Proportion of Patients Hospitalized with Stroke that have a Potentially Avoidable Complication (during the Index Stay or in the 30-day Post-Discharge Period)

Percent of adult population aged 18 – 65 years who were admitted to a hospital with stroke, were followed for one-month after discharge, and had one or more potentially avoidable complications (PACs). PACs may occur during the index stay or during the 30-day post discharge period (Please reference attached document labeled NQF_Stroke_PACs_Risk_Adjustment_2.16.10.xls, tabs labeled CIP_Index PAC_Stays and CIP_PAC_Readmission). We define PACs during each time period as one of three types:

(A) PACs during the Index Stay (Hospitalization):

(1) PACs related to the anchor condition: The index stay is regarded as having a PAC if during the index hospitalization for stroke the patient develops one or more complications such as hypertensive encephalopathy, malignant hypertension, coma, anoxic brain damage, or respiratory failure etc. that may result directly from stroke or its management.

(2) PACs due to Comorbidities: The index stay is also regarded as having a PAC if one or more of the patient’s controlled comorbid conditions is exacerbated during the hospitalization (i.e. it was not present on admission). Examples of these PACs are diabetic emergency with hypo- or hyperglycemia, pneumonia, lung complications, acute myocardial infarction, gastritis, ulcer, GI hemorrhage etc.

(3) PACs suggesting Patient Safety Failures: The index stay is regarded as having a PAC if there are one or more complications related to patient safety issues. Examples of these PACs are septicemia, meningitis, other infections, phlebitis, deep vein thrombosis, pulmonary embolism or any of the CMS-defined hospital acquired conditions (HACs).

(B) PACs during the 30-day post discharge period:

(1) PACs related to the anchor condition: Readmissions and emergency room visits during the 30-day post discharge period after a stroke are considered as PACs if they are for hypertensive encephalopathy, malignant hypertension, respiratory failure, coma, anoxic brain damage etc.

(2) PACs due to Comorbidities: Readmissions and emergency room visits during the 30-day post discharge period are also considered PACs if they are due to an exacerbation of one or more of the patient’s comorbid conditions, such as a diabetic emergency with hypo- or hyperglycemia, pneumonia, lung complications, acute myocardial infarction, acute renal failure etc.

(3) PACs suggesting Patient Safety Failures: Readmissions or emergency room visits during the 30-day post discharge period are considered PACs if they are due to sepsis, infections, deep vein thrombosis, pulmonary embolism, or for any of the CMS-defined hospital acquired conditions (HACs).

The enclosed workbook labeled NQF_Stroke_PACs_Risk_Adjustment_2.16.10.xls, gives the frequency and costs associated with each of these types of PACs during the index hospitalization (tab labeled CIP_Index PAC_Stays) and for readmissions and emergency room visits during the 30-day post-discharge period (tab labeled CIP_PAC_Readmission). The information is based on a two-year national commercially insured population (CIP) claims database. The database had 4.7 million covered lives and $95 billion in “allowed amounts” for claims costs. The database was an administrative claims database with medical as well as pharmacy claims. The two tabs demonstrate the most common PACs that occurred in patients hospitalized with stroke.