Abstract
BackgroundThe Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) provide information on hospital risk-adjusted rates for potentially preventable adverse events. Although designed to work with routine administrative data, it is unknown whether the PSIs can accurately distinguish between complications and pre-existing conditions. The objective of this study is to examine whether the AHRQ PSIs accurately measure hospital complication rates, using the data with present-on-admission (POA) codes to distinguish between complications and pre-existing conditionsMethodsRetrospective cohort study of patients undergoing isolated CABG surgery in California conducted using the 1998–2000 California State Inpatient Database. We calculated the positive predictive value of selected AHRQ PSIs using information from the POA as the gold standard, and the intra-class correlation coefficient to assess the level of agreement between the hospital risk-adjusted PSI rates with and without the information contained in the POA modifier.ResultsThe false positive error rate, defined as one minus the positive predictive value, was greater than or equal to 20% for four of the eight PSIs examined: decubitus ulcer, failure-to-rescue, postoperative physiologic and metabolic derangement, and postoperative pulmonary embolism or deep venous thrombosis. Pairwise comparison of the hospital risk-adjusted PSI rates, with and without POA information, demonstrated almost perfect agreement for five of the eight PSI's. For decubitus ulcer, failure-to-rescue, and postoperative pulmonary embolism or DVT, the intraclass-correlation coefficient ranged between 0.63 to 0.79.ConclusionFor some of the AHRQ Patient Safety Indicators, there are significant differences in the risk-adjusted rates of adverse events depending on whether the POA indicator is used to distinguish between pre-existing conditions and complications. The use of the POA indicator will increase the accuracy of the AHRQ PSIs as measures of adverse outcomes.
Highlights
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) provide information on hospital risk-adjusted rates for potentially preventable adverse events
The false positive error rate was greater than or equal to 20% for four of the eight PSIs: decubitus ulcer, failure-to-rescue, postoperative physiologic and metabolic derangement, and postoperative pulmonary embolism or Deep Venous Thrombosis (DVT)
In this study we find that the present-on-admission (POA) indicator has a significant impact on some of the AHRQ Patient Safety Indicators (PSI) rates in patients undergoing coronary artery bypass graft (CABG) surgery
Summary
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) provide information on hospital risk-adjusted rates for potentially preventable adverse events. The Agency for Healthcare Research and Quality (AHRQ) has constructed Patient Safety Indicators (PSI) [6] to serve as the "state-ofthe art in measuring the safety of hospital care through the analysis of inpatient discharge data [6].". A hospital can benchmark its performance using these safety indicators and target specific areas of poor performance for improvement. This 'global' approach to quality improvement is more likely to be effective than the traditional approach of narrowly focusing on the unsafe actions of a few physicians [7]. Using PSIs to guide QI efforts may force hospitals to focus their efforts on the development of systems which will reduce the incidence and mitigate the impact of dangerous medical errors [7]
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