Table 1.

Process of Care Measures for Composite Score

Indicators	Description
Heart failure
Discharge instructions	If discharged home, received written discharge instructions or educational material addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen
Left ventricular functional assessment	Evaluation of left ventricular function occurred before arrival, during hospitalization, or planned for after discharge
ACEI or ARB at discharge	If ventricular systolic dysfunction and no contraindications, prescribed an ACEI or ARB at discharge
Smoking cessation counseling	If a history of smoking cigarettes in the past year, received smoking cessation advice or counseling during the hospital stay
Pneumonia
Appropriate initial antibiotic	Received initial antibiotic regimen consistent with current guidelines within first 24 hours
Initial antibiotic timing	Received first dose of antibiotics within 4 hours after arrival at the hospital
Initial blood culture timing	Initial blood culture specimen was collected before the first hospital dose of antibiotics
Influenza vaccination	Patients >50 years discharged October–February screened for influenza vaccine and vaccinated if indicated
Pneumococcal vaccination	Patients >65 years screened for pneumococcal vaccine status and vaccinated if indicated
Oxygenation assessment	Assessment of arterial oxygenation within 24 hours of arrival
Smoking cessation counseling	If a history of smoking in the past year, received smoking cessation counseling
Acute myocardial infarction
Aspirin at arrival	Received aspirin within 24 hours before or after hospital arrival
Aspirin at discharge	Prescribed aspirin at hospital discharge
ACEI or ARB at discharge	If left ventricular systolic dysfunction, prescribed an ACEI or ARB at discharge
Beta-blocker on admission	Prescribed a beta-blocker at hospital admission
Beta-blocker at discharge	Prescribed a beta-blocker at discharge
Smoking cessation counseling	If a history of smoking cigarettes during the year before hospital arrival, received smoking cessation advice or counseling during the hospital stay
Fibrinolytic therapy within 30 minutes	If ST-segment elevation or left bundle branch block on theECG closest to arrival time, received fibrinolytic therapy within 30 minutes of arrival
Primary PCI within 30 minutes	If ST-segment elevation or left bundle branch block on theECG closest to arrival time received primary percutaneous coronary intervention within 30 minutes of arrival
Surgical care improvement project
Prophylactic antibiotic within 1 hour prior to surgical incision	Prophylactic antibiotics initiated within 1 hour prior to surgical incision as indicated
Prophylactic antibiotic selection	Received prophylactic antibiotics consistent with current guidelines
Prophylactic antibiotics discontinued within 24 hours after surgery end time	Prophylactic antibiotics discontinued within 24 hours after anesthesia end time

Note: ACEI, angtiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blockers. All items are reported as aggregated hospital percentages.