Dataset Information

Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment?

ABSTRACT:

Objective

To assess whether use of the AHRQ Patient Safety Indicator (PSI) composite measure versus modified composite measures leads to changes in hospital profiles and payments.

Data sources/study setting

Retrospective analysis of 2010 Veterans Health Administration discharge data.

Study design

We used the AHRQ PSI software (v4.2) to obtain PSI-flagged events and composite scores for all 151 hospitals in the database (n = 517,814 hospitalizations). We compared the AHRQ PSI composite to two modified composites that estimated "true safety events" from previous chart abstraction findings: one with modified numerators based on the positive predictive value (PPV) of each PSI, and one with similarly modified numerators but whose denominators were based on the expected fraction of PSI-eligible cases that remained after removing those PSIs that were present-on-admission (POA).

Principal findings

Although a small percentage (5-6 percent) of hospitals changed outlier status based on modified PSI composites, some of these changes were substantial; 30 and 19 percent of hospitals changed ?20 ranks after adjustment for PPVs and POA flags, respectively. We estimate that 33 percent of hospitals would see a change of at least 10 percent in performance payments.

Conclusions

Changes in hospital profiles and payments would be substantial for some hospitals if the PSI composite score used weights reflecting the relative prevalence of true versus flagged events.

SUBMITTER: Rosen AK

PROVIDER: S-EPMC4213043 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Publications

Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment?

Rosen Amy K AK Chen Qi Q Borzecki Ann M AM Shin Marlena M Itani Kamal M F KM Shwartz Michael M

Health services research 20140430 5

<h4>Objective</h4>To assess whether use of the AHRQ Patient Safety Indicator (PSI) composite measure versus modified composite measures leads to changes in hospital profiles and payments.<h4>Data sources/study setting</h4>Retrospective analysis of 2010 Veterans Health Administration discharge data.<h4>Study design</h4>We used the AHRQ PSI software (v4.2) to obtain PSI-flagged events and composite scores for all 151 hospitals in the database (n = 517,814 hospitalizations). We compared the AHRQ PS ...[more]

PMID: 24779721

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Project description:ImportanceThe COVID-19 pandemic introduced stresses on hospitals due to the surge in demand for care and to staffing shortages. The implications of these stresses for patient safety are not well understood.ObjectiveTo assess whether hospital COVID-19 burden was associated with the rate of in-hospital adverse effects (AEs).Design, setting, and participantsThis cohort study used data from the Agency for Healthcare Research and Quality's Quality and Safety Review System, a surveillance system that tracks the frequency of AEs among selected hospital admissions across the US. The study sample included randomly selected Medicare patient admissions to acute care hospitals in the US between September 1, 2020, and June 30, 2022.Main outcomes and measuresThe main outcome was the association between frequency of AEs and hospital-specific weekly COVID-19 burden. Observed and risk-adjusted rates of AEs per 1000 admissions were stratified by the weekly hospital-specific COVID-19 burden (daily mean number of COVID-19 inpatients per 100 hospital beds each week), presented as less than the 25th percentile (lowest burden), 25th to 75th percentile (intermediate burden), and greater than the 75th percentile (highest burden). Risk adjustment variables included patient and hospital characteristics.ResultsThe study included 40 737 Medicare hospital admissions (4114 patients [10.1%] with COVID-19 and 36 623 [89.9%] without); mean (SD) patient age was 73.8 (12.1) years, 53.8% were female, and the median number of Elixhauser comorbidities was 4 (IQR, 2-5). There were 59.1 (95% CI, 54.5-64.0) AEs per 1000 admissions during weeks with the lowest, 77.0 (95% CI, 73.3-80.9) AEs per 1000 admissions during weeks with intermediate, and 97.4 (95% CI, 91.6-103.7) AEs per 1000 admissions during weeks with the highest COVID-19 burden. Among patients without COVID-19, there were 55.7 (95% CI, 51.1-60.8) AEs per 1000 admissions during weeks with the lowest, 74.0 (95% CI, 70.2-78.1) AEs per 1000 admissions during weeks with intermediate, and 79.3 (95% CI, 73.7-85.3) AEs per 1000 admissions during weeks with the highest COVID-19 burden. A similar pattern was seen among patients with COVID-19. After risk adjustment, the relative risk (RR) for AEs among patients admitted during weeks with high compared with low COVID-19 burden for all patients was 1.23 (95% CI, 1.09-1.39; P < .001), with similar results seen in the cohorts with (RR, 1.33; 95% CI, 1.03-1.71; P = .03) and without (RR, 1.23; 95% CI, 1.08-1.39; P = .002) COVID-19 individually.Conclusions and relevanceIn this cohort study of hospital admissions among Medicare patients during the COVID-19 pandemic, greater hospital COVID-19 burden was associated with an increased risk of in-hospital AEs among both patients with and without COVID-19. These results illustrate the need for greater hospital resilience and surge capacity to prevent declines in patient safety during surges in demand.

Dataset Information

Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment?

Objective

Data sources/study setting

Study design

Principal findings

Conclusions

Publications

Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment?

Similar Datasets

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