Comparing the coding of complications in Queensland and Victorian admitted patient data

2011 ◽  
Vol 35 (3) ◽  
pp. 245 ◽  
Author(s):  
Jude L. Michel ◽  
Diana Cheng ◽  
Terri J. Jackson
Keyword(s):  
Patient Safety ◽  
Data Quality ◽  
Secondary Analysis ◽  
Routine Data ◽  
Complication Rates ◽  
Hospital Data ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

Objective. To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Design. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Methods. Comparison of depth of coding, and patterns in the coding of ten commonly coded complications of five elective procedures. Results. Comparison of the mean complication codes assigned per episode revealed Victoria assigns more valid codes than Queensland for all procedures, with the difference between the states being significantly different in all cases. The proportion of the codes flagged as complications was consistently lower for Queensland when comparing 10 common complications for each of the five selected elective procedures. The estimated complication rates for the five procedures showed Victoria to have an apparently higher complication rate than Queensland for 35 of the 50 complications examined. Conclusion. Our findings demonstrate that the coding of complications is more comprehensive in Victoria than in Queensland. It is known that inconsistencies exist between states in routine hospital data quality. Comparative use of patient safety indicators should be viewed with caution until standards are improved across Australia. More exploration of data quality issues is needed to identify areas for improvement. What is known about the topic? Routine data are low cost, accessible and timely but the quality is often questioned. This deters researchers and clinicians from using the data to monitor aspects of quality improvement. Previous studies have reported on the quality of diagnosis coding in Australia but not specifically on the quality of use of the condition-onset flag denoting hospital-acquired conditions. What does this paper add? Few studies have tested the consistency of the data between Australian states. No previous studies have evaluated the comprehensiveness of the coding of hospital-acquired conditions using routine data. This paper compares two states to highlight the differences in the coding of complications, with the aim of improving routine data to support patient safety. What are the implications for practitioners? The results imply more work needs to be done to improve the coding and flagging of complications so the data are valid and comprehensive. Further research should identify problem areas responsible for differences in the data so that training and audit strategies can be developed to improve the collection of this information. Practitioners may then be more confident in using routine coded inpatient data as part of the process of monitoring patient safety.

The prevalence of patient safety indicators and hospital-acquired conditions in patients with ruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database

2013 ◽  
Vol 119 (6) ◽  
pp. 1633-1640 ◽  
Author(s):  
Kyle M. Fargen ◽  
Dan Neal ◽  
Maryam Rahman ◽  
Brian L. Hoh
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Nationwide Inpatient Sample ◽  
Cerebral Aneurysms ◽  
Incidence Rates ◽  
Patient Safety Indicators ◽  
Nationwide Inpatient Sample Database ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

Object The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics used to gauge the quality of health care provided by health care institutions. To better understand the prevalence of these events in hospitalized patients treated for ruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of subarachnoid hemorrhage and procedure codes for either coiling or clipping in the Nationwide Inpatient Sample database. Methods The authors queried the Nationwide Inpatient Sample database, part of the AHRQ's Healthcare Cost and Utilization Project, for all hospitalizations between 2002 and 2010 involving coiling or clipping of ruptured cerebral aneurysms. The incidence rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The authors used the SAS statistical software package to calculate incidence rates and perform multivariate analyses to determine the effects of patient variables on the probability of developing each indicator. Results There were 62,972 patient admissions with a diagnosis code of subarachnoid hemorrhage between the years 2002 and 2010; 10,274 (16.3%) underwent clipping and 8248 (13.1%) underwent endovascular coiling. A total of 6547 PSI and HAC events occurred within the 10,274 patients treated with clipping; at least 1 PSI or HAC occurred in 47.9% of these patients. There were 5623 total PSI and HAC events among the 8248 patients treated with coils; at least 1 PSI or HAC occurred in 51.0% of coil-treated patients. Age, sex, comorbidities, hospital size, and hospital type had statistically significant associations with indicator occurrence. Compared with patients without events, those treated by either clipping or coiling and had at least 1 PSI during their hospitalization had significantly longer lengths of stay (p < 0.001), higher hospital costs (p < 0.001), and higher in-hospital mortality rates (p < 0.001). Conclusions These results estimate baseline national rates of PSIs and HACs in patients treated for ruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.

Prevalence of patient safety indicators and hospital-acquired conditions in those treated for unruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database

2013 ◽  
Vol 119 (4) ◽  
pp. 966-973 ◽  
Author(s):  
Kyle M. Fargen ◽  
Maryam Rahman ◽  
Dan Neal ◽  
Brian L. Hoh
Keyword(s):  
Health Care ◽  
Adverse Event ◽  
Patient Safety ◽  
Nationwide Inpatient Sample ◽  
Cerebral Aneurysms ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Unruptured Cerebral Aneurysms ◽  
Hospital Acquired

Object The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are metrics used to gauge the quality of health care provided by health care institutions. The PSIs and HACs are publicly reported metrics and are directly linked to reimbursement for services. To better understand the prevalence of these adverse events in hospitalized patients treated for unruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of unruptured aneurysm in the Nationwide Inpatient Sample (NIS) database. Methods The NIS, part of the AHRQ's Healthcare Cost and Utilization Project, was queried for all hospitalizations between 2002 and 2010 involving coiling or clipping of unruptured cerebral aneurysms. The incidence rate for each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate incidences and perform multivariate analyses to determine the effects of patient variables on the probability of each indicator developing. Results There were 54,589 hospitalizations involving unruptured cerebral aneurysms in the NIS database for the years 2002–2010; 8314 patients (15.2%) underwent surgical clipping and 9916 (18.2%) were treated with endovascular coiling. One thousand four hundred ninety-two PSI and HAC events occurred among the 8314 patients treated with clipping; at least 1 PSI or HAC occurred in 14.6% of these patients. There were 1353 PSI and HAC events among the 9916 patients treated with coiling; at least 1 PSI or HAC occurred in 10.9% of these patients. Age, sex, and comorbidities had statistically significant associations with an adverse event. Compared with the patients having no adverse event, those having at least 1 PSI during their hospitalizations had significantly longer hospital stays (p < 0.0001), higher hospital costs (p < 0.0001), and higher mortality rates (p < 0.0001). Conclusions These results estimate baseline national rates of PSIs and HACs in patients with unruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.

scholarly journals Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

2015 ◽  
Vol 122 (4) ◽  
pp. 870-875 ◽  
Author(s):  
Kyle M. Fargen ◽  
Dan Neal ◽  
Spiros L. Blackburn ◽  
Brian L. Hoh ◽  
Maryam Rahman
Keyword(s):  
Patient Safety ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Healthcare Research ◽  
Insurance Status ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator. RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001). CONCLUSIONS Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.

scholarly journals Adesão à identificação correta do paciente pelo uso da pulseira

2018 ◽  
Vol 12 (10) ◽  
pp. 2621
Author(s):  
Tamyris Garcia De Assis ◽  
Luana Ferreira De Almeida ◽  
Luciana Guimarães Assad ◽  
Ronilson Gonçalves Rocha ◽  
Cíntia Silva Fassarella ◽  
...  
Keyword(s):  
Patient Safety ◽  
Descriptive Statistics ◽  
University Hospital ◽  
Patient Identification ◽  
Hospital Data ◽  
Health Team ◽  
Systems Quality ◽  
Quantitative Descriptive ◽  
And Training

RESUMO Objetivo: analisar a adesão à identificação do paciente por pulseira pela equipe de saúde e pelos pacientes. Método: trata-se de estudo quantitativo, descritivo e documental. Constituiu-se a amostra por 137 pacientes internados em uma unidade cardiointensiva de um hospital universitário. Coletaram-se os dados, mediante o preenchimento de um formulário estruturado, em seguida, organizados e analisados utilizando-se a estatística descritiva simples. Resultados: observou-se a presença da pulseira de identificação em 100% dos pacientes. Destes, 26% apresentavam não conformidades. Ansalisou-se, a partir dos relatos dos pacientes, que 61% dos profissionais não utilizaram a pulseira para identificá-los no momento dos procedimentos e 90% dos pacientes não foram orientados quanto ao motivo e importância da utilização da pulseira. Conclusão: observou-se de forma unânime a identificação dos pacientes, no entanto, necessita-se, na prática, de maior sensibilização e treinamento da equipe multiprofissional para a adequação conforme se preconiza na Meta 1 de Segurança do Paciente. Descritores: Segurança do Paciente; Sistemas de Identificação de Pacientes; Qualidade da Assistência à Saúde; Gestão de Risco; Hospitalização; Hospitais Universitários.ABSTRACT Objective: to analyze the adherence to the identification of the patient by hospital wristband by the health team and by the patients. Method: this is a quantitative, descriptive and documentary study. The sample consisted of 137 patients hospitalized in a cardio-intensive unit of a university hospital. Data was collected by completing a structured form, then organized and analyzed using simple descriptive statistics. Results: the presence of the identification wristband was observed in 100% of the patients. Of these, 26% had nonconformities. From the patients' reports, 61% of the professionals did not use the wristband to identify them at the time of the procedures and 90% of the patients were not guided as to the reason and importance of the use of the wristband. Conclusion: the identification of patients was unanimously observed, however, it is necessary, in practice, to increase awareness and training of the multi-professional team for the adequacy as recommended in Goal 1 of Patient Safety. Descriptors: Patient Safety; Patient Identification Systems; Quality of Health Care; Risk Management; Hospitalization; Hospitals, University.RESUMENObjetivo: analizar la adhesión a la identificación del paciente por pulsera por el equipo de salud y por los pacientes. Método: se trata de un estudio cuantitativo, descriptivo y documental. Se constituyó la muestra por 137 pacientes internados en una unidad cardiointensiva de un hospital universitario. Se recogen los datos, mediante el llenado de un formulario estructurado, a continuación, organizado y analizado utilizando la estadística descriptiva simple. Resultados: se observó la presencia de la pulsera de identificación en el 100% de los pacientes. De ellos, el 26% presentaba no conformidades. Se analizó, a partir de los relatos de los pacientes, que el 61% de los profesionales no utilizaron la pulsera para identificarlos en el momento de los procedimientos y el 90% de los pacientes no fueron orientados en cuanto al motivo e importancia del uso de la pulsera. Conclusión: se observó de forma unánime la identificación de los pacientes, sin embargo, se necesita, en la práctica, de mayor sensibilización y entrenamiento del equipo multiprofesional para la adecuación conforme se preconiza en la Meta 1 de Seguridad del Paciente. Descriptores: Seguridad del Paciente; Sistemas de Identificación de Pacientes; Calidad de la Atención de Salud; Gestión de Riesgos; Hospitalización; Hospitales Universitarios.

Faculty Clinical Quality Goals Drive Improvement in University HealthSystem Consortium Outcome Measures

2012 ◽  
Vol 78 (7) ◽  
pp. 749-754 ◽  
Author(s):  
Kevin E. Behrns ◽  
Darwin Ang ◽  
Huazi Liu ◽  
Steven J. Hughes ◽  
Holly Creel ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Clinical Score ◽  
Outcome Data ◽  
Faculty Members ◽  
Clinical Quality ◽  
Patient Safety Indicators ◽  
Before And After ◽  
The University ◽  
Hospital Acquired

Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions (HACs) are routinely reported by the University HealthSystem Consortium (UHC) to measure quality at academic health centers. We hypothesized that a clinical quality measurable goal assigned to individual faculty members would decrease UHC measures of mortality, LOS, PSIs, and HACs. For academic year (AY) 2010–2011, faculty members received a clinical quality goal related to mortality, LOS, PSIs, and HACs. The quality metric constituted 25 per cent of each faculty member's annual evaluation clinical score, which is tied to compensation. The outcomes were compared before and after goal assignment. Outcome data on 6212 patients from AY 2009–2010 were compared with 6094 patients from AY 2010–2011. The mortality index (0.89 vs 0.93; P = 0.73) was not markedly different. However, the LOS index decreased from 1.01 to 0.97 ( P = 0.011), and department-wide PSIs decreased significantly from 285 to 162 ( P = 0.011). Likewise, HACs decreased from 54 to 18 ( P = 0.0013). Seven (17.9%) of 39 faculty had quality grades that were average or below. Quality goals assigned to individual faculty members are associated with decreased average LOS index, PSIs, and HACs. Focused, relevant quality assignments that are tied to compensation improve patient safety and outcomes.

Validation of new ICD-10-based patient safety indicators for identification of in-hospital complications in surgical patients: a study of diagnostic accuracy

2019 ◽  
Vol 29 (3) ◽  
pp. 209-216 ◽  
Author(s):  
Daniel I McIsaac ◽  
Gavin M Hamilton ◽  
Karim Abdulla ◽  
Luke T Lavallée ◽  
Husien Moloo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Secondary Analysis ◽  
Data Systems ◽  
Reference Standard ◽  
Likelihood Ratios ◽  
Primary Analysis ◽  
Predictive Values ◽  
Individual Level ◽  
Patient Safety Indicators ◽  
Icd 10

ObjectiveAdministrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. We assessed the accuracy of a new set of patient safety indicators (PSIs; designed to identify in hospital complications).Study designProspectively defined analysis of registry data (1 April 2010–29 February 2016) in a Canadian hospital network. Assignment of complications was by two methods independently. The National Surgical Quality Improvement Programme (NSQIP) database was the clinical reference standard (primary outcome=any in-hospital NSQIP complication); PSI clusters were assigned using International Classification of Disease (ICD-10) codes in the discharge abstract. Our primary analysis assessed the accuracy of any PSI condition compared with any complication in the NSQIP; secondary analysis evaluated accuracy of complication-specific PSIs.PatientsAll inpatient surgical cases captured in NSQIP data.AnalysisWe assessed the accuracy of PSIs (with NSQIP as reference standard) using positive and negative predictive values (PPV/NPV), as well as positive and negative likelihood ratios (±LR).ResultsWe identified 12 898 linked episodes of care. Complications were identified by PSIs and NSQIP in 2415 (18.7%) and 2885 (22.4%) episodes, respectively. The presence of any PSI code had a PPV of 0.55 (95% CI 0.53 to 0.57) and NPV of 0.93 (95% CI 0.92 to 0.93); +LR 6.41 (95% CI 6.01 to 6.84) and −LR 0.40 (95% CI 0.37 to 0.42). Subgroup analyses (by surgery type and urgency) showed similar performance. Complication-specific PSIs had high NPVs (95% CI 0.92 to 0.99), but low to moderate PPVs (0.13–0.61).ConclusionValidation of the ICD-10 PSI system suggests applicability as a first screening step, integrated with data from other sources, to produce an adverse event detection pathway that informs learning healthcare systems. However, accuracy was insufficient to directly identify or rule out individual-level complications.

scholarly journals Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Olga A. Vsevolozhskaya ◽  
Karina C. Manz ◽  
Pierre M. Zephyr ◽  
Teresa M. Waters
Keyword(s):  
Improve Patient Safety ◽  
Hospital Performance ◽  
Highly Sensitive ◽  
Hospital Acquired Conditions ◽  
Reduction Program ◽  
Hospital Discharge Records ◽  
Hospital Acquired ◽  
The Impact ◽  
Over Time

Abstract Background Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program’s scoring methodology has not been independently evaluated. Methods We used hospital discharge records from 14 states to evaluate the association between changes in HACRP scoring methodology and corresponding shifts in penalty status. To isolate the impact of changes in scoring methods over time, we used FY2018 hospital performance data to calculate total HAC scores using FY2015 through FY2018 CMS scoring methodologies. Results Comparing hospital penalty status based on various HACRP scoring methodologies over time, we found a significant overlap between penalized hospitals when using FY 2015 and 2016 scoring methodologies (95%) and between FY 2017 and 2018 methodologies (46%), but substantial differences across early vs later years. Only 15% of hospitals were eligible for penalties across all four years. We also found significant changes in a hospital’s (relative) ranking across the various years, indicating that shifts in penalty status were not driven by small changes in HAC scores clustered around the penalty threshold. Conclusions HACRP penalties have been highly sensitive to program updates, which are generally announced after performance periods are concluded. This disconnect between performance and penalties calls into question the ability of the HACRP to improve patient safety as intended.

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