1. Date of download: 6/23/2016 From: Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades? Ann Intern Med. 2013;159(8): 505-513. doi:10.7326/0003-4819-159-8-201310150-00003 Study flow diagram. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

2. Date of download: 6/23/2016 From: Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades? Ann Intern Med. 2013;159(8): 505-513. doi:10.7326/0003-4819-159-8-201310150-00003 The CHART grading method. Area of detail for Figure 3. To assign a performance grade, CHART compares a hospital's lower and upper confidence limits for the pressure ulcer prevalence rate with percentile cutoffs (see Appendix Table 6). This makes it possible for hospitals with higher point estimates for their pressure ulcer prevalence rate (i.e., hospitals immediately to the left of the green line) to receive better grades than peer hospitals with lower point estimates (i.e., hospitals immediately to the right of the green line). CHART = California Hospital Assessment and Reporting Taskforce; HAPU2+ = stage II or greater hospital-acquired pressure ulcer. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

3. Date of download: 6/23/2016 From: Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades? Ann Intern Med. 2013;159(8): 505-513. doi:10.7326/0003-4819-159-8-201310150-00003 HAPU2+ rates, by administrative data (top) and surveillance data (bottom). Ten hospitals in the administrative data set reported zero cases, and 23 hospitals in the surveillance data set reported zero cases. CHART = California Hospital Assessment and Reporting Taskforce; HAPU2+ = stage II or greater hospital-acquired pressure ulcer. * Denotes hospital that had fewer than 30 cases or was otherwise deemed by CHART as having too few cases to assign a grade. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

4. Date of download: 6/23/2016 From: Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades? Ann Intern Med. 2013;159(8): 505-513. doi:10.7326/0003-4819-159-8-201310150-00003 Relative performance of hospitals according to administrative data (top) and surveillance data (bottom). In the top graph, hospitals were ranked by their administrative HAPU2+ rates and divided into 4 performance quartiles, ranging from quartile 1 (lowest rates, best performers) to quartile 4 (highest rates, worst performers). Dark-green bars highlight the 49 worst-performing hospitals in quartile 4. In the bottom graph, the hospital performance grades were assigned by CHART using an algorithm involving rates and CIs. Because of the grading method used, surveillance rates may decrease from left to right. Further details on the CHART grading method can be found in Appendix Table 6 and the Appendix Figure. The hospital rates and performance scores are reported here without modification in ranking or scoring method from what is publicly reported on the CalHospitalCompare Web site. The 49 worst-performing hospitals by administrative data shown by dark- green bars in the top graph are the same hospitals identified by dark-green bars in the bottom graph. These worst-performing hospitals by administrative data rates were assigned grades over the entire performance spectrum, including several in the “superior” and “above average” categories. Only 17 (35%) of 49 hospitals in the worst quartile by administrative data were graded as “below average” by surveillance data. Of note, 5 hospitals did not receive a performance grade by the surveillance method because they had insufficient data. These 5 hospitals are excluded from the bottom graph. CHART = California Hospital Assessment and Reporting Taskforce; HAPU2+ = stage II or greater hospital-acquired pressure ulcer. * One hospital was identified as being in the worst quartile when administrative data were used but had a zero rate when surveillance data were used. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians