How to Calculate PQI 07: Hypertension Admission Rate

The heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries). Blood returns in the veins leading to the heart, aided by gravity and muscle contraction.

It is known as the "silent killer" since it has no initial symptoms but can lead to long-term disease and complications.. High Blood Pressure a.k.a. Hypertension can be controlled by outpatient means by either medication or lifestyle change. When someone is admitted to a hospital due to complications from hypertension, then preventative measures could have failed. However, the cause of failure is not represented here, and that can include both patient and provider based causes.

Prevention is an important role for all healthcare providers. Hypertension is a controllable condition using outpatient care and drug therapy. Prevention Quality Indicators (PQIs) are a set of measures that help identify quality of care for outpatient and other non-hospital care.

How to Calculate PQI 07 Hypertension Admission Rate?

PQI #5: How to Calculate COPD or Asthma in Older Adults Admission Rate

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.

COPD affects an estimated 30 million individuals in the U.S., and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.

Most cases of COPD are caused by inhaling pollutants; that includes smoking (cigarettes, pipes, cigars, etc.), and second-hand smoke.

Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD.

Genetics can also play a role in an individual’s development of COPD—even if the person has never smoked or has ever been exposed to strong lung irritants in the workplace.

How To Calculate Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate

How to Calculate PQI #3: Diabetes Long-term Complications Admission Rate

Diabetes is a complicated disease. But don’t confuse this thought with the term “diabetes complications”! Complications generally occur after years of high blood glucose. The blood vessels become damaged unless you can keep your glucose levels in a healthy range most of the time. The range of complications span from being simply annoying to actually life threatening. The lesser conditions include dry and itchy skin, mild gum disease, a tendency to be more susceptible to colds and flu, and in women, yeast infections. The more serious complications - some life-changing or life-threatening - include eye disease, kidney disease, nerve disease and heart disease.

Numerator
All discharges age 18 years and older with ICD-9-CM principal diagnosis code for diabeteslong-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified). 

How to Calculate PQI #2: Perforated Appendix Admission Rate

A perforated appendix is one of the complications of acute appendicitis. If appendicitis is left untreated, ischemic necrosis of a portion of appendiceal wall may occur, leading to perforation. An appendicolith is thought to be associated with a higher probability of perforation. Perforation of the appendix is more common among the elderly population due to an increased frequency of late and atypical presentation of appendicitis, delay in diagnosis, delayed decision for surgery and to the age-specific physiological changes.

Population Measured (Denominator)
Discharges, for patients ages 18 years and older, with any-listed ICD-CM diagnosis codes for appendicitis. Discharges are assigned to the denominator based on the metropolitan area or county of the patient residence, not the metropolitan area or county of the hospital where the discharge occurred.

How to Calculate PQI #1 Diabetes Short-Term Complications Admission Rate

Population Measured (Denominator)
After applying the exclusions outlined in the next section, all inpatient utilization of the member were counted. Percentage can be counted based on the member count or by the IP admit count.

Beneficiaries are excluded from the population measured if they:
• were under the age of 18
• were enrolled in Medicare managed care (a Medicare Advantage plan) for any month during the performance period
• were enrolled in Medicare Part A only or Medicare Part B only for any month during the performance period
• resided outside of the United States, its territories, and its possessions for any month during the performance period
• Hospitalizations are excluded from the measure outcome if:
• the hospital admission is a transfer from a hospital, skilled nursing facility, intermediate care facility, or other health care facility
• the hospitalization is missing a principal diagnosis
• the discharge had any diagnosis code for sickle-cell anemia or HB-S disease, or any diagnosis or procedure code for immunocompromised state (bacterial pneumonia
component measure only)
• the discharge had any diagnosis code for kidney/urinary tract disorder or any diagnosis or procedure code for immunocompromised state (urinary tract infection component measure only)
• the discharge had any diagnosis code for chronic renal failure (dehydration component measure only)





NUMERATOR:
ICD-9-CM    Description
250.10    Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
250.11    Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
250.12    Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.13    Diabetes with ketoacidosis, type I [juvenile type], uncontrolled
250.20    Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21    Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
250.22    Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23    Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
250.30    Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
250.31    Diabetes with other coma, type I [juvenile type], not stated as uncontrolled
250.32    Diabetes with other coma, type II or unspecified type, uncontrolled
250.33    Diabetes with other coma, type I [juvenile type], uncontrolled

ICD-10-CM    Description
E10.10    Type 1 diabetes mellitus with ketoacidosis without coma
E10.11    Type 1 diabetes mellitus with ketoacidosis with coma
E10.641    Type 1 diabetes mellitus with hypoglycemia with coma
E10.65    Type 1 diabetes mellitus with hyperglycemia
E11.00    Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.01    Type 2 diabetes mellitus with hyperosmolarity with coma
E11.641    Type 2 diabetes mellitus with hypoglycemia with coma
E11.65    Type 2 diabetes mellitus with hyperglycemia
E13.00    Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E13.01    Other specified diabetes mellitus with hyperosmolarity with coma
E13.10    Other specified diabetes mellitus with ketoacidosis without coma
E13.11    Other specified diabetes mellitus with ketoacidosis with coma
E13.641    Other specified diabetes mellitus with hypoglycemia with coma

NUMERATOR Exclude cases:
•transfer from a hospital (different facility) 
•transfer from a skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) 
•transfer from another health care facility
•MDC 14 (pregnancy, childbirth, and puerperium)

Know About Ambulatory-Care-Sensitive Admissions or PQI

Ambulatory-Care-Sensitive Admissions (ACSAs) are those that can be prevented. This is also commonly known as Prevention Quality Indicators or in short ‘PQI’.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are
one Agency response to this need for a multidimensional, accessible family of quality indicators.
They include a family of measures that providers, policy makers, and researchers can use with
inpatient data to identify apparent variations in the quality of either inpatient or outpatient care.

The PQI composites provide:
-Provide assessment of quality and disparity
-Provide baselines to track progress
-Identify information gaps
-Emphasize interdependence of quality and disparities
-Promote awareness and change

What AHRQ PQI Composite Measure:
PQI #01 Diabetes Short-Term Complications Admission Rate
PQI #03 Diabetes Long-Term Complications Admission Rate
PQI #05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate
PQI #07 Hypertension Admission Rate
PQI #08 Congestive Heart Failure (CHF) Admission Rate
PQI #10 Dehydration Admission Rate
PQI #11 Bacterial Pneumonia Admission Rate
PQI #12 Urinary Tract Infection Admission Rate
PQI #13 Angina without Procedure Admission Rate
PQI #14 Uncontrolled Diabetes Admission Rate
PQI #15 Asthma in Younger Adults Admission Rate
PQI #16 Rate of Lower-Extremity Amputation Among Patients With Diabetes

Acute Composite (PQI #91)
PQI #10 Dehydration Admission Rate
PQI #11 Bacterial Pneumonia Admission Rate
PQI #12 Urinary Tract Infection Admission Rate

Chronic Composite (PQI #92)
PQI #01 Diabetes Short-Term Complications Admission Rate
PQI #03 Diabetes Long-Term Complications Admission Rate
PQI #05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate
PQI #07 Hypertension Admission Rate
PQI #08 Congestive Heart Failure (CHF) Admission Rate
PQI #13 Angina without Procedure Admission Rate
PQI #14 Uncontrolled Diabetes Admission Rate
PQI #15 Asthma in Younger Adults Admission Rate
PQI #16 Rate of Lower-Extremity Amputation Among Patients With Diabetes