,718
$41,953
MS DRG 770 - Abortion w D&C, aspiration curettage or hysterotomy
Hospital
5
0.2%
1.4
Subgroup Average
15
0.4%
1.9
Database Average
13
0.3%
2.0
$15,974
$24,015
$22,613
1.2356
0.6801
0.6789
1.1
2.8
2.9
$12,928
$35,312
$33,307
MS DRG 780 - False labor
Hospital
Subgroup Average
Database Average
0.0
1.7
1.6
$0
$8,277
$7,087
0.0000
0.1675
0.1628
0.0
10.3
10.1
$0
$49,417
$43,525
MS DRG 781 - Other antepartum diagnoses w medical complications
Hospital
125
5.0%
2.8
Subgroup Average
238
5.6%
3.6
Database Average
197
4.3%
3.5
$11,314
$21,990
$17,821
0.4570
0.4720
0.4536
6.1
7.6
7.8
$24,758
$46,585
$39,288
MS DRG 782 - Other antepartum diagnoses w/o medical complications
Hospital
9
0.4%
4.9
Subgroup Average
41
0.9%
2.9
Database Average
36
0.8%
2.8
$14,635
$15,604
$12,887
0.3741
0.3936
0.3873
13.1
7.4
7.2
$39,116
$39,644
$33,270
Other DRGs associated with all MDCs**
Hospital
2
Subgroup Average
2
Database Average
3
$106,356
$85,228
$106,084
6.1070
2.1802
2.3386
2.2
3.9
4.0
$17,415
$39,092
$45,362
# of
Hospital: SAMPLE
Cases
MS DRG 777 - Ectopic pregnancy
Hospital
10
Subgroup Average
11
Database Average
11
ALOS
Average
Charge
0.4%
0.3%
0.3%
1.9
2.2
2.1
MS DRG 778 - Threatened abortion
Hospital
52
Subgroup Average
75
Database Average
64
2.1%
1.8%
1.5%
MS DRG 779 - Abortion w/o D&C
Hospital
11
Subgroup Average
19
Database Average
16
0.4%
0.4%
0.4%
0
3
5
% of
Total MDC
0.0%
0.1%
0.1%
0.0%
0.0%
0.1%
13.5
8.6
9.3
* CMI is calculated using the APR DRGs
**e.g. MS DRG 981 - Extensive O.R. Procedure unrelated to principal diagnosis; MS DRG 998 - Principal diagnosis invalid as discharge diagnosis; MS DRG 999 Ungroupable
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 12
Table OB 4: Delivery Analysis
Hospital: SAMPLE
Total Vaginal Deliveries
Hospital
Subgroup Average
Database Average
Total C-Section Deliveries
Hospital
Subgroup Average
Database Average
Primary C-Section
Hospital
Subgroup Average
Database Average
Repeat C-Section
Hospital
Subgroup Average
Database Average
# of
Cases
% of
Total
Deliveries
1392
2685
2579
833
1277
1383
Adjusted
Average
Charge
$10,176
$17,668
$14,395
0.3454
0.3512
0.3448
6.0
7.2
7.0
$29,457
$50,311
$41,753
$16,321
$30,346
$24,121
0.6356
0.6389
0.6139
5.4
6.7
6.3
$25,677
$47,494
$39,289
Adjusted
Average
Charge
ALOS
62.6%
67.9%
65.3%
2.1
2.5
2.4
37.4%
32.1%
34.7%
3.4
4.3
3.9
# of
Cases
% of
Total
Deliveries
452
704
751
20.3%
18.0%
18.9%
381
573
631
CMI
Adjusted
ALOS
Average
Charge
17.1%
14.1%
15.8%
% of cases
without a
% of Total prior uterine
C-Sections
scar
54.3%
56.0%
54.5%
25.0%
21.7%
23.1%
% of Total
C-Sections
% of cases
with a prior
uterine scar
45.7%
44.0%
45.5%
91.4%
82.7%
87.3%
ALOS
Average
Charge
CMI
Adjusted
ALOS
3.5
4.8
4.3
$17,576
$33,386
$26,424
0.6470
0.6760
0.6496
5.5
7.1
6.6
$27,166
$49,390
$40,678
3.3
3.7
3.3
$14,833
$26,511
$21,360
0.6222
0.5927
0.5715
5.2
6.2
5.8
$23,839
$44,727
$37,376
2.0
2.6
2.4
$10,300
$18,269
$14,932
0.3362
0.3621
0.3537
6.0
7.0
6.9
$30,636
$50,452
$42,220
% of cases
with a prior
uterine scar
Vaginal Birth after C-Section
Hospital
Subgroup Average
Database Average
36
115
89
1.6%
2.9%
2.2%
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
8.6%
17.3%
12.7%
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 13
Graph OB 4a: Comparative C-Section Rates
NPIC ID: SAMPLE
50%
Rate as Percent of Total Deliveries
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (37.4%)
Subgroup Average (32.1%)
Database Average (34.7%)
Database Top Decile Average (26.5%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 14
Table OB 5: Obstetrical Trend Analysis 2009-2014 (Q1-Q2)
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
3467
2.6
0.4390
6.0
3339
2.7
0.4562
5.8
3066
2.6
0.4460
5.9
2964
2.6
0.4499
5.8
2353
2.6
0.4593
5.6
1335
2.5
0.4469
5.7
-32.1%
-3.4%
Trend Data Base Average
ALOS
CMI
Adjusted LOS
Vaginal Deliveries
Hospital
Percent Of Total Deliveries
ALOS
CMI
Adjusted LOS
4593
3.0
0.4401
7.0
4484
3.0
0.4535
7.0
4468
3.0
0.4410
7.0
4453
3.0
0.4415
7.0
4404
3.0
0.4507
7.0
2162
3.0
0.4363
7.0
-4.1%
-0.7%
2253
65.0%
2.1
0.3378
6.3
2125
63.6%
2.1
0.3473
6.1
1927
62.9%
2.1
0.3401
6.1
1826
61.6%
2.1
0.3432
6.0
1524
64.8%
2.1
0.3540
6.0
840
62.9%
2.0
0.3412
5.9
-32.4%
-0.3%
-0.9%
Trend Data Base Average
Percent Of Total Deliveries
ALOS
CMI
Adjusted LOS
C-Section Deliveries
Hospital
Percent Of Total Deliveries
ALOS
CMI
Adjusted LOS
2970
65.0%
2.4
0.3435
7.0
2887
64.9%
2.4
0.3524
7.0
2900
65.5%
2.4
0.3468
7.0
2884
65.2%
2.4
0.3488
7.0
2866
65.4%
2.4
0.3554
7.0
1411
65.7%
2.4
0.3431
7.0
-3.5%
0.6%
0.8%
1214
35.0%
3.6
0.6268
5.7
1214
36.4%
3.6
0.6468
5.6
1139
37.2%
3.5
0.6252
5.6
1138
38.4%
3.5
0.6209
5.6
829
35.2%
3.4
0.6529
5.2
495
37.1%
3.4
0.6264
5.5
-31.7%
0.6%
-6.4%
Trend Data Base Average
Percent Of Total Deliveries
ALOS
CMI
Adjusted LOS
1624
35.0%
4.1
0.6207
7.0
1597
35.2%
4.1
0.6414
6.0
1569
34.5%
4.0
0.6208
6.0
1568
34.8%
4.1
0.6161
7.0
1538
34.6%
4.0
0.6316
6.0
750
34.3%
4.0
0.6158
6.0
-5.3%
-1.2%
-2.0%
NPIC ID: SAMPLE
Total Deliveries
Hospital
ALOS
CMI
Adjusted LOS
Page 15
Table OB 5: Obstetrical Trend Analysis 2009-2014 (Q1-Q2)
NPIC ID: SAMPLE
Primary C-Section Deliveries
Hospital
Percent Of Cases Without a Prior Uterine
Scar
ALOS
CMI
Adjusted LOS
Trend Data Base Average
Percent Of Cases Without a Prior Uterine
Scar
ALOS
CMI
Adjusted LOS
Repeat C-Section Deliveries
Hospital
Percent Of Cases With a Prior Uterine Scar
ALOS
CMI
Adjusted LOS
Trend Data Base Average
Percent Of Cases With a Prior Uterine Scar
ALOS
CMI
Adjusted LOS
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
712
699
649
708
465
279
-34.7%
24.5%
3.8
0.6529
5.8
25.3%
4.0
0.6798
5.9
25.9%
3.8
0.6539
5.7
28.5%
3.7
0.6451
5.7
23.8%
3.6
0.6823
5.2
25.6%
3.5
0.6285
5.6
-2.7%
-5.3%
942
908
879
878
844
409
-10.4%
24.3%
4.5
0.6531
7.0
24.1%
4.5
0.6745
7.0
23.4%
4.5
0.6532
7.0
23.7%
4.5
0.6489
7.0
23.2%
4.5
0.6693
7.0
23.0%
4.5
0.6516
7.0
-4.7%
-0.9%
502
89.6%
3.3
0.5899
5.1
515
89.0%
3.0
0.6019
4.5
490
87.7%
3.2
0.5872
4.9
430
90.3%
3.2
0.5812
5.0
364
90.6%
3.1
0.6153
4.6
216
88.9%
3.3
0.6237
5.2
-27.5%
1.0%
-6.9%
681
88.9%
3.5
0.5769
6.0
689
88.3%
3.5
0.5984
6.0
690
87.2%
3.5
0.5801
6.0
690
87.2%
3.5
0.5744
6.0
693
87.0%
3.4
0.5865
6.0
341
85.8%
3.4
0.5729
6.0
1.8%
-2.2%
-2.0%
Page 16
Graph OB 5a: C-Section Deliveries
2009
2014
(Q1-Q2)Deliveries
withHosp
TrendlinesNPIC
ID: SAMPLE
Graph
OB- 5a:
C-Section
2009 - 2014 (Q1-Q2)
with Trendlines
Trend Rate
Hosp Numerator
Denominator
LCI
NPIC ID: SAMPLE Hosp Rate
2009
35.0%
1214
3467
35.0%
45.0%
2010
35.2%
1214
3339
36.4%
2011
34.5%
1139
3066
37.1%
40.0%
2012
34.8%
1138
2964
38.4%
34.6%
829
2353
35.2%
35.0% 2013
2014
34.3%
495
1335
37.1%
UCI
0.015890406
0.016340063
0.017137785
0.017555268
0.019320043
0.025975806
0.016143839
0.016579356
0.017383215
0.017785112
0.019688222
0.026546564
C-Section Rate
30.0%
25.0%
20.0%
Correl Coefficient
-0.835845194
15.0%
10.0%
320.345%
-0.142%
Trend Trendline X Vals:
2009
5.0%
2014
-433.515%
0.234%
Hosp Trendline X Vals:
2009
36.0%
2014
37.1%
35.1%
34.4%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.0001
2009
2010
2011
2012
2013
2014 (Q1-Q2)
35.0%
35.0%
1214
3467
33.4%
36.6%
35.2%
36.4%
1214
3339
34.7%
38.0%
34.5%
37.2%
1139
3066
35.4%
38.9%
34.8%
38.4%
1138
2964
36.6%
40.2%
34.6%
35.2%
829
2353
33.3%
37.2%
34.3%
37.1%
495
1335
34.5%
39.7%
Page 17
Percent of cases without a prior uterine scar
Graph OB5b: Primary C-Section
2009Numerator
- 2014
(Q1-Q2)
ID: SAMPLE
Hosp
Hospwith TrendlinesNPIC
GraphDeliveries
OB5b: Primary
C-Section
Deliveries
2009 - 2014 (Q1-Q2)
with Trendlines
Trend Rate
(Csections
Denominator
(All
Hosp
Rate
LCI
UCI
NPIC ID: SAMPLE
2009
24.3%
712
2907
24.5%
0.015541924
0.01605703
35.0%
2010
24.1%
699
2760
25.3%
0.016136512
0.016661722
2011
23.4%
649
2507
25.9%
0.01705613
0.017620671
30.0% 2012
23.7%
708
2488
28.5%
0.017668404
0.018177259
2013
23.2%
465
1951
23.8%
0.018758001
0.019547148
25.0% 2014
23.0%
279
1092
25.5%
0.02563824
0.026963204
20.0%
15.0%
Correl Coefficient
-0.93408101
10.0%
542.585%
-0.258%
Trend Trendline X Vals:
5.0%
2009
2014
-168.481%
0.096%
Hosp Trendline X Vals:
2009
25.3%
2014
25.8%
24.3%
23.0%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
24.3%
24.5%
712
2907
22.9%
26.1%
24.1%
25.3%
699
2760
23.7%
27.0%
23.4%
25.9%
649
2507
24.2%
27.6%
23.7%
28.5%
708
2488
26.7%
30.3%
23.2%
23.8%
465
1951
22.0%
25.8%
23.0%
25.6%
279
1092
23.0%
28.2%
Page 18
Percent of cases with a prior uterine scar
Graph OB 5c: Repeat C-Section
2009
- 2014 (Q1-Q2)
TrendlinesNPIC
ID:with
SAMPLE
Numerator
Hosp with2009
GraphDeliveries
OB 5c:Hosp
Repeat
C-Section
Deliveries
- 2014 (Q1-Q2)
Trendlines
Trend Rate
(Csections with NPIC
Denominator
(All
Hosp
Rate
LCI
UCI
ID: SAMPLE
2009
88.9%
502
560
89.6%
0.028257467
0.023982579
100.0%
2010
88.3%
515
579
88.9%
0.028417119
0.024363042
2011
87.2%
490
559
87.7%
0.030167627
0.026112817
90.0%
2012
87.2%
430
476
90.3%
0.030156815
0.025016031
80.0%
2013
87.0%
364
402
90.5%
0.03290768
0.026764315
2014
85.8%
216
243
88.9%
0.046421899
0.036598629
70.0%
60.0%
50.0%
40.0%
Correl Coefficient
-0.962040977
1212.124%
-0.559%
30.0%
-124.008%
0.106%
Hosp Trendline X Vals:
2009
89.1%
2014
89.6%
20.0%
Trend Trendline X Vals:
2009
10.0%
2014
88.8%
86.0%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
88.9%
89.6%
502
560
86.8%
92.0%
88.3%
89.0%
515
579
86.1%
91.4%
87.2%
87.7%
490
559
84.6%
90.3%
87.2%
90.3%
430
476
87.3%
92.8%
87.0%
90.6%
364
402
87.3%
93.2%
85.8%
88.9%
216
243
84.2%
92.5%
Page 19
Table OB 6: Coded Reasons for C-Sections
Hospital
Subgroup Average
Database Average
Hospital: SAMPLE
# of
Cases
Primary C-Sections
Dystocia
Non-reassuring fetal tracing
Non-vertex presentation
Hemorrhage, Abruption, Placenta Previa
All other coded reasons
Repeat C-Sections
Dystocia
Non-reassuring fetal tracing
Repeat (654.2 as PDX)
Non-vertex presentation
Hemorrhage, Abruption, Placenta Previa
All other coded reasons
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
% of Primary
C-Sections
# of
Cases
452
186
164
47
6
49
# of
Cases
381
30
104
143
13
7
84
% of Primary
C-Sections
# of
Cases
% of Primary
C-Sections
41.2%
36.3%
10.4%
1.3%
10.8%
704
276
209
105
15
99
38.9%
30.2%
14.6%
2.4%
13.9%
751
306
201
105
16
123
41.2%
26.8%
13.6%
2.3%
16.2%
% of Repeat
C-Sections
# of
Cases
% of Repeat
C-Sections
# of
Cases
% of Repeat
C-Sections
7.9%
27.3%
37.5%
3.4%
1.8%
22.1%
573
37
113
312
20
8
82
6.9%
19.6%
52.6%
4.0%
1.6%
15.4%
631
31
115
387
15
7
77
5.4%
17.8%
60.4%
2.4%
1.1%
12.8%
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 20
Table OB7: Distribution of Coded Reasons for Primary and Repeat C-Sections
Trend Analysis 2009-2014 (Q1-Q2)
Coded Reasons for Primary C-Sections
Hospital: SAMPLE
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
Hospital
Dystocia
Non-Reassuring Fetal Tracing
Non-Vertex Presentation
46.2%
32.4%
9.1%
43.2%
34.8%
11.2%
44.7%
32.8%
10.6%
43.8%
30.9%
11.6%
45.4%
32.3%
9.0%
37.3%
40.9%
9.3%
-1.8%
-0.6%
-1.1%
Hemorrhage, Abruption, Placenta Previa
All Other Coded Reasons
1.4%
10.8%
2.4%
8.4%
2.0%
9.9%
1.0%
12.7%
1.9%
11.4%
1.4%
11.1%
38.6%
5.5%
Trend Data Base
Dystocia
Non-Reassuring Fetal Tracing
Non-Vertex Presentation
43.9%
26.0%
13.0%
43.6%
26.2%
13.6%
42.8%
25.8%
14.1%
41.7%
26.2%
14.5%
41.5%
26.5%
14.2%
39.7%
27.9%
13.9%
-5.5%
1.7%
9.2%
Hemorrhage, Abruption, Placenta Previa
All Other Coded Reasons
2.0%
15.2%
2.2%
14.5%
1.9%
15.4%
2.0%
15.6%
2.2%
15.7%
2.3%
16.2%
10.6%
3.5%
Coded Reasons for Repeat C-Sections
Hospital
Dystocia
Non-Reassuring Fetal Tracing
Repeat (654.2 as PDX)
Non-Vertex Presentation
Hemorrhage, Abruption, Placenta Previa
All Other Coded Reasons
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
5.8%
24.5%
59.2%
1.8%
0.2%
8.6%
4.1%
33.0%
53.4%
1.4%
1.0%
7.2%
4.7%
23.7%
61.0%
2.5%
0.4%
7.8%
5.1%
26.5%
51.4%
4.0%
1.4%
11.6%
6.6%
27.2%
37.6%
2.5%
2.2%
23.9%
6.5%
29.2%
41.7%
4.2%
0.9%
17.6%
14.0%
11.0%
-36.4%
38.0%
1000.0%
178.9%
4.6%
18.2%
65.0%
2.1%
1.1%
9.1%
4.7%
18.3%
63.6%
2.4%
1.0%
9.9%
4.7%
18.7%
62.8%
2.4%
1.0%
10.5%
5.1%
18.5%
60.1%
2.7%
1.1%
12.5%
5.4%
18.3%
59.2%
2.6%
1.2%
13.3%
5.5%
17.9%
58.9%
3.1%
1.1%
13.5%
18.0%
1.0%
-9.0%
25.1%
2.7%
47.1%
Trend Data Base
Dystocia
Non-Reassuring Fetal Tracing
Repeat (654.2 as PDX)
Non-Vertex Presentation
Hemorrhage, Abruption, Placenta Previa
All Other Coded Reasons
Page 21
Table OB 8: Operative Vaginal Deliveries
NPIC ID: SAMPLE
Operative Vaginal Deliveries
Hospital
Subgroup Average
Database Average
Database Top Decile Average
# of
Cases
98
156
161
% of Total
Vaginal
Deliveries
ALOS
Average
Charge
CMI
Adjusted
ALOS
Adjusted
Average
Charge
0.3485
0.3613
0.3544
6.1
7.7
7.4
$33,203
$54,343
$44,332
Adjusted
Average
Charge
2.1
2.8
2.6
$11,570
$19,632
$15,712
# of
Cases
7.0%
5.6%
6.2%
2.3%
% of Total
Operative
Vaginal
Deliveries
ALOS
Average
Charge
CMI
Adjusted
ALOS
72.0-72.4 Forceps
Hospital
Subgroup Average
Database Average
13
25
29
13.3%
13.4%
12.4%
2.1
2.8
2.7
$11,771
$22,380
$17,551
0.3320
0.3726
0.3622
6.3
7.6
7.4
$35,454
$60,070
$48,463
72.7 Vacuum Extraction
Hospital
Subgroup Average
Database Average
82
127
129
83.7%
84.0%
85.8%
2.2
2.8
2.6
$11,533
$19,359
$15,494
0.3522
0.3595
0.3521
6.1
7.7
7.3
$32,743
$53,851
$44,001
3.1%
2.6%
1.7%
1.7
3.8
3.3
$11,711
$34,799
$22,836
0.3166
0.3754
0.3769
5.3
10.1
8.8
$36,985
$92,707
$60,583
72.8-72.9 Other Operative Vaginal Deliveries
Hospital
3
Subgroup Average
4
Database Average
3
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 22
Percent of Total Vaginal Deliveries
Graph OB8a: Operative Vaginal
Deliveries
2009-2014
(Q1-Q2)
with TrendlinesNPIC
ID: SAMPLE
Hosp
Graph
OB8a: Operative
Vaginal
Deliveries
2009-2014 (Q1-Q2)
with Trendlines
Trend Rate
Hosp NumeratorNPIC
Denominator
Hosp
Rate
LCI
UCI
ID: SAMPLE
2009
7.5%
124
2253
5.5%
0.009055241
0.010232519
12.0%
2010
6.9%
102
2125
4.8%
0.008694946
0.009967358
2011
6.5%
129
1927
6.7%
0.010752309
0.012091483
2012
6.6%
97
1826
5.3%
0.009835873
0.011299861
10.0%
2013
6.2%
78
1524
5.1%
0.010517601
0.012286699
2014
5.8%
70
840
8.3%
0.017797152
0.020781954
8.0%
6.0%
Correl Coefficient
-7.825447149
-0.960858698
609.464%
-0.300%
4.0%
Trend Trendline X Vals:
2.0%
2009
2014
-782.545%
0.392%
Hosp Trendline X Vals:
2009
5.0%
2014
6.9%
7.3%
5.8%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
7.5%
5.5%
124
2253
4.6%
6.5%
6.9%
4.8%
102
2125
3.9%
5.8%
6.5%
6.7%
129
1927
5.6%
7.9%
6.6%
5.3%
97
1826
4.3%
6.4%
6.2%
5.1%
78
1524
4.1%
6.3%
5.8%
8.3%
70
840
6.6%
10.4%
Page 23
Table OB 9: Delivery Analysis by Day of the Week
Hospital: SAMPLE
# of Cases
% of Total
Deliveries
Repeat C-Sections
Hospital
Subgroup Average
Database Average
381
573
631
17.1%
14.1%
15.8%
%
Sunday
%
Monday
%
Tuesday
%
Wednesday
%
Thursday
%
Friday
%
Saturday
8.7%
5.5%
5.3%
22.1%
20.3%
20.0%
16.8%
18.1%
18.4%
12.9%
15.1%
15.6%
17.9%
17.1%
17.1%
16.3%
18.6%
18.3%
5.5%
5.3%
5.3%
% of Total
Deliveries
% Delivered
by C-Section
%
Sunday
%
Monday
%
Tuesday
%
Wednesday
%
Thursday
%
Friday
%
Saturday
23.9%
24.3%
21.5%
23.3%
20.7%
22.2%
4.5%
8.4%
9.1%
16.4%
17.9%
18.3%
17.3%
17.1%
17.5%
15.8%
16.0%
17.1%
21.2%
17.8%
17.1%
17.7%
16.0%
14.7%
7.1%
6.8%
6.2%
18.3%
19.3%
16.9%
4.4%
8.2%
8.6%
16.9%
17.8%
18.2%
16.9%
16.9%
17.5%
14.2%
16.2%
17.2%
22.1%
17.7%
17.1%
19.1%
16.5%
15.0%
6.4%
6.7%
6.3%
Primary C-Section Deliveries with Inductions
Hospital
117
5.3%
Subgroup Average
183
4.8%
Database Average
176
4.5%
5.1%
9.2%
10.9%
15.4%
18.1%
18.6%
17.1%
17.9%
17.4%
21.4%
14.9%
16.7%
17.1%
18.3%
16.9%
13.7%
14.3%
13.5%
10.3%
7.3%
6.0%
Repeat C-Section Deliveries with Inductions
Hospital
7
0.3%
Subgroup Average
11
0.3%
Database Average
7
0.2%
0.0%
7.8%
7.1%
0.0%
15.7%
16.3%
42.9%
18.2%
13.7%
14.3%
23.5%
15.1%
42.9%
16.2%
13.5%
0.0%
9.6%
11.7%
0.0%
9.0%
5.1%
# of Cases
Total Deliveries with Inductions
Hospital
532
Subgroup Average
960
Database Average
855
Vaginal Deliveries with Inductions
Hospital
408
Subgroup Average
766
Database Average
672
73.01 Induction of labor by artificial rupture of membranes
73.1 Other surgical induction of labor
73.4 Medical induction of labor, excluding medication to augment active labor.
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 24
Percent of Total Deliveries
Graph OB 9a: Induction Rates 2009-2014
(Q1-Q2)
with TrendlinesNPIC
ID:(Q1-Q2)
SAMPLE
Hosp2009-2014
Graph OB
9a: Induction
Rates
with Trendlines
Trend Rate
Hosp NumeratorNPIC
Denominator
LCI
ID: SAMPLE Hosp Rate
2009
21.4%
823
3467
23.7%
30.0%
2010
21.8%
751
3339
22.5%
2011
21.4%
668
3066
21.8%
2012
21.4%
642
2964
21.7%
25.0%
2013
21.9%
584
2353
24.8%
2014
22.5%
296
1335
22.2%
UCI
0.014080643
0.014066361
0.014500157
0.014712805
0.017343666
0.022026045
0.014525075
0.014549574
0.01504058
0.015274275
0.017972853
0.023257927
20.0%
15.0%
Correl Coefficient
0.69838608
10.0%
-313.900%
0.167%
Trend Trendline
X Vals:
5.0%
2009
2014
78.736%
-0.028%
Hosp Trendline X Vals:
2009
2014
21.3%
22.2%
22.8%
22.7%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Upward Trend, p = 0.007
2009
2010
2011
2012
2013
2014 (Q1-Q2)
21.4%
23.7%
823
3467
22.3%
25.2%
21.8%
22.5%
751
3339
21.1%
23.9%
21.4%
21.8%
668
3066
20.3%
23.3%
21.4%
21.7%
642
2964
20.2%
23.2%
21.9%
24.8%
584
2353
23.1%
26.6%
22.5%
22.2%
296
1335
20.0%
24.5%
Page 25
SECTION III: NEONATAL CLINICAL REPORT
The Neonatal Clinical Report presents data on all neonatal discharges
(defined as all cases 0-28 days old at admission) for the four-quarter
period 7/1/13-6/30/14. (If your hospital is new to NPIC/QAS and
just beginning to submit data, your report may display no data on
the hospital line. Your data will be displayed in subsequent
quarterly reports as soon as it is submitted, processed and
validated.)
The Neonatal Trend Analysis displays your hospital’s data for the
period 2009-2014 (Q2) compared to the NPIC/QAS Trend Database, a
subgroup of 59 hospitals that have participated in the NPIC/QAS
database for the same period.
The trend analysis consists of three tables and six graphs. The tables
display the data points for each year as well as the percent change from
2009-2014 (Q2). Below each graph is a table which includes all the
data displayed for the trend analysis period: the trend database average
rate, the hospital’s rate with upper and lower confidence intervals and
the hospital’s count of numerator and denominator cases for each year.
Trendlines for the time period are displayed on the graphs for your
hospital and the trend database. If your hospital has not submitted data
for the entire period, trendlines will only be displayed for the years that
data was submitted.
PLEASE NOTE: The graph presentation is displayed as annual data
points however the determination of significance is based upon
quarterly data points. This provides improved granularity and a
higher level of confidence in the evaluations of trend significance.
Table N 1: Neonatal Overview - is displayed on pages 29-31 of the
report. Page 29 shows total neonates 0-28 days old at admission for
your hospital and the average for the subgroup and database. The table
also displays total inborn neonates (subdivided into singletons, twins,
other multiples and unknown).
Page 30 displays other neonatal admits (those that are not inborn),
subdivided into neonates transferred in, inborns discharged to home or
home health and readmitted within 7 days post-discharge, inborn
discharged to home or home health and readmitted within 28 days postdischarge, and other neonatal admits 0-28 days old that are not
transfers in or inborn readmissions.
Page 31 shows the total number of inborns and other neonatal admits
which have been transferred out to another facility subdivided by
length of stay (0-3, 4-7, >7 days). The table displays average length of
stay, average charge, CMI, adjusted ALOS and adjusted average
charge for each category.
Graph N1a: Inborn Twins Birth Analysis 2009-2014 (Q2) with
Trendlines: graphs the rate of inborns with a diagnosis code indicating
twin births as a percentage of total inborns for your hospital and the
trend database.
Graph N1b: Inborn Other Multiples Birth Analysis 2009-2014
(Q1) with Trendlines: graphs the rate of inborns with a diagnosis code
indicating other multiple births as a percentage of total inborns for your
hospital and the trend database.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 26
Table N 2: Inborn Neonatal Analysis by Birthweight Category
displays percent of total inborn neonates, ALOS, average charge, CMI,
adjusted ALOS and adjusted average charge by birthweight category.
Table N 3: Neonates Transferred In from Another Hospital 0-28
days old at admission by Birthweight Category displays ALOS,
average charge, CMI, adjusted ALOS and adjusted average charge by
birthweight category for neonates transferred in from another hospital
between 0-28 days old at admission.
greater flexibility and case mix adjusting options. We do recognize,
however, that many hospitals use the MS DRGs for analysis and
payment so we provide this analysis for validation and
comparative purposes.
Table N 4: Neonatal Analysis by Birthweight Category 2009-2014
(Q2) with Trendlines displays all neonates 0-28 days old at admission
subdivided by birthweight category. The percent of total neonates is
displayed for your hospital and the trend database.
Table N 6: Inborns by APR DRG Subclass displays ALOS, average
charge, CMI, adjusted ALOS, and adjusted average charge broken
down into one of four APR-DRG severity subclasses: .1 minor
complications, .2 moderate complications, .3 major and .4 extreme
complications. Every case is assigned a subclass based on
complications, co-morbidities, age or other extenuating circumstance.
(Cases not grouping to any subclass are listed as “ungroupable”.) The
distribution of your cases by subclass tracks to the acuity of your
population and will impact your overall neonatal case mix index.
Graph N4a: Neonatal Birthweight Analysis 2009-2014 (Q2) with
Trendlines: Discharges 500-749 grams at admission: graphs the
percent of cases 500-749 grams as a percent of total discharges 5007000 grams for your hospital and the trend database.
Table N 7: Neonates Transferred In 0-28 days old at Admission by
APR DRG Subclass displays ALOS, average charge, CMI, adjusted
ALOS, and adjusted average charge broken down into one of the APRDRG severity subclasses as described in Table N6.
Graph N4b: Neonatal Birthweight Analysis 2009-2014 (Q2) with
Trendlines: Discharges 750-1499 grams at admission: graphs the
percent of cases 750-1499 grams as a percent of total discharges 5007000 grams for your hospital and the trend database.
Table N 8: Mortality Analysis by Admission Status displays all
neonates 0-28 days old at admission, the number that died and the
percent of total neonates. The analysis then subdivides all neonates into
inborn ≥ 500 grams, transferred in and other neonatal admits displaying
mortality rates at 0-7 days old, 8-27 days old and >= 28 days old. The
table shows the counts and rates for your hospital compared to the
subgroup and database averages.
Table N 5: MDC 15 Neonatal Analysis by MS DRG displays ALOS,
average charge, CMI, adjusted ALOS and adjusted average charge for
all neonates by MS DRG. Cases 0-28 days old at admission not
grouping to an MDC 15 MS DRG are also displayed.
As stated previously, NPIC/QAS has been using the All Patient
Refined (APR) DRGs for more than 10 years and prefers this
grouping scheme to the standard MS DRGs because it provides
Graph N 8a: Inborn Mortality Rate ≥ 500 grams displays mortality
rates of inborns with birthweights ≥ 500 grams with a 95% confidence
interval for your hospital and the hospitals in your subgroup. The
subgroup average is indicated by a broken line and the database
average is indicated by the solid line. If your confidence interval
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 27
passes through the subgroup or database average there is no significant
difference between your rate and the comparison rate.
Graph N 8b: Transferred In Mortality Rate displays the mortality
rates of the neonates transferred into your hospital with a 95%
confidence interval for your hospital and the hospitals in your
subgroup. The subgroup average is indicated by a broken line and the
database average is indicated by the solid line. If your confidence
interval passes through the subgroup or database average there is no
significant difference between your rate and the comparison rate.
Table N 9: Inborn Neonatal Trend Analysis: Deaths by
Birthweight Category 2009-2014 (Q2) displays inborn neonatal
deaths by birthweight category, as a percent of total inborn deaths and
percent of total inborn neonates in the birthweight category for your
hospital and the trend database.
Graph N 9a: Inborn Neonatal Mortality Analysis (≥ 500 Grams)
2009-2014 (Q2) with Trendlines graphs neonatal deaths of inborns
with birthweights ≥ 500 grams as a percent of total inborn neonates ≥
500 for the hospital and trend database.
Table N 10: Mortality Analysis by Birthweight Category and
Admission Status displays mortality rates for the hospital, subgroup
and database averages for inborns, neonates transferred in and other
neonatal admits by birthweight category.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 28
Table N 1: Neonatal Overview (All cases age 0-28 days old at admission)
Hospital: SAMPLE
Total Neonates 1
Hospital
Subgroup Average
Database Average
Total Inborn Neonates 2
Hospital
Subgroup Average
Database Average
Total Inborn Singletons
Hospital
Subgroup Average
Database Average
Total Inborn Twins
Hospital
Subgroup Average
Database Average
Total Inborn Other Multiples
Hospital
Subgroup Average
Database Average
Total Inborn: Unknown
Hospital
Subgroup Average
Database Average
# of
Cases
% of Total
Neonates
ALOS
Average
Charge
CMI
2400
4282
4135
100.0%
100.0%
100.0%
4.9
5.7
4.7
$15,658
$36,886
$22,546
0.6468
0.7147
0.5662
7.6
8.0
8.3
$24,210
$51,607
$39,818
2283
4046
4039
95.1%
93.8%
96.3%
4.8
5.3
4.3
$14,812
$31,601
$18,222
0.6128
0.6299
0.4665
7.8
8.4
9.3
$24,171
$50,166
$39,057
2135
3836
3854
89.0%
88.8%
92.1%
4.4
4.6
3.9
$13,302
$26,672
$15,485
0.5481
0.5261
0.3974
7.9
8.8
9.7
$24,268
$50,694
$38,966
142
194
171
5.9%
4.6%
3.8%
10.3
15.9
12.6
$35,740
$113,648
$66,892
1.5244
2.3239
1.7140
6.7
6.8
7.3
$23,445
$48,904
$39,026
6
8
8
0.3%
0.2%
0.2%
16.5
32.0
31.0
$56,794
$265,056
$185,104
2.0444
4.6452
4.4268
8.1
6.9
7.0
$27,780
$57,061
$41,815
0
8
6
0.0%
0.2%
0.1%
0.0
17.7
15.1
$0
$129,820
$99,467
0.0000
2.4122
2.2587
0.0
7.3
6.7
$0
$53,817
$44,037
1
- Subgroup and Database averages include all hospitals
2
- Subgroup and Database averages exclude hospitals that do not have inborns
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Adjusted
Adjusted
ALOS Average Charge
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 29
Table N 1: Neonatal Overview (All cases age 0-28 days old at admission)
Hospital: SAMPLE
# of
Cases
% of Total
Neonates
ALOS
Average
Charge
CMI
Total Other Neonatal Admits 1
Hospital
117
4.9%
7.9
$32,166
1.7015
Subgroup Average
236
6.2%
11.2
$88,609
1.9891
Database Average
146
4.9%
8.9
$55,514
1.4980
Total Neonates Transferred In (transferred from another hospital)
Hospital
11
0.5%
24.9
$100,631
5.4608
Subgroup Average
76
2.6%
20.2
$167,174
3.7444
Database Average
46
2.0%
19.4
$133,068
3.5724
2
Total Inborns discharged to home (with or without home health) and readmitted within 28 days
Readmissions within 7 days post-discharge
Hospital
24
1.1%
1.9
$6,515
0.4587
Subgroup Average
33
0.9%
2.8
$16,791
0.4167
Database Average
29
0.8%
2.4
$10,684
0.3341
Readmissions within 28 days post-discharge
Hospital
36
1.6%
2.2
$8,536
0.4992
Subgroup Average
51
1.3%
3.0
$18,736
0.4906
Database Average
40
1.1%
2.6
$12,142
0.3882
3
Other Neonates Admitted 0-28 days old at admission
Hospital
63
2.6%
8.8
$36,077
2.6914
Subgroup Average
106
2.4%
7.6
$58,357
1.4638
Database Average
57
1.8%
8.3
$47,438
1.3581
1
- Includes neonates born outside the hospital, neonates transferred from another hospital, and cases which were
readmissions of previous inborn neonates
2
- Readmissions as a percent of total inborns discharged to home (with or without home health)
3
- Excludes readmissions and cases identified as transferred in
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Adjusted
Adjusted
ALOS Average Charge
4.7
5.6
6.0
$18,905
$44,546
$37,060
4.6
5.4
5.4
$18,428
$44,646
$37,249
4.1
6.7
7.1
$14,205
$40,298
$31,979
4.4
6.2
6.8
$17,099
$38,188
$31,276
3.3
5.2
6.1
$13,405
$39,867
$34,930
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 30
Table N 1: Neonatal Overview (All cases age 0-28 days old at admission)
Hospital: SAMPLE
# of
Cases
% of Total
Neonates
ALOS
Average
Charge
Inborns Transferred Out to Another Facility
Hospital
12
0.5%
19.0
$155,413
Subgroup Average
26
0.7%
28.6
$302,821
Database Average
35
1.0%
21.5
$201,983
Inborns Transferred Out to Another Facility within 0-3 Days of Birth
Hospital
9
0.4%
1.2
$3,587
Subgroup Average
12
0.3%
1.6
$20,647
Database Average
19
0.6%
1.4
$14,124
Inborns Transferred Out to Another Facility within 4-7 Days of Birth
Hospital
0
0.0%
0.0
$0
Subgroup Average
3
0.1%
5.3
$67,845
Database Average
4
0.1%
5.3
$49,181
Inborns Transferred Out to Another Facility >7 Days of Birth
Hospital
3
0.1%
72.3
$610,891
Subgroup Average
12
0.3%
54.9
$581,381
Database Average
13
0.3%
49.0
$426,507
Other Neonatal Admits Transferred Out to Another Facility within 0-7 Days of Admission
Hospital
0
0.0%
0.0
$0
Subgroup Average
3
0.1%
2.3
$38,457
Database Average
3
0.1%
2.4
$27,043
Other Neonatal Admits Transferred Out to Another Facility >7 Days of Admission
Hospital
1
0.0%
13.0
$87,737
Subgroup Average
4
0.1%
32.9
$390,102
Database Average
3
0.1%
33.2
$281,816
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
CMI
Adjusted
Adjusted
ALOS Average Charge
6.0136
6.4549
4.1987
3.2
4.4
5.2
$25,843
$46,913
$48,731
0.1960
0.2754
0.2801
6.2
5.7
4.9
$18,300
$74,973
$50,415
0.0000
3.7027
3.3990
0.0
1.4
1.6
$0
$18,323
$14,469
21.5274
11.2265
9.1439
3.4
4.9
5.4
$28,377
$51,787
$46,644
0.0000
1.2412
1.6518
0.0
1.8
1.5
$0
$30,984
$16,371
7.1228
6.0221
6.9200
1.8
5.5
4.8
$12,318
$64,779
$40,725
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 31
Percent of Total Inborns
Graph N 1a: Inborn Twins Birth
Analysis
withBirth
Trendlines
(Q1-Q2)NPIC
ID:Trendlines
SAMPLE (Q1-Q2)
Hosp
Graph
N 1a:2009-2014
Inborn Twins
Analysis
2009-2014 with
Trend Rate
Hosp NumeratorNPIC
Denominator
Hosp
Rate
LCI
UCI
ID: SAMPLE
2009
4.4%
121
3536
3.4%
0.00574545
0.006531556
9.0%
2010
4.4%
160
3398
4.7%
0.006876963
0.007668648
2011
4.3%
159
3156
5.0%
0.007369538
0.00821631
8.0%
2012
4.4%
173
3060
5.7%
0.00791888
0.008779383
7.0%
2013
4.2%
118
2409
4.9%
0.008273576
0.009390216
2014
4.4%
91
1371
6.6%
0.012600507
0.014495738
6.0%
5.0%
4.0%
Correl Coefficient
3.0%
-0.618857304
53.196%
-0.024%
2.0%
Trend Trendline X Vals:
1.0%
2009
2014
-987.026%
0.493%
Hosp Trendline X Vals:
2009
3.8%
2014
6.3%
4.4%
4.3%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Significant Upward Trend, p = 0.004
Trend Rate: Stable Over Time
2009
2010
2011
2012
2013
2014 (Q1-Q2)
4.4%
3.4%
121
3536
2.8%
4.1%
4.4%
4.7%
160
3398
4.0%
5.5%
4.3%
5.0%
159
3156
4.3%
5.9%
4.4%
5.7%
173
3060
4.9%
6.5%
4.2%
4.9%
118
2409
4.1%
5.8%
4.4%
6.6%
91
1371
5.4%
8.1%
Page 32
Percent of Total Inborns
Graph N 1b: Inborn Other
Multiples
Analysis
(Q1-Q2)
with 2009-2014
TrendlinesNPIC
ID:with
SAMPLE
Graph
N 1b:Birth
Inborn
Other 2009-2014
MultiplesHosp
Birth
Analysis
(Q1-Q2)
Trendlines
Trend Rate
Hosp NumeratorNPIC
Denominator
Hosp
Rate
LCI
UCI
ID: SAMPLE
2009
0.3%
15
3536
0.4%
0.001866008
0.002744902
1.20%
2010
0.2%
13
3398
0.4%
0.001787263
0.002707098
2011
0.2%
6
3156
0.2%
0.00120353
0.002232591
2012
0.2%
19
3060
0.6%
0.002466758
0.003470197
1.00%
2013
0.2%
3
2409
0.1%
0.00098842
0.002389313
2014
0.2%
6
1371
0.4%
0.002768619
0.00512493
0.80%
0.60%
Correl Coefficient
0.40%
-0.834106012
28.972%
-0.014%
Trend0.20%
Trendline X Vals:
2009
2014
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
Hosp Trendline X Vals:
2009
2014
0.3%
0.2%
0.00%
2008
16.236%
-0.008%
2009
2010
2011
2012
0.4%
0.3%
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.031
2009
2010
2011
2012
2013
2014 (Q1-Q2)
0.3%
0.4%
15
3536
0.2%
0.7%
0.2%
0.4%
13
3398
0.2%
0.7%
0.2%
0.2%
6
3156
0.1%
0.4%
0.2%
0.6%
19
3060
0.4%
1.0%
0.2%
0.1%
3
2409
0.0%
0.4%
0.2%
0.4%
6
1371
0.2%
1.0%
Page 33
Table N 2: Inborn Neonatal Analysis by Birthweight Category
Hospital: SAMPLE
Total Inborn Neonates
Hospital
Subgroup Average
Database Average
Missing BW
Hospital
Subgroup Average
Database Average
BW > 0 < 500 Grams
Hospital
Subgroup Average
Database Average
BW 500-749 Grams
Hospital
Subgroup Average
Database Average
BW 750-999 Grams
Hospital
Subgroup Average
Database Average
BW 1000-1499 Grams
Hospital
Subgroup Average
Database Average
BW 1500-1999 Grams
Hospital
Subgroup Average
Database Average
BW 2000-2499 Grams
Hospital
Subgroup Average
Database Average
BW 2500-7000 Grams
Hospital
Subgroup Average
Database Average
# of Cases
% of Total
Inborns
ALOS
Average
Charge
CMI
Adjusted
ALOS
Adjusted
Average Charge
2283
4046
4039
100.0%
100.0%
100.0%
4.8
5.3
4.3
$14,812
$31,601
$18,222
0.6128
0.6299
0.4665
7.8
8.4
9.3
$24,171
$50,166
$39,057
9
32
48
0.4%
0.7%
0.9%
1.7
4.0
3.2
$3,241
$21,212
$14,261
0.0000
0.0969
3.6534
0.0
40.9
0.9
$0
$218,906
$3,903
6
10
8
0.3%
0.3%
0.2%
2.0
21.3
13.8
$11,857
$200,337
$121,503
3.4998
3.7602
2.6580
0.6
5.7
5.2
$3,388
$53,279
$45,712
11
20
15
0.5%
0.5%
0.4%
65.5
77.9
57.7
$343,144
$725,606
$468,362
16.4660
15.1840
12.4430
4.0
5.1
4.6
$20,840
$47,787
$37,641
15
22
18
0.7%
0.6%
0.4%
71.3
73.3
61.6
$375,125
$671,190
$451,432
15.4750
14.2140
11.7580
4.6
5.2
5.2
$24,241
$47,222
$38,393
36
57
46
1.6%
1.5%
1.1%
42.0
47.8
41.0
$169,744
$362,799
$239,654
8.1137
7.5997
6.5767
5.2
6.3
6.2
$20,921
$47,738
$36,440
68
98
84
3.0%
2.6%
2.1%
17.8
23.0
19.7
$67,238
$165,099
$104,199
2.5736
3.1110
2.6936
6.9
7.4
7.3
$26,126
$53,069
$38,684
191
251
228
8.4%
6.5%
5.6%
6.2
8.3
7.1
$19,528
$52,697
$33,067
0.9449
1.0861
0.8667
6.6
7.6
8.2
$20,667
$48,519
$38,154
1947
3556
3592
85.3%
87.2%
89.3%
2.6
2.8
2.6
$5,085
$12,361
$7,575
0.1696
0.2112
0.1747
15.5
13.4
15.0
$29,987
$58,520
$43,364
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 34
Table N 3: Neonates Transferred In From Another Hospital (0-28 Days Old at Admission)
by Birthweight Category
Hospital: SAMPLE
Total Neonates Transferred In
0-28 days old at admission
Hospital
Subgroup Average
Database Average
Missing BW
Hospital
Subgroup Average
Database Average
BW >0 and <500 grams
Hospital
Subgroup Average
Database Average
BW 500-749 grams
Hospital
Subgroup Average
Database Average
BW 750-999 grams
Hospital
Subgroup Average
Database Average
BW 1000-1499 grams
Hospital
Subgroup Average
Database Average
BW 1500-1999 grams
Hospital
Subgroup Average
Database Average
BW 2000-2499 grams
Hospital
Subgroup Average
Database Average
BW >=2500 grams
Hospital
Subgroup Average
Database Average
# of Cases
% of Total Neonates
Transferred In
ALOS
Average
Charge
CMI
Adjusted
LOS
Adjusted Average
Charge
11
76
46
100.0%
100.0%
100.0%
24.9
20.2
19.4
$100,631
$167,174
$133,068
5.4608
3.7444
3.5724
4.6
5.4
5.4
$18,428
$44,646
$37,249
7
12
7
63.6%
27.0%
19.1%
18.4
9.3
9.8
$64,742
$59,173
$72,631
1.2498
0.8178
1.0198
14.8
11.4
9.6
$51,802
$72,358
$71,224
0
0
0
0.0%
0.2%
0.7%
0.0
78.0
30.5
$0
$613,926
$233,872
0.0000
27.1880
11.8640
0.0
2.9
2.6
$0
$22,581
$19,713
1
1
1
9.1%
2.4%
1.6%
13.0
78.7
82.9
$87,737
$852,608
$759,867
7.1228
16.6820
17.5610
1.8
4.7
4.7
$12,318
$51,110
$43,269
1
2
1
9.1%
2.9%
2.7%
111.0
76.9
77.8
$496,086
$625,784
$520,110
16.6070
12.3910
14.1310
6.7
6.2
5.5
$29,872
$50,503
$36,805
0
3
3
0.0%
5.1%
13.4%
0.0
62.6
48.4
$0
$521,663
$318,662
0.0000
8.8659
8.1905
0.0
7.1
5.9
$0
$58,839
$38,906
1
7
4
9.1%
10.6%
12.9%
20.0
28.3
24.3
$65,469
$258,583
$161,723
1.8987
3.0767
3.2478
10.5
9.2
7.5
$34,481
$84,045
$49,796
0
10
6
0.0%
13.0%
11.7%
0.0
20.6
17.6
$0
$171,846
$121,341
0.0000
3.6645
2.7971
0.0
5.6
6.3
$0
$46,895
$43,381
1
41
25
9.1%
38.9%
37.8%
1.0
12.4
10.6
$4,448
$110,347
$83,753
0.4260
1.9555
1.7208
2.4
6.4
6.2
$10,441
$56,428
$48,672
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 35
Table N 4: Neonatal Trend Analysis By Birthweight Category 2009-2014 (Q1-Q2)
NPIC ID: SAMPLE
2009
Total Neonates 0-28 Days at Admission
Hospital
3654
Percent Of Total
100.0%
Trend Data Base Average
4778
Percent Of Total
100.0%
Missing Birthweight
Hospital
347
Percent Of Total
9.5%
Trend Data Base Average
87
Percent Of Total
1.7%
< 500 Grams
Hospital
17
Percent Of Total
0.5%
Trend Data Base Average
13
Percent Of Total
0.3%
500-749 Grams
Hospital
31
Percent Of Total
0.9%
Trend Data Base Average
22
Percent Of Total
0.5%
750-999 Grams
Hospital
34
Percent Of Total
0.9%
Trend Data Base Average
26
Percent Of Total
0.6%
1000-1499 Grams
Hospital
62
Percent Of Total
1.7%
Trend Data Base Average
64
Percent Of Total
1.5%
1500-1999 Grams
Hospital
90
Percent Of Total
2.5%
Trend Data Base Average
112
Percent Of Total
2.5%
2000-2499 Grams
Hospital
275
Percent Of Total
7.5%
Trend Data Base Average
274
Percent Of Total
6.0%
2500-7000 Grams
Hospital
2798
Percent Of Total
76.6%
Trend Data Base Average
4180
Percent Of Total
86.9%
*Excludes readmissions and birth weights > 7000 grams
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
3519
100.0%
4656
100.0%
3237
100.0%
4611
100.0%
3159
100.0%
4597
100.0%
2471
100.0%
4548
100.0%
1424
100.0%
2239
100.0%
-32.4%
0.0%
-4.8%
0.0%
378
10.7%
99
1.8%
148
4.6%
88
2.2%
82
2.6%
81
1.5%
62
2.5%
80
1.4%
45
3.2%
32
1.4%
-82.1%
-73.6%
-8.2%
-19.1%
16
0.5%
12
0.3%
22
0.7%
11
0.3%
16
0.5%
11
0.3%
11
0.5%
12
0.3%
3
0.2%
5
0.2%
-35.3%
-4.3%
-10.2%
3.7%
21
0.6%
23
0.6%
16
0.5%
20
0.5%
16
0.5%
20
0.5%
10
0.4%
21
0.5%
11
0.8%
10
0.5%
-67.7%
-52.9%
-4.6%
1.9%
19
0.5%
26
0.6%
19
0.6%
24
0.6%
23
0.7%
24
0.6%
20
0.8%
24
0.6%
11
0.8%
12
0.6%
-41.2%
-12.9%
-8.3%
-6.3%
74
2.1%
62
1.4%
57
1.8%
61
1.4%
61
1.9%
60
1.4%
41
1.7%
59
1.4%
21
1.5%
29
1.4%
-33.9%
-2.4%
-8.3%
-5.5%
99
2.8%
111
2.6%
97
3.0%
107
2.5%
107
3.4%
108
2.5%
59
2.4%
105
2.4%
45
3.2%
51
2.4%
-34.4%
-2.8%
-6.6%
-2.4%
258
7.3%
272
6.1%
270
8.3%
267
5.9%
268
8.5%
262
5.9%
186
7.5%
263
6.0%
129
9.1%
132
6.1%
-32.4%
0.0%
-4.3%
-0.2%
2654
75.4%
4052
86.8%
2608
80.6%
4032
86.7%
2586
81.9%
4032
87.5%
2082
84.3%
3986
87.4%
1159
81.4%
1969
87.4%
-25.6%
10.0%
-4.6%
0.6%
Page 36
Percent of Total Discharges
500-7000 Grams at Admission
Graph N 4a: Neonatal Birthweight
2009-2014
(Q1-Q2)
with Trendlines:Discharges
500-749
Grams at Admission NPIC ID: SAMPLE
Hosp
Graph Analysis
N 4a: Neonatal
Birthweight
Analysis
2009-2014 (Q1-Q2) with
Trendlines:
Trend Rate
Hosp Discharges
Numerator 500-749
Denominator
Hosp
Rate
LCI
UCI
Grams at Admission
NPIC ID:3290
SAMPLE
2009
0.6%
31
0.9%
0.003011528 0.003925652
2010
0.6%
21
3125
0.7%
0.002555684 0.003533774
1.6%
2011
0.5%
16
3067
0.5%
0.00223237 0.003241231
1.4% 2012
0.5%
16
3061
0.5%
0.002236746 0.003247838
2013
0.6%
10
2398
0.4%
0.00216881 0.003485864
1.2% 2014
0.5%
11
1376
0.8%
0.003996605 0.006264273
1.0%
0.8%
Correl Coefficient
0.6%
-0.544704779
17.775%
-0.009%
0.4%
Trend Trendline X Vals:
20090.2%
2014
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
Hosp Trendline X Vals:
2009
2014
0.6%
0.5%
0.0%
2008
85.594%
-0.042%
2009
2010
2011
2012
0.8%
0.5%
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Stable Over Time
2009
2010
2011
2012
2013
2014 (Q1-Q2)
0.6%
0.9%
31
3290
0.6%
1.3%
0.6%
0.7%
21
3125
0.4%
1.0%
0.5%
0.5%
16
3067
0.3%
0.8%
0.5%
0.5%
16
3061
0.3%
0.8%
0.6%
0.4%
10
2398
0.2%
0.8%
0.5%
0.8%
11
1376
0.4%
1.4%
Page 37
Percent of Total Discharges
500-7000 Grams at Admission
Graph N 4b: Neonatal Birthweight
2009-2014
(Q1-Q2)
with Trendlines:Discharges
750-1499
Grams at Admission NPIC ID: SAMPLE
Hosp
Graph Analysis
N 4b: Neonatal
Birthweight
Analysis
2009-2014 (Q1-Q2) with
Trendlines:
Trend Rate
HospDischarges
Numerator750-1499
Denominator
Hosp
Rate
LCI
UCI
Grams at Admission
NPIC ID:3290
SAMPLE
2009
2.2%
96
2.9%
0.005481365 0.006337884
2010
2.1%
93
3125
3.0%
0.005673999 0.006575594
4.0%
2011
2.1%
76
3067
2.5%
0.00520773 0.006138745
3.5%2012
2.0%
84
3061
2.7%
0.005495856 0.006421571
2013
2.0%
61
2398
2.5%
0.005925125 0.007119783
3.0%2014
2.0%
32
1376
2.3%
0.007295475 0.009416957
2.5%
2.0%
Correl Coefficient
1.5%
-0.976568464
63.559%
-0.031%
1.0%
Trend Trendline X Vals:
20090.5%
2014
2.1%
2.0%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
232.101%
-0.114%
Hosp Trendline X Vals:
2009
2.9%
2014
2.4%
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.021
2009
2010
2011
2012
2013
2014 (Q1-Q2)
2.2%
2.9%
96
3290
2.4%
3.6%
2.1%
3.0%
93
3125
2.4%
3.6%
2.1%
2.5%
76
3067
2.0%
3.1%
2.0%
2.7%
84
3061
2.2%
3.4%
2.0%
2.5%
61
2398
2.0%
3.3%
2.0%
2.3%
32
1376
1.6%
3.3%
Page 38
Table N 5: MDC 15 Neonate Analysis by MS DRG
% of Total
Hospital: SAMPLE
# of Cases
Neonates
MS DRG 789 - Neonates, died or transferred to another acute care facility
Hospital
28
1.2%
Subgroup Average
57
1.5%
Database Average
59
1.6%
MS DRG 790 - Extreme immaturity or respiratory distress syndrome, neonate
Hospital
81
3.4%
Subgroup Average
173
4.6%
Database Average
121
2.9%
MS DRG 791 - Prematurity w major problems
Hospital
99
4.1%
Subgroup Average
126
3.0%
Database Average
100
2.4%
MS DRG 792 - Prematurity w/o major problems
Hospital
159
6.6%
Subgroup Average
241
5.8%
Database Average
216
5.1%
MS DRG 793 - Full term neonate w major problems
Hospital
158
6.6%
Subgroup Average
248
6.0%
Database Average
194
4.8%
MS DRG 794 - Neonate w other significant problems
Hospital
361
15.0%
Subgroup Average
920
20.8%
Database Average
819
19.0%
MS DRG 795 -Normal newborn
Hospital
1494
62.3%
Subgroup Average
2463
57.1%
Database Average
2591
62.8%
Other DRGs associated with all MDCs1
Hospital
Subgroup Average
Database Average
Neonates 0-28 days old not grouping to MDC 15
Hospital
Subgroup Average
Database Average
1
CMI
Adjusted
ALOS
Adjusted
Average
Charge
$81,446
$179,479
$108,218
7.0850
5.5646
4.1188
1.4
2.6
2.7
$11,496
$32,254
$26,275
45.4
44.6
39.2
$200,273
$365,047
$254,077
8.3535
6.8159
6.0391
5.4
6.5
6.5
$23,975
$53,559
$42,072
11.6
20.2
18.1
$38,495
$146,200
$96,100
1.6890
2.7459
2.4057
6.9
7.3
7.5
$22,792
$53,244
$39,946
7.9
7.5
6.6
$25,498
$40,400
$27,292
0.8209
0.6880
0.6150
9.6
10.8
10.8
$31,062
$58,722
$44,375
6.8
7.6
6.7
$23,102
$59,125
$35,973
0.8613
1.0890
0.8570
7.9
7.0
7.8
$26,821
$54,291
$41,975
3.1
2.8
2.7
$6,884
$10,341
$7,470
0.2365
0.2126
0.2081
12.9
13.0
12.8
$29,104
$48,651
$35,896
2.1
2.2
2.2
$3,084
$5,803
$4,273
0.1148
0.1032
0.1044
18.4
21.3
20.9
$26,859
$56,257
$40,927
ALOS
Average
Charge
9.8
14.4
11.1
10
29
19
0.4%
0.6%
0.8%
5.4
27.6
21.8
$30,193
$308,034
$215,499
2.7168
6.0563
4.3867
2.0
4.6
5.0
$11,114
$50,862
$49,125
30
60
37
1.3%
1.5%
1.4%
3.6
8.3
11.2
$14,959
$65,853
$64,022
0.8259
1.1046
1.2581
4.3
7.5
8.9
$18,112
$59,617
$50,886
e.g. MS DRG 999 ungroupable
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 39
Table N 6: Inborns by APR DRG Subclass
CMI
Adjusted
ALOS
Adjusted
Average
Charge
$14,812
$31,601
$18,222
0.6128
0.6299
0.4665
7.8
8.4
9.3
$24,171
$50,166
$39,057
2.6
2.6
2.5
$5,115
$8,829
$6,076
0.1773
0.1535
0.1446
14.9
17.1
17.6
$28,854
$57,523
$42,028
28.1%
18.8%
18.3%
4.2
6.2
5.2
$11,211
$33,050
$20,641
0.4451
0.6642
0.5294
9.5
9.3
9.8
$25,187
$49,758
$38,988
236
308
278
10.3%
7.9%
6.6%
11.3
15.8
12.7
$41,903
$108,824
$67,802
1.6519
2.3173
1.8495
6.8
6.8
6.9
$25,367
$46,961
$36,659
Subclass .4 - Extreme Complications
Hospital
Subgroup Average
Database Average
35
65
51
1.5%
1.9%
1.2%
49.5
51.8
38.5
$264,453
$494,356
$307,562
13.5310
11.0330
8.6627
3.7
4.7
4.4
$19,544
$44,808
$35,504
Ungroupable
Hospital
Subgroup Average
Database Average
16
44
59
0.7%
1.0%
1.1%
9.6
11.8
11.2
$34,191
$94,615
$65,589
0.0000
0.0000
0.0000
0.0
0.0
0.0
$0
$0
$0
# of Cases
% of Total
Inborns
ALOS
Average
Charge
Total Inborns
Hospital
Subgroup Average
Database Average
2283
4046
4039
100.0%
100.0%
100.0%
4.8
5.3
4.3
Subclass .1 - Minor Complications
Hospital
Subgroup Average
Database Average
1354
2887
2899
59.3%
70.4%
72.8%
Subclass .2 - Moderate Complications
Hospital
Subgroup Average
Database Average
642
742
753
Subclass .3 - Major Complications
Hospital
Subgroup Average
Database Average
Hospital: SAMPLE
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 40
Table N 7: Neonates Transferred In 0-28 days old at admission by APR DRG Subclass
Hospital: SAMPLE
% of Total
# of Cases Transferred In
ALOS
Average
Charge
CMI
Adjusted
ALOS
Adjusted
Average
Charge
Total Neonates Transferred In
Hospital
Subgroup Average
Database Average
11
76
46
100.0%
100.0%
100.0%
24.9
20.2
19.4
$100,631
$167,174
$133,068
5.4608
3.7444
3.5724
4.6
5.4
5.4
$18,428
$44,646
$37,249
Subclass .1 - Minor Complications
Hospital
Subgroup Average
Database Average
3
15
8
27.3%
19.0%
19.7%
8.0
8.3
8.6
$28,553
$52,120
$46,912
1.1915
0.8836
1.0408
6.7
9.4
8.3
$23,964
$58,985
$45,073
Subclass .2 - Moderate Complications
Hospital
Subgroup Average
Database Average
0
17
11
0.0%
17.4%
23.7%
0.0
12.5
14.0
$0
$85,376
$73,880
0.0000
1.4523
1.5924
0.0
8.6
8.8
$0
$58,786
$46,395
Subclass .3 - Major Complications
Hospital
Subgroup Average
Database Average
2
21
13
18.2%
26.9%
26.2%
62.0
27.1
23.4
$291,912
$194,075
$151,896
11.8650
3.7034
3.7441
5.2
7.3
6.2
$24,603
$52,404
$40,569
Subclass .4 - Extreme Complications
Hospital
Subgroup Average
Database Average
0
11
9
0.0%
12.7%
11.0%
0.0
49.0
49.9
$0
$502,487
$413,751
0.0000
10.2420
10.7270
0.0
4.8
4.7
$0
$49,062
$38,572
Ungroupable
Hospital
Subgroup Average
Database Average
6
12
6
54.6%
24.0%
19.5%
21.0
13.0
11.0
$72,909
$119,153
$82,551
0.0000
0.0000
0.0000
0.0
0.0
0.0
$0
$0
$0
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 41
Table N 8: Mortality Analysis by Admission Status
Hospital: SAMPLE
Hospital
Subgroup Average
Database Average
Total Neonates 0-28 days old at admission
Neonatal deaths
% of total neonates
2400
16
0.7%
4282
29
0.8%
4135
22
0.6%
Inborns (≥ 500 Grams)
Inborn deaths
% of total Inborns
2268
8
0.4%
4003
15
0.4%
3982
11
0.3%
7
1
0
11
2
2
8
2
1
11
0
0.0%
76
1
1.2%
46
2
1.1%
0
0
0
1
0
0
1
1
0
106
1
0.9%
160
2
0.8%
99
1
0.9%
1
0
0
1
1
0
1
0
0
# died 0-7 days old
# died 8-27 days old
# died ≥ 28 days old
Transferred In
Transferred In deaths
% of total transfers
# died 0-7 days old
# died 8-27 days old
# died ≥ 28 days old
Other Neonatal Admits *
Other Neonatal Admit deaths
% of total other neonatal admits
# died 0-7 days old
# died 8-27 days old
# died ≥ 28 days old
* Includes readmissions
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 42
Graph N 8a: NPIC Inborn Mortality (≥ 500 Grams)
NPIC ID: SAMPLE
2.5%
2.0%
Rate
1.5%
1.0%
0.5%
0.0%
Hospital Rate with 95% Confidence Interval (0.35%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (0.37%)
Database Average (0.28%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 43
Graph N 8b: NPIC Transferred In Mortality
NPIC ID: SAMPLE
50.0%
45.0%
40.0%
35.0%
Rate
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
* Hospital had no denominator cases for this metric.
Hospital Rate with 95% Confidence Interval (0.0%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (1.2%)
Database Average (1.1%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 44
Table N 9: Inborn Neonatal Trend Analysis: Deaths By Birthweight Category 2009 - 2014 (Q1-Q2)
NPIC ID: SAMPLE
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
Total Deaths, Inborn Neonates *
Hospital
Percent Of Total Inborn Neonates
31
0.9%
26
0.8%
33
1.1%
26
0.9%
14
0.6%
10
0.7%
-54.8%
-34.1%
Trend Data Base Average
Percent Of Total Inborn Neonates
Missing Birthweight
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in Missing Birthweight Category
28
0.6%
28
0.6%
26
0.6%
24
0.6%
25
0.6%
12
0.6%
-12.8%
-7.8%
1
3.2%
0.4%
0
0.0%
0.0%
1
3.0%
1.1%
1
3.9%
25.0%
0
0.0%
0.0%
1
10.0%
16.7%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in Missing Birthweight Category
< 500 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in < 500 Grams Birthweight Category
1
1.9%
3.6%
1
1.7%
3.6%
1
2.6%
4.9%
1
1.8%
5.1%
1
1.9%
7.6%
0
1.9%
3.8%
40.0%
1.1%
112.8%
16
51.6%
94.1%
15
57.7%
100.0%
22
66.7%
100.0%
15
57.7%
100.0%
11
78.6%
100.0%
3
30.0%
100.0%
-31.3%
52.2%
6.2%
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in < 500 Grams Birthweight Category
500-749 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 500-749 Grams Birthweight Category
11
35.6%
73.7%
10
32.0%
73.8%
10
34.9%
74.3%
9
33.7%
73.4%
10
42.7%
80.2%
5
31.3%
67.2%
-9.2%
20.1%
8.8%
10
32.3%
33.3%
6
23.1%
28.6%
4
12.1%
28.6%
4
15.4%
25.0%
1
7.1%
10.0%
3
30.0%
30.0%
-90.0%
-77.9%
-70.0%
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 500-749 Grams Birthweight Category
750-999 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 750-999 Grams Birthweight Category
7
21.9%
31.8%
8
29.0%
35.9%
6
22.6%
30.5%
6
21.8%
29.1%
6
25.2%
29.6%
3
21.4%
27.1%
-7.4%
15.1%
-6.9%
3
9.7%
10.0%
1
3.9%
5.9%
1
3.0%
5.6%
3
11.5%
13.6%
0
0.0%
0.0%
1
10.0%
12.5%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 750-999 Grams Birthweight Category
*Excludes Readmissions
3
9.2%
11.5%
2
8.9%
8.6%
2
8.8%
8.6%
2
6.5%
7.1%
2
5.4%
6.3%
1
8.3%
7.4%
-38.5%
-40.5%
-45.4%
Page 45
Table N 9: Inborn Neonatal Trend Analysis: Deaths By Birthweight Category 2009 - 2014 (Q1-Q2)
NPIC ID: SAMPLE
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
1000-1499 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 1000-1499 Grams Birthweight Category
0
0.0%
0.0%
1
3.9%
1.5%
4
12.1%
7.4%
1
3.9%
1.7%
1
7.1%
2.6%
2
20.0%
9.5%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 1000-1499 Grams Birthweight Category
1500-1999 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 1500-1999 Grams Birthweight Category
2
5.5%
2.6%
2
6.5%
3.0%
2
6.0%
3.8%
2
5.3%
2.2%
2
5.2%
2.4%
1
4.7%
2.4%
-28.6%
-4.7%
-11.0%
1
3.2%
1.2%
0
0.0%
0.0%
1
3.0%
1.1%
0
0.0%
0.0%
0
0.0%
0.0%
0
0.0%
0.0%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 1500-1999 Grams Birthweight Category
2000-2499 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 2000-2499 Grams Birthweight Category
1
4.8%
1.1%
2
8.0%
1.6%
2
6.0%
1.6%
1
4.3%
1.1%
1
3.9%
1.0%
1
9.1%
1.3%
-7.1%
-20.0%
-11.9%
0
0.0%
0.0%
1
3.9%
0.4%
0
0.0%
0.0%
0
0.0%
0.0%
1
7.1%
0.6%
0
0.0%
0.0%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 2000-2499 Grams Birthweight Category
2500-7000 Grams
Hospital
Percent Of Total Inborn Deaths
Percent Of Inborns in 2500-7000 Grams Birthweight Category
1
4.7%
0.5%
1
5.3%
0.6%
1
7.6%
0.5%
1
4.8%
0.5%
1
5.7%
0.4%
1
5.6%
0.6%
-28.6%
21.4%
-13.7%
0
0.0%
0.0%
2
7.7%
0.1%
0
0.0%
0.0%
2
7.7%
0.1%
0
0.0%
0.0%
0
0.0%
0.0%
----
Trend Data Base Average
Percent Of Total Inborn Deaths
Percent Of Inborns in 2500-7000 Grams Birthweight Category
2
7.6%
0.1%
2
6.9%
0.1%
2
6.2%
0.1%
2
9.3%
0.1%
2
8.2%
0.1%
1
7.2%
0.1%
0.0%
7.8%
0.0%
Page 46
Percent of Total Inborns
Graph N 9a: Inborn Neonatal Mortality
Analysis
500 Grams)
2009-2014
Trendlines
Hosp
Graph
N 9a: (≥
Inborn
Neonatal
Mortality(Q1-Q2)
Analysis with
(≥ 500
Grams) NPIC ID: SAMPLE
Trend Rate
Hosp Numerator
Denominator
Hosp
Rate
LCI
2009-2014 (Q1-Q2) with Trendlines
NPIC ID:3250
SAMPLE
2009
0.39%
14
0.4%
0.001950608
2010
0.41%
11
3082
0.4%
0.001785863
1.2%
2011
0.36%
10
3046
0.3%
0.001707622
2012
0.35%
10
3041
0.3%
0.001710429
1.0%
2013
0.34%
3
2383
0.1%
0.000999204
2014
0.38%
6
1362
0.4%
0.002786914
UCI
0.002908996
0.002807574
0.002746595
0.002750382
0.00241595
0.005158013
0.8%
0.6%
Correl Coefficient
-0.546785799
15.889%
-0.008%
0.4%
Trend Trendline X Vals:
0.2%
2009
2014
37.331%
-0.018%
Hosp Trendline X Vals:
2009
2014
0.4%
0.4%
0.4%
0.3%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.007
2009
2010
2011
2012
2013
2014 (Q1-Q2)
0.39%
0.43%
14
3250
0.24%
0.72%
0.41%
0.36%
11
3082
0.18%
0.64%
0.36%
0.33%
10
3046
0.16%
0.60%
0.35%
0.33%
10
3041
0.16%
0.60%
0.34%
0.13%
3
2383
0.03%
0.37%
0.38%
0.44%
6
1362
0.16%
0.96%
Page 47
Table N 10: Mortality Analysis by Birthweight Category & Admission Status
Hospital: SAMPLE
Hospital
Subgroup Average
Database Average
Missing BW
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
68
1
11.1%
0
0.0%
1
1.9%
72
1
8.1%
0
0.7%
0
0.3%
73
1
4.4%
0
0.4%
0
0.3%
BW >0 and <500 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
6
6
100.0%
0
0.0%
0
0.0%
11
9
76.9%
0
0.0%
0
5.6%
9
7
69.8%
0
1.2%
0
11.7%
BW 500-749 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
12
3
27.3%
0
0.0%
0
0.0%
22
6
28.6%
0
5.6%
0
9.8%
17
5
26.9%
0
5.2%
0
4.5%
BW 750-999 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
18
1
6.7%
0
0.0%
0
0.0%
25
2
8.3%
0
1.1%
0
3.9%
20
1
6.1%
0
2.2%
0
4.8%
* Other neonatal admits includes readmissions.
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 48
Table N 10: Mortality Analysis by Birthweight Category & Admission Status
Hospital: SAMPLE
Hospital
Subgroup Average
Database Average
BW 1000-1499 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
37
3
8.3%
0
0.0%
0
0.0%
63
2
4.2%
0
2.9%
0
0.3%
50
1
2.4%
0
3.1%
0
1.9%
BW 1500-1999 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
72
0
0.0%
0
0.0%
0
0.0%
111
1
1.7%
0
0.3%
0
0.3%
91
1
1.2%
0
1.5%
0
1.0%
BW 2000-2499 Grams
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
200
1
0.5%
0
0.0%
0
0.0%
274
1
0.5%
0
4.6%
0
1.0%
241
1
0.4%
0
1.4%
0
0.8%
BW >= 2500 Grams **
# inborns died
% inborns died
# Transferred In died
% transfers died
# other neonatal admits died
% other neonatal admits died
1987
0
0.0%
0
0.0%
0
0.0%
3705
3
0.1%
0
0.5%
1
0.5%
3683
2
0.1%
1
0.5%
0
0.3%
* Other neonatal admits includes readmissions.
** Excludes Birth Weights > 7000 grams
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 49
SECTION IV: NEONATAL SPECIAL CARE REPORT
The tables in this section of the quarterly report are devoted entirely to
the neonatal population admitted to the special care serviceintermediate, intensive, step down and/or rehabilitation. This analysis
uses the fields of NINT and/or NICU days and charges from your
hospital’s data submission to identify these cases. If your hospital does
not provide this financial or utilization detail, these tables will only
reflect the part of your special care activity that we are able to identify.
The Neonatal Special Care Trend Analysis displays your hospital’s
data for the period 2009-2014 (Q2) compared to a subgroup of 59
hospitals that have participated in the NPIC/QAS database for the same
period.
This trend analysis consists of two tables and four graphs. The tables
display the data points for each year as well as the percent change from
2009 – 2014 (Q2). Below each graph is a table which includes all the
data displayed for the trend analysis period: the trend database average
rate, the hospital’s rate with upper and lower confidence intervals, and
the hospital’s count of numerator and denominator cases for each year.
Table N 11: Special Care Analysis displays all neonates 0-28 days
old at admission and identifies the count and percent of total cases with
a special care discharge (defined as Intermediate Care Nursery or
Neonatal Intensive Care Nursery days or charges) for your hospital,
and the average for your subgroup and the database. It also divides
these discharges into inborn, transferred in, readmission and other
special care admission categories and displays them as a percentage of
total special care discharges along with their ALOS, average charge,
case mix index, adjusted ALOS and adjusted average charge.
Table N 12 Neonatal Special Care Trend Analysis 2009-2014 (Q2)
displays all special care discharges as a percent of total neonates 0-28
days old at admission. The table also displays average length of stay,
case mix index and adjusted length of stay.
Graph N 12a: Special Care Discharges 2009-2014 (Q2) with
Trendlines graphs the number of special care discharges as a percent
of total neonatal discharges for your hospital and the trend database.
Trendlines for the time period are displayed on the graphs for
your hospital and the trend database. If your hospital has not
submitted data for the entire period, trendlines will only be
displayed for the years that data was submitted.
Table N 13: Special Care Discharges by Birthweight Category
displays the percent of total special care discharges, ALOS, average
charge, CMI, adjusted ALOS and adjusted average charge for special
care discharges by birthweight category.
PLEASE NOTE: The graph presentation is displayed as annual
data points however the determination of significance is based upon
quarterly data points. This provides improved granularity and a
higher level of confidence in the evaluations of trend significance.
Table N 14: Special Care Discharges by Discharge Status displays
the percent of total special care discharges, ALOS, average charge,
CMI, adjusted ALOS and adjusted charge for special care discharges
by discharge status category.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 50
Table N 15: Special Care Analysis: Complications displays the
count and rate of neonatal complications: Meconium Aspiration
Syndrome,
Intraventricular
Hemorrhage,
Infection
(Septicemia/Bacteremia), Respiratory Distress Syndrome, Transitory
Tachypnea of Newborn, Necrotizing Entercolitis, Patent Ductus
Arteriosus with and without repair, Interstitial Emphysema and related
conditions, Retinopathy of Prematurity (ROP), and ROP with eye
procedure.
The denominator for all rates is the total special care population with
the exception of MAS and ROP with eye procedure. MAS is
subdivided into inborns in special care with MAS and transfers in to
special care with MAS. The denominator for these rates are inborns or
transfers in respectively.
The denominator for ROP with eye
procedure is all special care discharges with ROP.
Graph N 16a: Special Care Analysis 2009-2014 (Q2) with
Trendlines: Proportion of BPD to RDS, Neonates with Birthweight
500 – 1499 Grams graphs the proportion of BPD to RDS in special
care discharges with birthweight 500-1499 grams for the hospital and
trend database.
Graph N 16b: Special Care Analysis 2009-2014 (Q2) Trendlines:
NEC Rate Neonates with Birthweight with Birthweight 500-1499
Grams graphs the rate of NEC in special care discharges with
birthweight 500- 1499 grams for the hospital and trend database.
Graph N 16c: Special Care Analysis 2009-2014 (Q2) with
Trendlines: IVH (Grade III or IV) Rate Neonates with Birthweight
500-1499 Grams graphs the rate of IVH in special care discharges
with birthweight 500- 1499 grams for the hospital and trend database.
Table N 16: Special Care Analysis: Neonatal Complication Trends
2009-2014 (Q2). Neonates with Birthweight 500–1499 Grams
displays the total special care cases with birthweight 500–1499 grams
for the hospital and trend database. The proportion of BPD/RDS, and
percentage of NEC and IVH is also displayed.
.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 51
Table N 11: Special Care Analysis
Hospital
Subgroup
Average
Database
Average
2400
598
24.9%
4282
839
20.3%
4135
659
16.3%
# of Cases
% of Total
Special Care
Discharges
ALOS
Average
Charge
555
703
630
92.8%
84.4%
88.7%
12.9
18.7
16.0
Neonates Transferred In
Hospital
Subgroup Average
Database Average
10
67
40
1.7%
9.8%
6.2%
Inborn Readmissions
Hospital
Subgroup Average
Database Average
1
11
12
Other Neonatal Admits
Hospital
Subgroup Average
Database Average
32
58
29
Hospital: SAMPLE
Total Neonates 0-28 days old at admission
Special Care Discharges *
% of Total Neonates
Special Care Discharges Only
Inborns
Hospital
Subgroup Average
Database Average
CMI
Adjusted
ALOS
Adjusted
Average
Charge
$51,421
$149,364
$95,593
2.1025
2.8452
2.3527
6.1
6.6
6.8
$24,457
$52,496
$40,630
27.1
21.2
21.7
$109,119
$157,926
$136,840
6.5136
3.9336
3.9794
4.2
5.4
5.5
$16,753
$40,148
$34,387
0.2%
1.1%
1.7%
3.0
7.3
9.8
$17,939
$41,595
$49,778
1.9806
1.1503
1.2485
1.5
6.3
7.8
$9,057
$36,159
$39,870
5.4%
4.8%
3.4%
14.5
13.1
16.6
$61,108
$101,392
$104,807
4.7484
2.5397
2.7424
3.1
5.1
6.0
$12,869
$39,922
$38,217
* Special Care discharges are those having NICU or NINT days > 0 or NICU or NINT charges > 0
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 52
Table N 12: Neonatal Special Care Trend Analysis 2009-2014 (Q1-Q2)
NPIC ID: SAMPLE
Pct Change
09 - 13
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Total Neonates 0-28 Days at Admission*
Hospital
Percent Of Total Neonates 0-28 days at admission
ALOS
CMI
Adjusted LOS
3665
100.0%
5.3
0.8223
6.4
3526
100.0%
4.9
0.7930
6.2
3286
100.0%
5.0
0.6964
7.1
3211
100.0%
5.4
0.7076
7.6
2511
100.0%
5.0
0.6961
7.1
1452
100.0%
5.1
0.6865
7.5
-31.5%
0.0%
-5.7%
Trend Data Base Average
Percent Of Total Neonates 0-28 days at admission
ALOS
CMI
Adjusted LOS
4826
100.0%
4.9
0.6687
7.3
4703
100.0%
5.0
0.7070
7.0
4657
100.0%
5.0
0.6662
7.5
4641
100.0%
5.0
0.6472
7.7
4596
100.0%
5.1
0.6614
7.7
2263
100.0%
5.1
0.6469
7.9
-4.8%
0.0%
3.1%
Total Special Care Discharges**
Hospital
Percent Of Total Neonates 0-28 days at admission
ALOS
CMI
Adjusted LOS
854
23.3%
15.4
3.0211
5.1
796
22.6%
14.1
2.8529
5.0
847
25.8%
12.8
2.2864
5.6
825
25.7%
14.4
2.3553
6.1
588
23.4%
14.3
2.5439
5.6
385
26.5%
13.2
2.2127
6.0
-31.1%
0.5%
-7.2%
Trend Data Base Average
Percent Of Total Neonates 0-28 days at admission
ALOS
CMI
Adjusted LOS
759
17.4%
16.4
2.7952
5.9
765
17.8%
16.5
2.9523
5.6
754
17.9%
16.5
2.7002
6.1
762
17.9%
16.7
2.6707
6.2
774
18.7%
16.7
2.6633
6.3
380
18.9%
16.4
2.5239
6.5
2.0%
7.1%
1.4%
* Includes All Neonates <= 7000 grams
** Special Care discharges are those having NICU or NINT days > 0 or NICU or NINT charges > 0
Page 53
Rate
(Percent of Total Neonates)
Graph N 12a: Special Care Discharges
2009-2014
with TrendlinesNPIC
ID: SAMPLE
Hosp
Graph N 12a:
Special (Q1-Q2)
Care Discharges
2009-2014 (Q1-Q2)
with Trendlines
Trend Rate
Hosp NumeratorNPIC
Denominator
Hosp
Rate
LCI
UCI
ID: SAMPLE
2009
17.4%
854
3665
23.3%
0.013605668
0.014032577
35.0%
2010
17.8%
796
3526
22.6%
0.013709457
0.014165467
2011
17.9%
847
3286
25.8%
0.014886324
0.015319045
30.0% 2012
17.9%
825
3211
25.7%
0.0150422
0.015485718
2013
18.7%
588
2511
23.4%
0.016444955
0.017067248
25.0% 2014
18.9%
385
1452
26.5%
0.022555084
0.023508892
20.0%
15.0%
Correl Coefficient
0.954908548
-560.636%
0.288%
10.0%
Trend Trendline X Vals:
5.0%
2008.8
2014.2
-1039.284%
0.529%
Hosp Trendline X Vals:
2009
23.2%
2014.2
26.0%
17.3%
18.9%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Upward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
17.4%
23.3%
854
3665
21.9%
24.7%
17.8%
22.6%
796
3526
21.2%
24.0%
17.9%
25.8%
847
3286
24.3%
27.3%
17.9%
25.7%
825
3211
24.2%
27.2%
18.7%
23.4%
588
2511
21.8%
25.1%
18.9%
26.5%
385
1452
24.3%
28.9%
Page 54
Table N 13: Special Care Discharges by Birthweight Category
Count
% of Special Care
Discharges
ALOS
Average
Charge
CMI
Adjusted
ALOS
Adjusted
Average
Charge
Missing BW
Hospital
Subgroup Average
Database Average
26
29
17
4.4%
4.0%
2.1%
10.5
8.6
13.8
$42,773
$99,993
$100,017
0.0000
2.5307
2.8379
0.0
3.4
4.9
$0
$39,512
$35,243
BW >0 and <500 Grams
Hospital
Subgroup Average
Database Average
2
4
2
0.3%
0.5%
0.3%
4.0
54.8
45.5
$33,380
$527,045
$423,088
9.9266
10.6170
9.5048
0.4
5.2
4.8
$3,363
$49,640
$44,513
BW 500-749 Grams
Hospital
Subgroup Average
Database Average
12
19
15
2.0%
2.5%
2.0%
61.1
87.1
67.4
$321,860
$836,624
$561,683
15.6870
16.4360
14.1450
3.9
5.3
4.8
$20,517
$50,902
$39,709
BW 750-999 Grams
Hospital
Subgroup Average
Database Average
16
25
20
2.7%
3.2%
2.6%
82.2
74.6
62.4
$420,497
$669,191
$456,662
17.1110
14.0750
11.8580
4.8
5.3
5.3
$24,575
$47,543
$38,512
BW 1000-1499 Grams
Hospital
Subgroup Average
Database Average
36
62
49
6.0%
7.8%
6.7%
43.6
49.7
43.4
$175,715
$386,096
$260,017
8.2928
7.8392
6.9992
5.3
6.3
6.2
$21,189
$49,252
$37,150
BW 1500-1999 Grams
Hospital
Subgroup Average
Database Average
67
105
83
11.2%
12.9%
12.1%
19.0
24.1
22.0
$72,727
$174,445
$118,862
2.6613
3.2122
2.9708
7.1
7.5
7.4
$27,327
$54,306
$40,010
BW 2000-2499 Grams
Hospital
Subgroup Average
Database Average
116
146
114
19.4%
17.8%
16.8%
9.0
13.8
12.7
$31,200
$103,120
$69,853
1.4535
1.8949
1.6361
6.2
7.3
7.7
$21,466
$54,419
$42,695
BW 2500-7000 Grams
Hospital
Subgroup Average
Database Average
323
449
360
54.0%
51.3%
50.0%
5.1
8.0
7.1
$15,531
$68,811
$43,923
0.4361
1.0466
0.8611
11.8
7.7
8.3
$35,616
$65,750
$51,006
NPIC ID: SAMPLE
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 55
Table N 14: Special Care Discharges by Discharge Status
# of Cases
% of Total
Special Care
Discharges
CMI
Adjusted
ALOS
Adjusted
Average
Charge
Home
Hospital
Subgroup Average
Database Average
574
663
533
$48,368
$121,302
$81,682
1.8647
2.3125
1.9898
6.9
6.9
7.3
$25,939
$52,455
$41,051
Transferred to another short
term/acute care hospital
Hospital
Subgroup Average
Database Average
38.7
30.0
22.6
$322,317
$328,908
$213,700
12.0910
6.3262
4.7324
3.2
4.7
4.8
$26,657
$51,992
$45,157
0.7%
17.6%
10.7%
48.8
45.5
49.0
$261,051
$379,538
$363,611
9.2853
6.1435
5.9963
5.3
7.4
8.2
$28,114
$61,779
$60,639
9
17
12
1.5%
1.9%
1.5%
4.3
20.8
14.1
$43,873
$294,029
$185,841
13.1490
10.6410
10.3940
0.3
2.0
1.4
$3,337
$27,631
$17,880
Other discharge status
Hospital
Subgroup Average
Database Average
5
5
4
0.8%
0.5%
0.6%
16.2
23.8
24.0
$93,438
$215,218
$191,739
5.0814
3.7559
4.2775
3.2
6.3
5.6
$18,388
$57,301
$44,825
Missing discharge status
Hospital
Subgroup Average
Database Average
0
3
1
0.0%
0.3%
0.1%
0.0
0.0
0.0
$0
$0
$0
0.0000
0.0000
0.0000
0.0
0.0
0.0
$0
$0
$0
ALOS
Average
Charge
96.0%
76.0%
74.1%
12.8
16.0
14.4
6
29
35
1.0%
3.7%
5.6%
Discharged/Transferred to home
under care of organized home
health service organization
Hospital
Subgroup Average
Database Average
4
122
73
Died
Hospital
Subgroup Average
Database Average
NPIC ID: SAMPLE
Discharge Status:
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 56
Table N 15: Special Care Analysis: Complications
NPIC ID: SAMPLE
Meconium Aspiration Syndrome (770.12)
Special Care Inborns
Special Care Inborn Rate
Special Care Transfers In
Special Care Transfer In Rate
Intraventricular Hemorrhage (772.13 or 772.14)
# Grade III
Grade III (772.13) Rate
# Grade IV
Grade IV (772.14) Rate
Infection: Septicemia/Bacteremia (771.81, 771.83)
# Septicemia/Bacteremia
Septicemia/Bacteremia Rate
Respiratory Distress Syndrome (769)
# RDS
RDS Rate
Transitory Tachypnea of Newborn (770.6)
# Transitory Tachypnea
Transitory Tachypnea Rate
Necrotizing Enterocolitis (777.50 - 777.53)
# Necrotizing Enterocolitis
Necrotizing Enterocolitis Rate
Patent Ductus Arteriosus Without Repair (747.0)
# Patent Ductus Arteriosus
Patent Ductus Arteriosus Rate
Patent Ductus Arteriosus With Repair (747.0 with 38.85)
# Patent Ductus Arteriosus
Patent Ductus Arteriosus Rate
Interstitial Emphysema and Related Conditions (pneumothorax)
(770.2)
# Interstitial Emphysema
Interstitial Emphysema Rate
Retinopathy of Prematurity Stage 3 - 5 (362.25 - 362.27)
# Retinopathy of Prematurity
Retinopathy of Prematurity Rate
# ROP with eye procedure (14.2x or 14.3x)
ROP with eye procedure Rate
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Hospital
Subgroup Average Database Average
2
0.4%
0
0.0%
13
2.1%
3
2.9%
10
1.7%
2
1.9%
1
0.2%
2
0.3%
5
0.7%
4
0.5%
3
0.4%
3
0.4%
30
5.0%
94
11.2%
72
10.9%
88
14.7%
183
22.8%
135
18.7%
120
20.1%
109
13.2%
101
14.5%
5
0.8%
10
1.1%
8
1.0%
54
9.0%
74
8.7%
51
6.7%
3
0.5%
11
1.2%
5
0.6%
13
2.2%
34
3.9%
24
3.3%
0
0.0%
0
0.0%
3
0.3%
0
9.5%
2
0.2%
0
6.4%
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 57
Table N16: Special Care Analysis
Complication Trends 2009-2014 (Q1-Q2)
Neonates with Birthweight 500 - 1499 Grams
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Pct Change
09 - 13
125
109
111
108
89
101
98
100
70
100
41
48
-44.0%
-8.3%
22
93
23.7%
24
97
24.7%
17
68
25.0%
26
75
34.7%
16
55
29.1%
15
31
48.4%
-27.3%
-40.9%
23.0%
16
70
18.1%
17
72
20.1%
15
66
18.9%
15
66
18.3%
17
68
21.2%
8
33
20.9%
6.3%
-2.9%
17.3%
23
18.4%
15
13.5%
10
11.2%
6
6.1%
4
5.7%
4
9.8%
-82.6%
-69.0%
Trend Data Base Average
Rate
IVH (Grade III -Dx 772.13 or IV - Dx 772.14)
Hospital
Rate
9
7.0%
9
7.9%
8
7.3%
7
6.3%
6
5.2%
3
5.8%
-33.3%
-26.4%
7
5.6%
8
7.2%
3
3.4%
5
5.1%
5
7.1%
2
4.9%
-28.6%
27.5%
Trend Data Base Average
Rate
7
5.9%
8
7.0%
6
5.5%
6
5.5%
7
6.3%
3
5.1%
0.0%
6.6%
NPIC ID: SAMPLE
Special Care Cases with Birthweight 500 - 1499 Grams
Hospital
Trend Data Base Average
Proportion of BPD to RDS
Hospital
RDS cases (Dx 769.x) with BPD (Dx 770.7)
Total RDS Cases
Proportion
Trend Data Base Average
RDS cases (Dx 769.x) with BPD (Dx 770.7)
Total RDS Cases
Proportion
NEC (777.5; 777.50 - 777.53)
Hospital
Rate
Page 58
Proportion of BPD to RDS
Graph N 16a: Special Care Analysis 2009-2014 (Q1-Q2) with Trendlines
Proportion of RDS with BPD to Total
Neonates
with Birthweight
500 - 1499
Grams
GraphRDS,
N 16a:
Special Care
Analysis 2009-2014
(Q1-Q2)
with Trendlines
NPIC ID: SAMPLE
Proportion of RDS with BPD to TotalHosp
RDS, Neonates with Birthweight 500 - 1499 Grams
ID: SAMPLE Hosp Rate (R)
Trend Rate
Hosp NumeratorNPIC
Denominator
Lo Bar Len
Up Bar Len
80.0%
2009
18.1%
22
93
23.7%
0.081983628
0.099402115
2010
20.1%
24
97
24.7%
0.082014733
0.097996264
70.0%
2011
18.9%
17
68
25.0%
0.097119808
0.119822145
2012
18.3%
26
75
34.7%
0.10623497
0.118754431
60.0%
2013
21.2%
16
55
29.1%
0.11460932
0.138073358
2014
20.9%
15
31
48.4%
0.182325148
0.185522756
50.0%
40.0%
30.0%
Correl Coefficient
0.661057357
-941.925%
0.478%
20.0%
Trend Trendline
X Vals:
10.0%
2009
2014
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
-8381.083%
4.182%
Hosp Trendline X Vals:
2009
20.5%
2014
41.4%
18.4%
20.8%
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Significant Upward Trend, p = 0.008
Trend Rate: Significant Upward Trend, p = 0.040
2009
2010
2011
2012
2013
2014 (Q1-Q2)
18.1%
23.7%
22
93
15.5%
33.6%
20.1%
24.7%
24
97
16.5%
34.5%
18.9%
25.0%
17
68
15.3%
37.0%
18.3%
34.7%
26
75
24.0%
46.5%
21.2%
29.1%
16
55
17.6%
42.9%
20.9%
48.4%
15
31
30.2%
66.9%
Page 59
Graph N 16b: Special Care Analysis
2009-2014
(Q1-Q2)
TrendlinesNEC
Rate, Neonates
with Birthweight 500 - 1499 Grams NPIC ID: SAMPLE
Hosp
Graph
N 16b: Special
Carewith
Analysis
2009-2014 (Q1-Q2)
with Trendlines
Trend Rate
Hosp
Numerator
Denominator
Hosp
Rate
UCI
NEC Rate, Neonates with Birthweight 500 - 1499 Grams LCI
NPIC ID: 125
SAMPLE
2009
7.0%
23
18.4%
0.063637802
0.079186729
2010
7.9%
15
111
13.5%
0.057484137
0.077938183
30.0%
2011
7.3%
10
89
11.2%
0.057145451
0.084581305
2012
6.3%
6
98
6.1%
0.038427392
0.067282988
25.0%
2013
5.2%
4
70
5.7%
0.041356114
0.082750961
2014
5.8%
4
41
9.8%
0.070333713
0.133753974
NEC Rate
20.0%
15.0%
Correl Coefficient:
-0.795524677
874.402%
-0.431%
10.0%
Trend Trendline
X Vals:
5.0%
2009
2014
4133.256%
-2.049%
Hosp Trendline X Vals:
2009
15.9%
2014
5.7%
7.7%
5.5%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Significant Downward Trend, p = 0.002
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
7.0%
18.4%
23
125
12.0%
26.3%
7.9%
13.5%
15
111
7.8%
21.3%
7.3%
11.2%
10
89
5.5%
19.7%
6.3%
6.1%
6
98
2.3%
12.9%
5.2%
5.7%
4
70
1.6%
14.0%
5.8%
9.8%
4
41
2.7%
23.1%
Page 60
Graph N 16c: Special
Care Analysis 200918.0%
16.0%
14.0%
IVH Rate
12.0%
2009
2010
2011
2012
2013
2014
Graph N 16c: Special Care Analysis 2009-2014 (Q1-Q2) with Trendlines
Hosp
IVH (Grade III or IV) Rate, Neonates with Birthweight 500 - 1499 Grams
Trend Rate
Hosp NumeratorNPIC
Denominator
LCI
UCI
ID: SAMPLE Hosp Rate
5.9%
7
125
5.6%
0.033191467
0.055979149
7.0%
8
111
7.2%
0.040444039
0.065005556
5.5%
3
89
3.4%
0.026701766
0.061653448
5.5%
5
98
5.1%
0.034249364
0.064037678
6.3%
5
70
7.1%
0.047830037
0.087443658
5.1%
2
41
4.9%
0.042817279
0.116552458
10.0%
8.0%
Correl Coefficient
6.0%
-0.487929869
370.809%
-0.181%
4.0%
Trend Trendline X Vals:
2.0%
2009
2014
124.605%
-0.059%
Hosp Trendline X Vals:
2009
5.7%
2014
5.4%
6.3%
5.4%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.045
2009
2010
2011
2012
2013
2014 (Q1-Q2)
5.9%
5.6%
7
125
2.3%
11.2%
7.0%
7.2%
8
111
3.2%
13.7%
5.5%
3.4%
3
89
0.7%
9.5%
5.5%
5.1%
5
98
1.7%
11.5%
6.3%
7.1%
5
70
2.4%
15.9%
5.1%
4.9%
2
41
0.6%
16.5%
Page 61
SECTION V: PERINATAL QUALITY INDICATORS
Maternal, Neonatal and Linked Mother/Baby Indicators
The Maternal Indicators section displays two critical counts:
 Total All Patient Refined (APR) Major Diagnostic Category
(MDC 14) Pregnancy, Childbirth and the Pueperium Cases:
total cases falling into MDC 14 APR DRGs 540-566 which
includes all antepartum, delivered and postpartum discharges
 Total Deliveries: total cases delivered during the timeframe
referenced
The Maternal section includes 16 indicators: 7 Agency for Healthcare
Quality (AHRQ www.ahrq.gov) indicators drawn from the Patient
Safety and Inpatient Quality Indicator sets; a National Quality Forum
(NQF www.qualityforum.org) indicator which can be calculated using
administrative data and is currently part of the 14 endorsed NQF
perinatal indicators; 8 NPIC/QAS measures that are currently displayed
in our reports or have been profiled in previous versions and a table
displaying the coded reasons for postpartum readmissions.
The Neonatal Indicators section includes two counts:
 Total neonates which includes all inborns and discharges 0-28
days old at admission
 Total inborns which includes only those infants born at your
facility during the timeframe referenced
The Neonatal section also includes 7 indicators: 3 AHRQ measures
from the Patient Safety and Newborn Quality Indicator set, the TJC
Perinatal Care measure that can be calculated using administrative
data- PC-04, Health Care-Associated Bloodstream Infections in
Newborns; NQF# 716, Unexpected Newborn Complications, a
National Quality Forum (NQF www.qualityforum.org) indicator
which also can be calculated using administrative data, and two
NPIC/QAS measures: the Inborn Readmission rate and the total Inborn
Birth Trauma Rate. The Neonatal Section also includes a table
displaying Coded Reasons for Inborn Readmissions.
The Linked Mother/Baby Indicators section displays three critical
counts:
 Total deliveries
 Total deliveries linked to an inborn(s)
 Deliveries linked to an inborn(s) as a percent of total deliveries
(If your hospital’s NPIC/QAS data submission does not provide
mother’s medical record on the baby’s record, we will not be able to
link mother/baby records. Your report will only display your subgroup
and the data base averages.)
The Linked Mother/Baby Indicator section also displays 7 maternal
indicators with neonatal outcome.
Each section of the Report provides the numerator count, denominator
count and rate for your hospital along with upper and lower confidence
intervals, your subgroup average, data base average and the AHRQ
2010 comparative provider rates for the AHRQ indicators displayed.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 62
Types of Indicators
AHRQ (Agency for Healthcare Research and Quality) Indicators
The AHRQ Perinatal Patient Safety Indicators (PSI), Inpatient
Quality Indicators (IQI) and Pediatric Quality Indicators (PQI), of
which the Newborn Quality Indicators (NQI) are a subset, use
administrative data to calculate the 10 rates profiled in this Report and
have national 2010 provider benchmarks associated with them. The
AHRQ makes the software to calculate these rates publically available
and many states use these rates for state-wide benchmarking. We are
using the most current software (Version 4.6) for this report.
total charges, length of stay, and expected payment source
(e.g., Medicare, Medicaid, private insurance, self-pay; for
some States, additional discrete payer categories, such as
managed care).
 In 2010, the HCUP databases represent more than 95 percent
of all annual discharges in the U.S.
 In addition to the core set of uniform data elements common to
all SID, some include State-specific data elements, such as the
patient's race.
 The SID's large sample size enables analyses of rare
Definitions for all cases in the numerator and denominator and those
excluded from the indicator entirely, are listed in Appendix E.
The comparative rates for the AHRQ Quality Indicators ™ are based
on analysis of 44 states from the 2010 Agency for Healthcare Research
and Quality’s Healthcare Cost and Utilization Project (HCUP) State
Inpatient Databases (SID)
 HCUP includes the largest collection of longitudinal hospital
care in the US with all-payer, encounter-level information
beginning in 1988. The SID includes all patients, regardless of
payer, e.g., persons covered by Medicare, Medicaid, private
insurance, and the uninsured.
 The SID contains clinical and resource use information
included in a typical discharge abstract, with safeguards to
protect the privacy of individual patients, physicians, and
hospitals (as required by data sources). Data elements include
but are not limited to: diagnoses, procedures, admission and
discharge status, patient demographics (e.g., gender, age),
conditions, such as congenital anomalies; uncommon
treatments, such as organ transplantation; and special patient
populations, such as the uninsured.
(http://www.qualityindicators.ahrq.gov/Modules)
PLEASE NOTE: For AHRQ NQI 02 - Neonatal Mortality, we
display your observed (actual) rate as well as the “expected” rate.
AHRQ defines the expected rate as “the rate the provider would have
if it performed the same as the reference population given the
provider’s actual case-mix (e.g., age, gender, DRG, and comorbidity
categories).”
“If the observed rate is higher than the expected rate (i.e., the ratio of
observed/expected is greater than 1.0, or observed minus expected is
positive), then the implication is that the provider performed worse
than the reference population for that particular indicator. Users
may want to focus on these indicators for quality improvement.”
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 63
“If the observed rate is lower than the expected rate ((i.e., the ratio of
observed/expected is less than 1.0, or observed minus expected is
negative), then the implication is that the provider performed better
than the reference population. Users may want to focus on these
indicators for identifying best practices.”
Numerator and denominator specifications for Unexpected Newborn
Complications (NQF #716) can be found in Appendix K.
National Quality Forum (NQF) Measure: Incidence of Episiotomy
(Measure #0470)
Beginning with April, 2010 discharges, The Joint Commission
replaced the three previous perinatal core measures with the Perinatal
Care Set. The set contains a total of five measures, four of which
require sampling and abstraction of one or more variables in order to
calculate the rate. The one measure that can be calculated using
administrative data is PC-04 Health Care-Associated Bloodstream
Infections in Newborns.
In the spring of 2012, the National Quality Forum announced their
endorsement of 14 quality measures for perinatal care. The endorsed
measures include twelve measures that were previously endorsed by
NQF and two new measures. (http://www.qualityforum.org)
Measure #0470, Incidence of Episiotomy is a re-endorsed NQF
measure that can be calculated using administrative data. NPIC/QAS
along with the “owner” of the measure, Christiana Care Health
Services of Delaware have been tracking this rate for a subset of
NPIC/QAS hospitals.
The rationale for looking at the Incidence of Episiotomy and rate
algorithm is profiled in Appendix F.
The Neonatal NQF measure highlighted in the report is NQF# 716,
Unexpected Newborn Complications, which identifies the percent of
babies without pre-existing conditions (no pre-mature infants, multiple
gestations, birth defects or other fetal conditions) and who were
normally grown and were not exposed to maternal drug use that had
severe or moderate complications. This indicator is based on the work
of the California Maternal Quality Care Collaborative and was initially
endorsed by the NQF in January of 2011 as Healthy Term Newborn.
The Joint Commission Perinatal Care Measure PC-04: Health
Care-Associated Bloodstream Infections in Newborns
It is important to note that the calculation algorithm for PC 04 differs
from the AHRQ NQI 03 Neonatal Bloodstream Infections algorithm
(Appendix E).
PC 04 data is not displayed in the V14.2 Quarterly Comparative
Report because we are in the process of validating the accuracy of
the rates for all NPIC/QAS hospitals using the revised measure
that became effective beginning with 7/1/2013 discharges. Hospital
specific PC04 rates will be displayed again starting with the V14.4
Quarterly Report.
Documentation for the PC 04 measure can be found in Appendix G.
NPIC/QAS Indicators
The Report presents 16 NPIC/QAS maternal and neonatal indicators
that have been displayed in previous versions of the quarterly reports.
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 64
The 7 indicators where we have linked each mother with her infant(s)
allow us to identify a subset of mothers whose infant(s) were admitted
to a special care unit or had birth trauma as a coded complication.
Definitions for each linked mother/baby calculation can be found in
Appendix H.
Graphs
The graphs in Section V show your hospital’s rate compared to the
rates for all the hospitals in your subgroup and the data base average.
Each rate also displays a 95% confidence interval that allows you to
determine whether your rate is significantly different from the
subgroup and data base average rates. The graphs for the following
indicators also provide a comparison to the database top decile
average:
AHRQ IQI 33 Primary Cesarean Delivery Rate
NQF Incidence of Episiotomy
NPIC/QAS Postpartum Hemorrhage Rate
NPIC/QAS Inductions Resulting in a Cesarean Delivery
=======NPIC/QAS ANALYTIC REPORT V.14.2
© NPIC/QAS
Page 65
Table QM 1: Maternal Indicators
NPIC ID: SAMPLE
Total APR MDC 14 (APR DRGs 540-566)
Total Deliveries
AHRQ PSI 2: Death in Low-mortality DRGs
Observed Rate
Expected Rate
Numerator Denominator
Hospital
2,491
2,225
LCI
UCI
AHRQ
Subgroup Database Provider
Average Average
Rate 1
4,455
4,376
3,962
3,962
0
2,471
0.0000
0.0001
0.0000
0.0001
0.0000
0.0029
0.0001
0.0001
0.0001
0.0001
0.0003
AHRQ PSI 18: Obstetric Trauma: Vaginal Deliveries with Instruments
14
98
14.3%
7.4%
21.2%
16.6%
14.6%
13.9%
AHRQ PSI 19: Obstetric Trauma: Vaginal Deliveries without Instruments
25
1,294
1.9%
1.2%
2.7%
2.2%
2.0%
2.2%
AHRQ IQI 21: Cesarean Delivery Rate, Uncomplicated
631
1,861
33.9%
31.8%
36.1%
28.3%
31.4%
30.0%
AHRQ IQI 22: VBAC Rate Uncomplicated
29
343
8.5%
5.5%
11.4%
17.5%
12.5%
9.1%
AHRQ IQI 33: Primary Cesarean Delivery Rate, Uncomplicated
317
1,518
20.9%
18.8%
22.9%
17.0%
18.9%
18.0%
AHRQ IQI 34: VBAC Rate All
36
417
8.6%
5.9%
11.3%
16.7%
12.3%
9.0%
NQF #0470: Incidence of Episiotomy
147
1,344
10.9%
9.3%
12.7%
5.2%
8.8%
NPIC/QAS 3rd and 4th Degree Laceration Rate,
with Forceps or Vacuum Extraction
NPIC/QAS 3rd Degree Laceration Rate, with Forceps or Vacuum Extraction
NPIC/QAS 4th Degree Laceration Rate, with Forceps or Vacuum Extraction
14
6
8
99
99
99
14.1%
6.1%
8.1%
8.0%
2.3%
3.6%
22.6%
12.7%
15.3%
15.5%
11.9%
3.6%
13.4%
10.6%
2.8%
NPIC/QAS 3rd and 4th Degree Laceration Rate,
without Forceps or Vacuum Extraction
NPIC/QAS 3rd Degree Laceration Rate, without Forceps or Vacuum Extraction
NPIC/QAS 4th Degree Laceration Rate, without Forceps or Vacuum Extraction
25
20
5
1,293
1,293
1,293
1.9%
1.6%
0.4%
1.3%
0.9%
0.1%
2.8%
2.4%
0.9%
2.3%
2.1%
0.3%
2.0%
1.7%
0.3%
NPIC/QAS Postpartum Readmission Rate
Readmissions within 30 days post-discharge
Readmissions within 42 days post-discharge
26
27
2,220
2,220
1.2%
1.2%
0.8%
0.8%
1.7%
1.8%
1.1%
1.2%
0.9%
1.0%
NPIC/QAS Postpartum Hemorrhage Rate
NPIC/QAS Rate of Disruption or Infection of Obstetrical Wound
NPIC/QAS Anesthesia Complication Rate
60
13
0
2,225
2,225
2,225
2.7%
0.6%
0.0%
2.1%
0.3%
0.0%
3.5%
1.0%
0.1%
4.5%
0.5%
0.0%
3.4%
0.3%
0.0%
NPIC/QAS Rate of Vaginal Deliveries Coded with Shoulder Dystocia
48
1,392
3.5%
2.6%
4.5%
2.3%
2.3%
NPIC/QAS Rate of Inductions resulting in Cesarean Delivery
124
532
23.3%
19.8%
27.1%
20.7%
22.2%
1
Source: 2010 State Inpatient Databases (SID), V4.5, May 2013.
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 66
Table QM 2: Coded Reasons for Postpartum Readmissions
Readmissions within 42 days post-discharge
Hospital
NPIC ID: SAMPLE
Subgroup
Average
Database
Average
# of
Cases
% of
Total
% of
Total
% of
Total
27
1.2%
1.2%
1.0%
Principal Diagnosis 2
Hypertension
Major Puerperal Infection
Delivery Complications (including surgical)
Selected Infections
Hemorrhage
Cardio/Pulmonary/Cerebrovascular problems
Obstetric Thrombosis/Pulmonary Embolism
# of
Cases
12
3
7
1
1
1
1
% of
Postpartum
Readmissions
44.4%
11.1%
25.9%
3.7%
3.7%
3.7%
3.7%
% of
Postpartum
Readmissions
30.7%
19.1%
17.6%
10.9%
4.6%
4.8%
2.7%
% of
Postpartum
Readmissions
32.0%
18.6%
16.6%
9.8%
6.1%
3.9%
2.5%
All Others (including pre-existing conditions)
1
3.7%
9.7%
9.1%
Postpartum Readmission Rate 1
1
2
Total deliveries discharged to home (with or without home health) and readmitted within 42 days
Please refer to Appendix I for the list of ICD-9 codes within each principal diagnosis category
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 67
Graph QM 1a: AHRQ Perinatal Patient Safety Indicator:
Obstetric Trauma - Vaginal Deliveries with Instruments (PSI 18)
NPIC ID: SAMPLE
35%
30%
Rate
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (14.3%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (16.6%)
Database Average (14.6%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 68
Graph QM 1b: AHRQ Perinatal Patient Safety Indicator:
Obstetric Trauma - Vaginal Deliveries without Instruments (PSI 19)
NPIC ID: SAMPLE
5.0%
4.5%
4.0%
3.5%
Rate
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Hospital Rate with 95% Confidence Interval (1.9%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (2.2%)
Database Average (2.0%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 69
Graph QM 1c: AHRQ Inpatient Quality Indicator:
Cesarean Delivery Rate (IQI 21)
NPIC ID: SAMPLE
45%
40%
35%
Rate
30%
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (33.9%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (28.3%)
Database Average (31.4%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 70
Graph QM 1d: AHRQ Inpatient Quality Indicator:
VBAC Rate Uncomplicated (IQI 22)
NPIC ID: SAMPLE
35%
30%
Rate
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (8.5%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (17.5%)
Database Average (12.5%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 71
Graph QM 1e: AHRQ Inpatient Quality Indicator:
Primary Cesarean Delivery Rate (IQI 33)
NPIC ID: SAMPLE
30%
25%
Rate
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (20.9%)
Subgroup Average (17.0%)
Database Average (18.9%)
Database Top Decile Average (12.7%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 72
Graph QM 1f: AHRQ Inpatient Quality Indicator:
VBAC Rate All (IQI 34)
NPIC ID: SAMPLE
35%
30%
Rate
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (8.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (16.7%)
Database Average (12.3%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 73
Graph QM 1g: NQF Incidence of Episiotomy
NPIC ID: SAMPLE
18%
16%
14%
12%
Rate
10%
8%
6%
4%
2%
0%
Hospital Rate with 95% Confidence Interval (10.9%)
Subgroup Average (5.2%)
Database Average (8.8%)
Database Top Decile Average (1.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 74
Graph QM 1h: NPIC/QAS Third & Fourth Degree Perineal Laceration Rate,
with Forceps or Vacuum Extractions
NPIC ID: SAMPLE
40%
35%
30%
Rate
25%
20%
15%
10%
5%
0%
Hospital Rate with 95% Confidence Interval (14.1%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (15.5%)
Database Average (13.4%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 75
Graph QM 1i: NPIC/QAS 3rd & 4th Degree Laceration Rate with Forceps or
Vacuum Extraction 2009-2014 (Q1-Q2) with Trendlines NPIC ID: SAMPLE
Hosp
35.0%
30.0%
Rate
25.0%
Graph QM 1i: NPIC/QAS 3rd & 4th Degree Laceration Rate with Forceps or Vacuum Extraction
Trend Rate
Hosp Numerator
Denominator
Hosp Rate
LCI
2009-2014 (Q1-Q2)
with Trendlines
2009
15.6%
23
18.4%
0.063637802
NPIC ID: 125
SAMPLE
2010
16.0%
24
102
23.5%
0.078348048
2011
16.0%
24
132
18.2%
0.061712438
2012
13.7%
19
97
19.6%
0.073629576
2013
14.0%
15
78
19.2%
0.080488278
2014
13.6%
9
71
12.7%
0.067124434
UCI
0.079186729
0.094279542
0.076525471
0.092985163
0.104962734
0.100279513
20.0%
15.0%
Correl Coefficient
-0.826260857
1049.282%
-0.514%
10.0%
Trend Trendline
X Vals:
5.0%
2009
2014
2323.770%
-1.146%
Hosp Trendline X Vals:
2009
21.5%
2014
15.7%
16.1%
13.5%
0.0%
2008
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
Trend Rate
15.6%
16.0%
16.0%
13.7%
14.0%
13.6%
Hospital Rate
18.4%
23.5%
18.2%
19.6%
19.2%
12.7%
Hospital Numerator
23
24
24
19
15
9
Hospital Denominator
125
102
132
97
78
71
Lower CI
12.0%
15.7%
12.0%
12.2%
11.2%
6.0%
Upper CI
26.3%
33.0%
25.8%
28.9%
29.7%
22.7%
Page 76
Graph QM 1j: NPIC/QAS Third & Fourth Degree Perineal Laceration Rate,
without Forceps or Vacuum Extractions
NPIC ID: SAMPLE
5.0%
4.5%
4.0%
3.5%
Rate
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Hospital Rate with 95% Confidence Interval (1.9%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (2.3%)
Database Average (2.0%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 77
Graph QM 1k: NPIC/QAS 3rd & 4th Degree Laceration Rate without Forceps
Hosp or Vacuum Extraction 2009-2014 (Q1-Q2) with Trendlines NPIC ID: SAMPLE
4.0%
3.5%
3.0%
Graph QM 1k: NPIC/QAS 3rd & 4th Degree Laceration Rate without Forceps or Vacuum Extraction
Trend Rate
Hosp Numerator
Denominator
Hosp Rate
LCI
UCI
2009-2014 (Q1-Q2)
with Trendlines
2009
2.4%
48
2.3%
0.005879682
0.007239643
NPIC ID:2128
SAMPLE
2010
2.3%
48
2023
2.4%
0.006181959
0.007609907
2011
2.1%
30
1795
1.7%
0.005409262
0.007060679
2012
2.2%
27
1729
1.6%
0.005300792
0.007023496
2013
2.1%
24
1446
1.7%
0.005935099
0.007998417
2014
2.1%
16
769
2.1%
0.008868115
0.012762214
Rate
2.5%
2.0%
Correl 1.5%
Coefficient
-0.882086687
138.992%
-0.068%
1.0%
Trend Trendline X Vals:
0.5%
2009
2014
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
181.456%
-0.089%
Hosp Trendline X Vals:
2009
2.2%
2014
1.7%
2.4%
2.0%
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
2.4%
2.3%
48
2128
1.7%
3.0%
2.3%
2.4%
48
2023
1.8%
3.1%
2.1%
1.7%
30
1795
1.1%
2.4%
2.2%
1.6%
27
1729
1.0%
2.3%
2.1%
1.7%
24
1446
1.1%
2.5%
2.1%
2.1%
16
769
1.2%
3.4%
Page 78
Graph QM 1l: NPIC/QAS Postpartum Readmission Rate
Readmissions within 42 days post-discharge
NPIC ID: SAMPLE
3.0%
2.5%
Rate
2.0%
1.5%
1.0%
0.5%
0.0%
Hospital Rate with 95% Confidence Interval (1.2%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (1.2%)
Database Average (1.0%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 79
Rate
Graph QM 1m: NPIC/QAS Postpartum Graph
Readmission
RateReadmissions
within 42
days post-discharge2009-2014
(Q1-Q2) with Trendlines NPIC ID: SAM
HospPostpartum
QM 1m:
NPIC/QAS
Readmission
Rate
Trend Rate
Hosp
Numerator within
Denominator
Hosp Rate
LCI
UCI
Readmissions
42 days post-discharge
2009-2014
(Q1-Q2)3454
with Trendlines
2009
1.1%
45
1.3%
0.003509566
0.004365986
NPIC
ID:
SAMPLE
2010
1.1%
45
3330
1.4%
0.003640252
0.004527537
2.5%
2011
1.0%
48
3062
1.6%
0.004095535
0.005054562
2012
1.0%
49
2955
1.7%
0.004289992
0.005281561
2013
1.1%
38
2349
1.6%
0.004704332
0.005960212
2.0%
2014
1.0%
14
1330
1.1%
0.004759778
0.007072077
1.5%
Correl
1.0%Coefficient:
-0.471932344
30.349%
-0.015%
0.5%
Trend Trendline
X Vals:
2009
2014
22.192%
-0.010%
Hosp Trendline X Vals:
2009
2014
1.1%
1.0%
1.5%
1.4%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Stable Over Time
2014
2009
2010
2011
2012
2013
2014 (Q1-Q2)
1.1%
1.3%
45
3454
1.0%
1.7%
1.1%
1.4%
45
3330
1.0%
1.8%
1.0%
1.6%
48
3062
1.2%
2.1%
1.0%
1.7%
49
2955
1.2%
2.2%
1.1%
1.6%
38
2349
1.1%
2.2%
1.0%
1.1%
14
1330
0.6%
1.8%
Page 80
Graph QM 1n: NPIC/QAS Postpartum Hemorrhage Rate
NPIC ID: SAMPLE
10.0%
9.0%
8.0%
7.0%
Rate
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Hospital Rate with 95% Confidence Interval (2.7%)
Subgroup Average (4.5%)
Database Average (3.4%)
Database Top Decile Average (.9%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 81
Graph QM 1o: NPIC/QAS Postpartum Graph
Hemorrhage
2009-2014
(Q1-Q2) Hemorrhage
with Trendlines
NPIC ID: SAMPLE
HospPostpartum
QM 1o:Rate
NPIC/QAS
Rate
Trend Rate
Hosp Numerator
Denominator
Hosp
Rate
LCI
UCI
2009-2014 (Q1-Q2) with Trendlines
NPIC ID: SAMPLE
2009
3.0%
57
3467
1.6%
0.003965432
0.004808632
2010
3.3%
65
3339
1.9%
0.004411362
0.005279159
4.5%
2011
3.5%
60
3066
2.0%
0.004603615
0.00554976
4.0%
2012
3.6%
51
2964
1.7%
0.004369095
0.005355063
2013
3.7%
67
2353
2.8%
0.006340413
0.007547888
3.5%
2014
3.7%
40
1335
3.0%
0.008472228
0.010615983
Rate
3.0%
2.5%
2.0%
Correl Coefficient:
0.90573846
-249.401%
0.126%
1.5%
-528.093%
0.264%
Hosp Trendline X Vals:
2009
1.5%
2014
2.8%
1.0%
Trend Trendline X Vals:
2009
0.5%
2014
3.2%
3.8%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Significant Upward Trend, p = 0.003
Trend Rate: Significant Upward Trend, p = 0.000
2014
2009
2010
2011
2012
2013
2014 (Q1-Q2)
3.0%
1.6%
57
3467
1.2%
2.1%
3.3%
2.0%
65
3339
1.5%
2.5%
3.5%
2.0%
60
3066
1.5%
2.5%
3.6%
1.7%
51
2964
1.3%
2.3%
3.7%
2.9%
67
2353
2.2%
3.6%
3.7%
3.0%
40
1335
2.1%
4.1%
Page 82
Graph QM 1p: NPIC/QAS Rate of Disruption or Infection of Obstetrical Wound
NPIC ID: SAMPLE
1.4%
1.2%
1.0%
Rate
0.8%
0.6%
0.4%
0.2%
0.0%
Hospital Rate with 95% Confidence Interval (0.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (0.5%)
Database Average (0.3%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 83
Graph QM 1q: NPIC/QAS Rate
of Disruption
or Infection
of of
Obstetrical
Wound
2009-2014
(Q1-Q2)Wound
with Trendlines NPIC ID: SAMPLE
Hosp
Graph
QM 1q: NPIC/QAS
Rate
Disruption
or Infection
of Obstetrical
Trend Rate
Hosp Numerator
Denominator
Hosp
Rate
LCI
UCI
2009-2014 (Q1-Q2) with Trendlines
NPIC ID: SAMPLE
2009
0.5%
20
3467
0.6%
0.00224177
0.0031266
1.2%
2010
0.5%
16
3339
0.5%
0.002050518
0.002977815
2011
0.5%
17
3066
0.6%
0.002311751
0.00331793
2012
0.4%
14
2964
0.5%
0.002138825
0.003188736
1.0%
2013
0.4%
16
2353
0.7%
0.002908106
0.004219256
2014
0.4%
5
1335
0.4%
0.002527816
0.004973312
Rate
0.8%
0.6%
Correl Coefficient:
0.4%
-0.951786621
55.599%
-0.027%
Trend Trendline
X Vals:
0.2%
2009
2014
28.765%
-0.014%
Hosp Trendline X Vals:
2009
2014
0.5%
0.4%
0.6%
0.5%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Stable Over Time
Trend Rate: Significant Downward Trend, p = 0.000
2009
2010
2011
2012
2013
2014 (Q1-Q2)
0.5%
0.6%
20
3467
0.4%
0.9%
0.5%
0.5%
16
3339
0.3%
0.8%
0.5%
0.6%
17
3066
0.3%
0.9%
0.4%
0.5%
14
2964
0.3%
0.8%
0.4%
0.7%
16
2353
0.4%
1.1%
0.4%
0.4%
5
1335
0.1%
0.9%
Page 84
Graph QM 1r: NPIC/QAS Rate of Vaginal Deliveries Coded with Shoulder Dystocia
NPIC ID: SAMPLE
6.0%
5.0%
Rate
4.0%
3.0%
2.0%
1.0%
0.0%
Hospital Rate with 95% Confidence Interval (3.5%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (2.3%)
Database Average (2.3%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 85
Graph QM 1s: NPIC/QAS Rate of Inductions Resulting in Cesarean Delivery
NPIC ID: SAMPLE
40.0%
35.0%
30.0%
Rate
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Hospital Rate with 95% Confidence Interval (23.3%)
Subgroup Average (20.7%)
Database Average (22.2%)
Database Top Decile Average (14.3%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 86
Table QN 1: Neonatal Indicators
NPIC ID: SAMPLE
Total Neonates
Total Inborns
AHRQ PSI 17: Birth Trauma: Injury to Neonate
Numerator Denominator Hospital
2,400
2,283
0
2,158
0.0%
AHRQ NQI 02: Neonatal Mortality
Observed Rate
Expected Rate
9
2,293
0.4%
0.3%
LCI
UCI
0.0%
0.0%
0.0%
0.8%
AHRQ
Subgroup Database Provider
Average Average
Rate 1
4,282
4,135
4,046
4,039
0.2%
0.2%
0.2%
0.4%
0.4%
0.3%
0.3%
0.3%
AHRQ NQI 03: Neonatal Bloodstream Infection
2
86
2.3%
0.0%
5.5%
2.8%
2.4%
2.4%
Hospital
specific
PC
04
rates
will
be
displayed
again
starting
with
the
V14.4
Quarterly
Report.
We
are
in the
The Joint Commission Perinatal Care: Health Care-Associated
process of validating the accuracy of the rates for all NPIC/QAS hospitals using the revised measure that began
Bloodstream Infections in Newborns (PC 04)
with 7/1/2013 discharges. The Q2 2014 Joint Commission PC 04 rate is 2.66% (as of 12/29/2014 - National Core
Observed Rate
Comparison Group file, n = 1,013 hospitals). The Joint Commission is in a continual process of updating this
information and evaluating potential improvements for data collection.
Expected Rate
NQF #716: Unexpected Newborn Complications 2
3
Inborn Readmission Rate
NPIC/QAS Total Inborn Birth Trauma Rate
Count by Code:
767.0 Subdural or cerebral hemorrhage
767.11 Epicranial subaponeurotic hemorrhage
767.19 Other injuries to scalp
767.2 Fracture of clavicle
767.3 Other injuries to skeleton
767.4 Injury to spine and spinal cord
767.5 Facial nerve injury
767.6 Injury to brachial plexus
767.7 Other cranial and peripheral nerve injuries
767.8 Other specified birth trauma
767.9 Birth trauma unspecified
Total Codes
Total Cases
Total Inborn Birth Trauma Rate
4
60
1,667
3.6%
2.8%
4.6%
4.0%
3.7%
36
2,252
1.6%
1.1%
2.2%
1.3%
1.1%
2
1
113
7
1
0
1
5
0
4
1
135
132
2
1
87
8
1
0
1
4
0
4
0
108
106
3.1%
2.7%
0
0
14
5
0
0
0
3
0
0
0
22
21
21
2,283
0.9%
1
Source: 2010 State Inpatient Databases (SID), V4.5, May 2013.
2
The Unexpected Newborn Complications measure is an update of the Healthy Term Newborn measure.
3
Total Inborns discharged to home (with or without home health) and readmitted within 28 days.
4
Total inborn cases with a birth trauma code divided by total inborns.
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
0.6%
1.4%
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 87
Graph QN 1a: AHRQ Perinatal Patient Safety Indicator:
Birth Trauma - Injury to Neonate (PSI 17)
NPIC ID: SAMPLE
0.80%
0.70%
0.60%
Rate
0.50%
0.40%
0.30%
0.20%
0.10%
0.00%
Hospital Rate with 95% Confidence Interval (0.00%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (0.20%)
Database Average (0.17%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 88
Graph QN 1b: AHRQ Neonatal Quality Indicator:
Neonatal Mortality (NQI 02)
NPIC ID: SAMPLE
3.00%
2.50%
Rate
2.00%
1.50%
1.00%
0.50%
0.00%
Observed Rate (0.39%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Expected Rate with 99% Confidence Interval (0.33%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 89
Graph QN 1c: AHRQ Neonatal Quality Indicator:
Neonatal Bloodstream Infection (NQI 03)
NPIC ID: SAMPLE
14.0%
12.0%
Rate
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Hospital Rate with 95% Confidence Interval (2.3%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (2.8%)
Database Average (2.4%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 90
Graph QN 1d: The Joint Commission Perinatal Care:
Health Care-Associated Bloodstream Infections in Newborns (PC 04) *
NPIC ID: SAMPLE
100.0%
90.0%
80.0%
70.0%
Rate
60.0%
Hospital specific PC 04 rates will be displayed again starting with the
V14.4 Quarterly Report. We are in the process of validating the accuracy of the rates for all
NPIC/QAS hospitals using the revised measure that began with 7/1/2013 discharges.
50.0%
40.0%
The Q2 2014 Joint Commission PC 04 rate is 2.66%.*
30.0%
20.0%
10.0%
0.0%
* As of 12/29/2014 - National Core Comparison Group file (n = 1,013 hospitals). The Joint Commission is in a
continual process of updating this information and evaluating potential improvements for data collection.
Subgroup: AR - Academic, Regional Perinatal Centers
Page 91
Table QN 2: Unexpected Newborn Complications (UNC)
(NQF #716 “Healthy Term Newborn”)
Hospital
SAMPLE
Subgroup
Average
Database
Average
Total Inborns
2,283
4,046
4,039
UNC Final Denominator: Inborns in measure population without
preexisting complications 1
1,667
3,046
3,143
A. Inborns
B. Unexpected Newborn Complication Rates
#
%
#
%
#
%
Total UNC Rate: Inborns with severe or moderate complications
60
3.6%
125
4.0%
116
3.7%
Severe UNC Rate: Inborns with severe complications
16
1.0%
39
1.4%
39
1.3%
Moderate UNC Rate: Inborns with moderate complications
44
2.6%
86
2.6%
78
2.4%
#
%
#
%
#
%
Respiratory
Severe
35
4
58.3%
6.7%
85
15
68.0%
12.0%
71
11
61.2%
9.5%
Infection
Severe
5
4
8.3%
6.7%
12
10
9.6%
8.0%
16
13
13.8%
11.2%
Transfer to Higher Level of Care (Severe only)
1
1.7%
1
0.8%
2
1.7%
Neurologic/Birth Injury
Severe
9
3
15.0%
5.0%
18
10
14.4%
8.0%
18
10
15.5%
8.6%
Shock/Resuscitation (Severe only)
4
6.7%
2
1.6%
3
2.6%
Long Length of Stay without clear diagnosis (Moderate only)
6
10.0%
6
4.8%
6
5.2%
C. Neonatal Complication Sub-Categories
2
1
Includes singletons; birthweight ≥ 2500 grams; gestational age ≥ 37 weeks. Excludes fetal malformations; maternal/fetal complications; exposure to
maternal drug use (see Appendix K).
2
Does not include neonatal deaths.
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 92
Graph QN 2a: Comparative Unexpected Newborn Complication Rates
NPIC ID: SAMPLE
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Hospital Total UNC Rate with 95% Confidence Interval: 3.6%
Hospital Severe UNC Rate (1.0%)
Hospital Moderate UNC Rate (2.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Total UNC Average Rate (4.0%)
Database Total UNC Average Rate (3.7%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 93
Table QN 3: Coded Reasons for Inborn Readmissions
Readmissions within 28 days post-discharge
Hospital
NPIC ID: SAMPLE
Inborn Readmission Rate 1
2
Principal Diagnosis
Jaundice and Related Conditions
Infections
Feeding Problems
Temperature Regulation
Respiratory Problems
All Others
Subgroup
Average
Database
Average
# of
Cases
% of
Total
% of
Total
% of
Total
36
1.6%
1.3%
1.1%
# of
Cases
14
5
5
1
1
10
% of Total
% of Total
% of Total
Inborn
Inborn
Inborn
Readmissions Readmissions Readmissions
38.9%
43.1%
55.3%
13.9%
11.5%
10.4%
13.9%
10.4%
7.5%
2.8%
9.9%
5.3%
2.8%
3.3%
2.7%
27.8%
21.9%
18.9%
1
Total Inborns discharged to home (with or without home health) and readmitted within 28 days
2
Please refer to Appendix J for the list of ICD-9 codes within each principal diagnosis category
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 94
Graph QN 3a: NPIC/QAS Inborn Readmission Rate
Readmissions within 28 days post-discharge
NPIC ID: SAMPLE
5.0%
4.5%
4.0%
3.5%
Rate
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Hospital Rate with 95% Confidence Interval (1.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (1.3%)
Database Average (1.1%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 95
Table QN 4: NPIC/QAS Total Inborn Birth Trauma Rate 2009-2014 (Q1-Q2)
2014 (Q1-Q2) Pct Change
09 - 13
NPIC ID: SAMPLE
2009
2010
2011
2012
2013
Inborns with Birth Trauma*
Hospital
Percent of Total Inborns
52
1.5%
52
1.5%
21
0.7%
35
1.1%
19
0.8%
12
0.9%
-63.5%
-46.3%
Trend Data Base Average
Percent of Total Inborns
117
2.6%
110
2.6%
104
2.5%
111
2.6%
115
2.7%
59
2.8%
-1.7%
3.1%
* Rate includes inborn cases with any birth trauma code:
767.0 Subdural or cerebral hemorrhage
767.11 Epicranial subaponeurotic hemorrhage
767.19 Other injuries to scalp
767.2 Fracture of clavicle
767.3 Other injuries to skeleton
767.4 Injury to spine and spinal cord
767.5 Facial nerve injury
767.6 Injury to brachial plexus
767.7 Other cranial and peripheral nerve injuries
767.8 Other specified birth trauma
767.9 Birth trauma unspecified
Page 96
Graph QN 4a: NPIC/QAS Total InbornGraph
Birth Trauma
Rate2009-2014
with TrendlinesNPIC
ID: SAMPLE
Hosp
QN 4a: NPIC/QAS
Total(Q1-Q2)
Inborn Birth
Trauma Rate
Trend Rate
Hosp Numerator
Denominator
Hosp
Rate
LCI
UCI
2009-2014 (Q1-Q2) with Trendlines
NPIC ID:3536
SAMPLE
2009
2.6%
52
1.5%
0.003703847
0.00453428
2010
2.6%
52
3398
1.5%
0.003853334
0.00471653
3.0%
2011
2.5%
21
3156
0.7%
0.00253058
0.003499905
2012
2.6%
35
3060
1.1%
0.00345811
0.004434301
2.5%
2013
2.7%
19
2409
0.8%
0.003132403
0.004401975
2014
2.8%
12
1371
0.9%
0.004222244
0.006486362
Rate
2.0%
1.5%
Correl Coefficient
0.752966452
-77.264%
0.040%
1.0%
Trend Trendline
X Vals:
0.5%
2009
2014
272.516%
-0.135%
Hosp Trendline X Vals:
2009
1.4%
2014
0.7%
2.5%
2.7%
0.0%
2008
Trend Rate
Hospital Rate
Hospital Numerator
Hospital Denominator
Lower CI
Upper CI
2009
2010
2011
2012
2013
2014
Hospital Rate with 95% Confidence Intervals
Trend Hospitals Average Rate
Hospital Rate: Significant Downward Trend, p = 0.040
Trend Rate: Significant Upward Trend, p = 0.047
2009
2010
2011
2012
2013
2014 (Q1-Q2)
2.6%
1.5%
52
3536
1.1%
1.9%
2.6%
1.5%
52
3398
1.1%
2.0%
2.5%
0.7%
21
3156
0.4%
1.0%
2.6%
1.1%
35
3060
0.8%
1.6%
2.7%
0.8%
19
2409
0.5%
1.2%
2.8%
0.9%
12
1371
0.5%
1.5%
Page 97
Table QL 1: Linked Mother/Baby Indicators
Numerator Denominator Hospital
NPIC ID: SAMPLE
Total Deliveries
2,225
Total Deliveries linked to an inborn(s)
1,969
Deliveries linked to an inborn(s) as a percent of total deliveries
88.5%
Vaginal Deliveries with coded Shoulder Dystocia
linked to an inborn ≥ 2500 grams with birth trauma
4
45
8.9%
Count by Code:
767.19 - Other injuries to scalp
0
767.2 - Fracture of clavicle
3
767.6 - Injury to brachial plexus
2
All other birth trauma codes
0
Coded Maternal Conditions with
Neonatal Special Care Admission
Hypertension
28
71
39.4%
LCI
UCI
2.5%
21.2%
Subgroup Database
Average Average
4,066
4,059
3,877
3,867
94.6%
95.0%
14.8%
12.4%
4
2
3
1
3
2
2
1
28.0%
51.7%
20.7%
19.5%
Diabetes Mellitus
29
36
80.6%
64.0%
91.8%
44.1%
37.4%
Obesity
25
107
23.4%
15.7%
32.5%
24.7%
19.5%
26
106
24.5%
16.7%
33.8%
20.5%
16.3%
77
327
23.6%
19.1%
28.5%
18.2%
14.7%
52
293
17.8%
13.5%
22.6%
10.6%
9.0%
Thyroid dysfunction
Primary Cesarean Deliveries ≥ 37 weeks with
Neonatal Special Care Admission
Repeat Cesarean Deliveries ≥ 37 weeks with
Neonatal Special Care Admission
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 98
Graph QL 1a: Vaginal Deliveries with coded Shoulder Dystocia
linked to an inborn ≥ 2500 grams with birth trauma
NPIC ID: SAMPLE
70%
60%
50%
Rate
40%
30%
20%
10%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (8.9%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (14.8%)
Database Average (12.4%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 99
Graph QL 1b: Coded Maternal Conditions with Neonatal Special Care Admission
Hypertension (642.0; 642.1; 642.9)
NPIC ID: SAMPLE
60%
50%
Rate
40%
30%
20%
10%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (39.4%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (20.7%)
Database Average (19.5%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 100
Graph QL 1c: Coded Maternal Conditions with Neonatal Special Care Admission
Diabetes Mellitus (250.x and 648.0)
NPIC ID: SAMPLE
100%
90%
80%
70%
Rate
60%
50%
40%
30%
20%
10%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (80.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (44.1%)
Database Average (37.4%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 101
Graph QL 1d: Coded Maternal Conditions with Neonatal Special Care Admission
Obesity (649.1)
NPIC ID: SAMPLE
60%
50%
Rate
40%
30%
20%
10%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (23.4%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (24.7%)
Database Average (19.5%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 102
Graph QL 1e: Coded Maternal Conditions with Neonatal Special Care Admission
Thyroid Dysfunction (648.1)
NPIC ID: SAMPLE
60%
50%
Rate
40%
30%
20%
10%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (24.5%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (20.5%)
Database Average (16.3%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 103
Graph QL 1f: Primary Cesarean Deliveries ≥ 37 weeks
with Neonatal Special Care Admission
NPIC ID: SAMPLE
35%
30%
Rate
25%
20%
15%
10%
5%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (23.6%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (18.2%)
Database Average (14.7%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 104
Graph QL 1g: Repeat Cesarean Deliveries ≥ 37 weeks
with Neonatal Special Care Admission
NPIC ID: SAMPLE
35%
30%
Rate
25%
20%
15%
10%
5%
0%
* Hospital did not provide a valid mother/baby link
Hospital Rate with 95% Confidence Interval (17.8%)
Date Range of Hospital Data: 7/1/2013 - 6/30/2014
Subgroup: AR - Academic, Regional Perinatal Centers
Subgroup Average (10.6%)
Database Average (9.0%)
Date Range of Comparison Data: 7/1/2013 - 6/30/2014
Page 105
APPENDICES A-C
A.
ALL PATIENT REFINED DRGS V.31 - PERINATAL
B.
GLOSSARY OF BASIC TERMS AND DEFINITIONS
C.
DATA SCREENS
APPENDICES D-K
(Sent as a separate document)
D.
CALCULATION ALGORITHMS FOR OB AND NEONATAL SECTIONS II, III AND IV
E.
AHRQ INPATIENT, QUALITY AND PEDIATRIC INDICATORS
F.
NATIONAL QUALITY FORUM INCIDENCE OF EPISIOTOMY
G.
THE JOINT COMMISSION PERINATAL CARE MEASURE PC-04
H.
NPIC/QAS INDICATORS
I.
CODED REASONS FOR POSTPARTUM READMISSIONS
J.
CODED REASONS FOR INBORN READMISSIONS
K.
APPENDICES FOR UNEXPECTED NEWBORN COMPLICATIONS (NQF #716)
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APPENDIX A -- List of Consolidated APR-DRGS V.31.0
MED/
MDC SURG
14
P
14
P
14
P
14
P
14
P
14
P
14
M
14
M
14
M
14
M
14
M
14
M
15
M
15
M
15
M
15
P
15
M
15
M
15
M
15
M
15
M
15
M
15
M
15
P
APRDRG
540
541
542
544
545
546
560
561
563
564
565
566
580
581
583
588
589
591
593
602
603
607
608
609
DESCRIPTION
CESAREAN DELIVERY
VAGINAL DELIVERY W STERILIZATION &/OR D&C
VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C
D&C, ASPIRATION CURETTAGE OR HYSTERECTOMY, FOR OBSTETRIC DIAGNOSES
ECTOPIC PREGNANCY PROCEDURE
OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES
VAGINAL DELIVERY
POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE
THREATENED ABORTION
ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
FALSE LABOR
OTHER ANTEPARTUM DIAGNOSES
NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE
NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE
NEONATE, W ECMO
NEONATE BWT<1500G W MAJOR PROCEDURE
NEONATE BWT <500G
NEONATE,BIRTHWT 500-749G W/O MAJOR O.R. PROCEDURE
NEONATE, BIRTHWT 750G-999G W/O MAJOR O.R. PROCEDURE
NEONATE, BIRTHWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM
NEONATE, BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION
NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM
NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION
NEONATE BWT 1500-2499G W MAJOR PROCEDURE
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15
15
15
15
15
15
15
15
15
15
15
15
15
M
M
M
M
M
M
M
M
M
P
P
M
M
611
612
613
614
621
622
623
625
626
630
631
633
634
NEONATE, BIRTHWT 1500-1999G W MAJOR ANOMALY
NEONATE, BIRTHWT 1500-1999G W RESPIRATORY DISTRESS SYNDROME
NEONATE, BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION
NEONATE, BIRTHWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION
NEONATE, BIRTHWT, 2000-2499G W MAJOR ANOMALY
NEONATE, BIRTHWT 2000-2499G W RESPIRATORY DISTRESS SYNDROME
NEONATE, BIRTHWT 2000-2499G W CONGENITAL/PERINATAL INFECTION
NEONATE, BIRTHWT 2000-2499G,W OTHER SIGNIFICANT CONDITION
NEONATE, BWT 2000-2499G, NORMAL NEW BORN OR NEONATE W OTHER PROBLEM
NEONATE, BIRTHWT >2499G W MAJOR CARDIOVASC O.R. PROC
NEONATE, BIRTHWT >2499G W OTHER MAJOR O.R. PROC
NEONATE, BIRTHWT >2499G W MAJOR ANOMALY
NEONATE, BIRTHWT >2499G W RESPIRATORY DISTRESS SYNDROME / OTHER MAJ
RESP COND
15
M
636 NEONATE, BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION
15
M
639 NEONATE, BIRTHWT >2499G, W OTHER SIGNIFICANT CONDITION
15
M
640 NEONATE, BWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM
23
M
850 PROCEDURE WITH DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SVC
23
M
860 REHABILITATION
23
M
861 SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS
23
M
862 OTHER AFTERCARE AND CONVALESCENCE
23
M
863 NEONATAL AFTERCARE
P
004 TRACHEOSTOMY EXCEPT FOR FACE, MOUTH & NECK DIAGNOSES
P
005 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES
P
950 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
P
951 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
P
952 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
M
955 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS
M
956 UNGROUPABLE
Subclass Codes: Severity or Risk of Mortality – 1-Minor, 2-Moderate, 3-Major, 4-Extreme
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APPENDIX B: GLOSSARY
OF BASIC TERMS AND DEFINITIONS
ALL PATIENT REFINED DIAGNOSIS RELATED GROUPS (APR-DRGS)
VERSION 31.0 - The APR-DRGs expand the basic DRG structure by adding four
subclasses to each DRG. The addition of the four subclasses addresses patient
differences relating to severity of illness and risk of mortality. Severity of illness
and risk of mortality relate to distinct patient attributes. Severity of illness relates to
the extent of physiologic decompensation or organ system loss of function
experienced by the patient while risk of mortality relates to the likelihood of dying.
APR DRG SEVERITY OF ILLNESS OR RISK OF MORTALITY SUBCLASS
The assignment of a patient to a severity of illness or risk of mortality subclass
takes into consideration not only the level of the secondary diagnoses but also the
interaction among secondary diagnoses, age, principal diagnosis, and the presence
of certain non-OR procedures. There are four severity of illness subclasses: 1.
minor, 2. moderate, 3. major and 4. extreme complications. Each patient will
group to a subclass and the distribution across subclasses will drive your
hospital’s case mix index. The subdivision of each of the 314 APR-DRGs into the
four subclasses, combined with the two error APR-DRGs (955, 956), which are
not subdivided, results in 1258 APR-DRGs.
MAJOR DIAGNOSTIC CATEGORY (MDC)- A system of 26 broad clinical
categories which are based on body system involvement and disease etiology.
They were developed at Yale University and are used in the development and
organization of the diagnostic related groupings (DRGs).
INTERNATIONAL CLASSIFICATION OF DISEASES, 9th REVISION,
CLINICAL MODIFICATION (ICD-9-CM) CODES is based on the official
version of the World Health Organization's 9th Revision, International
Classification of Diseases (ICD-9). ICD-9 codes are designed for the
classification of morbidity and mortality information for statistical purposes, and
for the indexing of hospital records by disease and operations, for data storage and
retrieval.
identified by the NPIC/QAS code number, and will match the information in your
institutional report set.
NPIC/QAS SUBGROUPAVERAGE This row provides comparative data from
your hospital’s "Subgroup”. The values are computed at the hospital level with all
hospital rates, counts or percentages summed and then divided by the number of
hospitals in the subgroup. These computations are unweighted averages. The
counts, rates and percentages of your hospital are compared to hospital-level
averages of all the hospitals within your subgroup. The AHRQ rates displayed
are weighted averages (calculated at the case level). Please note, that in rows
with small numbers of cases that contain information in subsequent columns,
zeros will result from rounding less than 0.5. Your subgroup is listed on all
comparative graphs. NPIC/QAS has six subgroups:
Subgroup AR:
Subgroup AO:
Subgroup NL:
Subgroup NS:
Subgroup C:
Subgroup G:
Academic regional perinatal centers (20 hospitals)
Academic perinatal centers, OB level II and III (11 hospitals)
Non - Academic Large ≥ 1,100 annual live births (22 hospitals)
Non - Academic Small < 1,100 annual live births (10 hospitals)
Perinatal centers that are members of the Council of Women and
Infants’ Specialty Hospitals (CWISH) (13 hospitals)
All state designated perinatal centers in Georgia (8 hospitals)
NPIC/QAS DATABASE AVERAGE- This row provides comparative data from the
NPIC/QAS database. The values are computed at the hospital level with all
hospital rates, counts or percentages summed and then divided by the number of
hospitals within the entire NPIC database. These computations are unweighted
averages. The counts, rates and percentages of your hospital are compared to
hospital-level averages of all of the hospitals within the entire NPIC database. The
AHRQ rates displayed are weighted averages (calculated at the case level).
Please note, that in rows with small numbers of cases that contain information in
subsequent columns, zeroes will result from rounding less than 0.5
NPIC/QAS HOSPITAL #XX- This row provides the information on your hospital,
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NPIC/QAS DATABASE TOP DECILE AVERAGE - This value provides the
average rate of those hospitals whose rates are in the top 10% of the NPIC/QAS
database.
NPIC/QAS TREND DATABASE AVERAGE This row provides comparative data
from the NPIC/QAS trend database. The values are computed at the hospital
level with all hospital rates, counts or percentages summed and then divided by
the number of hospitals within the entire NPIC/QAS trend database. These
computations are unweighted averages. The counts, rates and percentages of your
hospital are compared to hospital-level averages of all of the hospitals within the
entire NPIC/QAS trend database. Please note, that in rows with small numbers of
cases that contain information in subsequent columns, zeros will result from
rounding less than 0.5
The trend database is made up of 59 hospitals that have been members of
NPIC/QAS for the entire trend period 2009-2014 (Q2). The number of hospitals
in each subgroup which comprise the trend database is as follows:
Subgroup AR:
Subgroup AO:
Subgroup NS:
Subgroup NL:
Subgroup C:
Subgroup G:
16 hospitals
7 hospitals
4 hospitals
12 hospitals
12 hospitals
8 hospitals
MDC 14 PAYER CATEGORIES
MEDICAID - All cases with a Medicaid or HMO/Medicaid payer code on your
hospital’s data file.
MEDICARE - All cases with a Medicare payer code on your hospital’s data file.
COMMERCIAL INSURANCE/TRICARE - All cases with a Blue Cross, Tricare,
other government or Commercial Insurance payer code on your hospital’s data
file.
HMO - All cases with a HMO payer code on your hospital’s data file
SELF PAY /FREE CARE - All cases with Self Pay/Free Care payer code on your
hospital’s data file.
OTHER/MISSING - All cases with a Workers Compensation, Other or Missing
payer code on your hospital’s data file.
COLUMN DEFINITIONS
TOTAL # OF CASES - This column provides the information on the total number
of valid cases in each table.
% OF TOTAL DISCH - This column provides the information on the distribution
of cases within each MDC, MS DRG or APR DRG as a percent of the total
number of discharges displayed on the summary lines for the Hospital, Subgroup
Average and Database Average.
AVG LOS - This column refers to the average length of stay for all the cases in
each MDC, MS DRG or APR DRG. Length of stay is calculated using admission
and discharge date. All cases admitted and discharged on the same day have a
length of stay of one.
AVG CHARGE/CASE - This column represents the total charges divided by the
corresponding number of cases for each MDC, CMS/MS DRG or APR DRG.
CASE MIX INDEX (CMI) - The Case Mix Index is a number that reflects the
relative acuity of the patients included in an analysis. Each APR-DRG has a
resource weight associated with it. The resource weight reflects the degree to
which the case consumes more or less resources than the “average case” with a
weight of 1.000. For example, if an APR-DRG has a weight of 2.000, the
assumption is that it consumes twice as many resources as an average case
because it is twice as complex. An APR-DRG with a weight of .5000 consumes
half as many resources.
The CMI for a particular cohort of patients is calculated by summing the resource
weights for all the cases in the cohort and dividing by the total number of cases.
Comparing the CMI for one hospital with the CMI for another provides a measure
of differential acuity which can then be used to adjust lengths of stay, charges and
costs.
ADJUSTED LOS AND ADJUSTED CHARGE - Dividing length of stay or average
charge by the CMI, removes or neutralizes the impact of the cohort’s case mix and
allows for a more valid comparison across hospitals.
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APPENDIX C
DATA SCREENS

If the medical record and billing numbers for any two discharges were identical, one of the duplicate records was eliminated.

If the total charges were greater than 5 million dollars, the discharge was eliminated.

If the length of stay (LOS) was more than 999 days, the discharge was eliminated.

If the birthweight was 1,500 grams or less, the disposition was home and the length of stay (LOS) was less than three days, the discharge was
eliminated.

If the length of stay (LOS) was more than 1 day and the patient was discharged with no charges, the discharge was eliminated. This screen
did not apply to non-neonates who died in the hospital.

If the admit date was later than the discharge date, the discharge was eliminated.

If the date of birth was later than the admit date or the discharge date, the discharge was eliminated.
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