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 Modulation of corticomotor excitability in response to distal focal cooling

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e6163 ◽  
Author(s):  
Yekta Ansari ◽  
Anthony Remaud ◽  
François Tremblay
Keyword(s):  
Skin Temperature ◽  
Motor Evoked Potentials ◽  
Secondary Analysis ◽  
Initial Study ◽  
Primary Analysis ◽  
Single Digit ◽  
Corticomotor Excitability ◽  
Individual Level ◽  
Cooling Phase ◽  
The Individual

Background Thermal stimulation has been proposed as a modality to facilitate motor recovery in neurological populations, such as stroke. Recently (Ansari, Remaud & Tremblay, 2018), we showed that application of cold or warm stimuli distally to a single digit produced a variable and short lasting modulation in corticomotor excitability. Here, our goal was to extend these observations to determine whether an increase in stimulation area could elicit more consistent modulation. Methods Participants (n = 22) consisted of a subset who participated in our initial study. Participants were asked to come for a second testing session where the thermal protocol was repeated but with extending the stimulation area from single-digit (SD) to multi-digits (MD, four fingers, no thumb). As in the first session, skin temperature and motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation were measured at baseline (BL, neutral gel pack at 22 °C), at 1 min during the cooling application (pre-cooled 10 °C gel pack) and 5 and 10 min post-cooling (PC5 and PC10). The analysis combined the data obtained previously with single-SD cooling (Ansari, Remaud & Tremblay, 2018) with those obtained here for MD cooling. Results At BL, participants exhibited comparable measures of resting corticomotor excitability between testing sessions. MD cooling induced similar reductions in skin temperature as those recorded with SD cooling with a peak decline at C1 of respectively, −11.0 and −10.3 °C. For MEPs, the primary analysis revealed no main effect attributable to the stimulation area. A secondary analysis of individual responses to MD cooling revealed that half of the participants exhibited delayed MEP facilitation (11/22), while the other half showed delayed inhibition (10/22); which was sustained in the post-cooling phase. More importantly, a correlation between variations in MEP amplitude recorded during the SD cooling session with those recorded in the second session with MD cooling, revealed a very good degree of correspondence between the two at the individual level. Conclusion These results indicate that increasing the cooling area in the distal hand, while still eliciting variable responses, did produce more sustained modulation in MEP amplitude in the post-cooling phase. Our results also highlight that responses to cooling in terms of either depression or facilitation of corticomotor excitability tend to be fairly consistent in a given individual with repeated applications.

Abstract P533: Incidence and Outcomes of Thrombectomy Rescue Therapies in Acute Basilar Artery Occlusions

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ronda Lun ◽  
Greg B Walker ◽  
David Weisenburger-Lile ◽  
Bertrand Lapergue ◽  
Adrien Guenego ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Secondary Analysis ◽  
Hematoma Expansion ◽  
Primary Analysis ◽  
Predictive Values ◽  
Previous Definition ◽  
Secondary Analyses ◽  
Revised Definitions ◽  
Definition Of ◽  
Sensitivity Specificity

Background: Hematoma expansion (HE) is an important therapeutic target in intracerebral hemorrhage. Recently proposed HE definitions have not been validated, and no previous definition has accounted for withdrawal of care (WOC). Objective: To compare conventional and revised definitions of hematoma expansion (HE), while accounting for WOC. Methods: We analyzed data from the ATACH-2 trial, comparing revised definitions of HE incorporating intraventricular hemorrhage (IVH) expansion to the conventional definition of “≥6 mL or ≥33%”. The primary outcome was modified Rankin Scale of 4-6 at 90-days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c- statistic for all definitions of HE. Definitions were compared using non-parametric methods. Secondary analyses were performed after removing patients who experienced WOC. Results: Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any IVH”, with increased c -statistic from 60.2% to 65.9% (p < 0.001). Secondary analysis excluded 46 participants who experienced WOC. The revised definitions outperformed the conventional definition in this population as well, with the greatest improvement in c -statistic using “≥6 mL or ≥33% or any IVH” (58.1% vs 64.1%, p < 0.001). Conclusions: HE definitions incorporating intraventricular expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.

Research Methods, Statistics, Patient Safety, and Quality Improvement

2020 ◽  
pp. 521-530
Author(s):  
Carlos Lerner
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Adverse Events ◽  
Research Methods ◽  
Confidence Intervals ◽  
Medical Errors ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Analysis Of Variation ◽  
Answer Format

The chapter on research methods, statistics, patient safety, and quality improvement (QI) uses a question-and-answer format to make concepts in these areas relevant and accessible to general pediatricians. Research topics covered include study design and study types, validity, sources of bias, types of errors, sensitivity and specificity, positive and negative predictive values, likelihood ratios, incidence and prevalence, p values and confidence intervals. The patient safety questions focus on medical errors and adverse events, including their categorization, detection, prevention, and disclosure. Finally, the QI questions address key QI principles and methods, including tools to understand systems (e.g. fishbone diagrams and Pareto charts), analysis of variation, and the Langley Model for Improvement.

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.

scholarly journals Validity of AHRQ patient safety indicators derived from ICD-10 hospital discharge abstract data (chart review study)

BMJ Open ◽  
2013 ◽  
Vol 3 (10) ◽  
pp. e003716 ◽  
Author(s):  
Hude Quan ◽  
Cathy Eastwood ◽  
Ceara Tess Cunningham ◽  
Mingfu Liu ◽  
Ward Flemons ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hospital Discharge ◽  
Chart Review ◽  
Patient Safety Indicators ◽  
Icd 10 ◽  
Abstract Data ◽  
Review Study

scholarly journals Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM

2014 ◽  
Vol 22 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Andrew D Boyd ◽  
Young Min Yang ◽  
Jianrong Li ◽  
Colleen Kenost ◽  
Mike D Burton ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
International Classification Of Diseases ◽  
Healthcare Research ◽  
Coding System ◽  
Patient Safety Indicators ◽  
Safety Reporting ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Icd 10

Abstract Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38 644 patients (1 446 581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.

scholarly journals Diagnostic accuracy of GeneXpert MTB/RIF assay for detection of tubercular pleural effusion

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251618
Author(s):  
Jyoti Jain ◽  
Pooja Jadhao ◽  
Shashank Banait ◽  
Preetam Salunkhe
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Tertiary Care ◽  
Public Health Problem ◽  
P Value ◽  
Care Hospital ◽  
Reference Standard ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Composite Reference Standard

India has been engaged in tuberculosis (TB) control activities for over 50 years and yet TB continues to remain India’s important public health problem. The present study was conducted to compare the performance of GeneXpert MTB/RIF (GXpert) assay with composite reference standard in diagnosing cases of tubercular pleural effusion (TPE) and to evaluate the reliability of rifampicin resistance. A cross-sectional study was performed in a Department of Medicine of a rural teaching tertiary care hospital in central India. In all consecutive patients with pleural effusion on chest radiograph presenting to Department of Medicine, GXpert assay and composite reference standard was performed to evaluate the diagnostic accuracy of GXpert assay for detecting TPE in comparison to composite reference standard. Standard formulae were used to calculate the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (LR+) and negative likelihood ratios (LR-). Mc-Nemar’s test was applied to compare variables. All comparisons were two-tailed. We considered the difference to be statistically significant if the P value was less than 0.05. The sensitivity of the GXpert assay in diagnosing TPE was 16.6% among 158 study participants, the specificity was 100% and diagnostic accuracy was 52.5% which was statistically significant (p value < 0.05). It had a PPV of 100% (95%CI: 88.3% - 100%) and a NPV of 47.5% (95%CI: 39.3% - 55.7%). The LR+ and LR-were 23.5 (95%CI: 1.43–38.6) and 0.83 (95%CI: 0.76–0.91) respectively. GXpert assay has a very high specificity in diagnosing TPE but has a low sensitivity. In comparison to composite reference standard Thus its clinical utility is limited when used as a standalone test. A physician’s clinical acumen in combination with routine pleural fluid analysis should be the key factor in the diagnosis of TPE in clinically and radiologically suspected patients, especially in high TB burden countries.

scholarly journals Towards Prevention of Acute Syndromes

2014 ◽  
Vol 05 (01) ◽  
pp. 58-72 ◽  
Author(s):  
C. Thongprayoon ◽  
B.W. Pickering ◽  
A. Akhoundi ◽  
G. Wilson ◽  
D. Pieczkiewicz ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Pancreatitis ◽  
Hospital Admission ◽  
Data Extraction ◽  
Secondary Analysis ◽  
Reference Standard ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Automated Algorithm ◽  
Patients At Risk

SummaryBackground: Identifying patients at risk for acute respiratory distress syndrome (ARDS) before their admission to intensive care is crucial to prevention and treatment. The objective of this study is to determine the performance of an automated algorithm for identifying selected ARDS predis-posing conditions at the time of hospital admission.Methods: This secondary analysis of a prospective cohort study included 3,005 patients admitted to hospital between January 1 and December 31, 2010. The automated algorithm for five ARDS pre-disposing conditions (sepsis, pneumonia, aspiration, acute pancreatitis, and shock) was developed through a series of queries applied to institutional electronic medical record databases. The automated algorithm was derived and refined in a derivation cohort of 1,562 patients and subsequently validated in an independent cohort of 1,443 patients. The sensitivity, specificity, and positive and negative predictive values of an automated algorithm to identify ARDS risk factors were compared with another two independent data extraction strategies, including manual data extraction and ICD-9 code search. The reference standard was defined as the agreement between the ICD-9 code, automated and manual data extraction.Results: Compared to the reference standard, the automated algorithm had higher sensitivity than manual data extraction for identifying a case of sepsis (95% vs. 56%), aspiration (63% vs. 42%), acute pancreatitis (100% vs. 70%), pneumonia (93% vs. 62%) and shock (77% vs. 41%) with similar specificity except for sepsis and pneumonia (90% vs. 98% for sepsis and 95% vs. 99% for pneumonia). The PPV for identifying these five acute conditions using the automated algorithm ranged from 65% for pneumonia to 91 % for acute pancreatitis, whereas the NPV for the automated algorithm ranged from 99% to 100%.Conclusion: A rule-based electronic data extraction can reliably and accurately identify patients at risk of ARDS at the time of hospital admission.Citation: Ahmed A, Thongprayoon C, Pickering BW, Akhoundi A, Wilson G, Pieczkiewicz D, Herasevich V. Towards prevention of acute syndromes: Electronic identification of at-risk patients during hospital admission. Appl Clin Inf 2014; 5: 58–72http://dx.doi.org/10.4338/ACI-2013-07-RA-0045

scholarly journals Quantifying the Accuracy of a Diagnostic Test or Marker

2012 ◽  
Vol 58 (9) ◽  
pp. 1292-1301 ◽  
Author(s):  
Kristian Linnet ◽  
Patrick M M Bossuyt ◽  
Karel G M Moons ◽  
Johannes B Reitsma
Keyword(s):  
Diagnostic Test ◽  
Prospective Cohort ◽  
Roc Curves ◽  
Test Accuracy ◽  
Index Test ◽  
Reference Standard ◽  
Single Test ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Cohort Design

Abstract BACKGROUND In recent years, increasing focus has been directed to the methodology for evaluating (new) tests or biomarkers. A key step in the evaluation of a diagnostic test is the investigation into its accuracy. CONTENT We reviewed the literature on how to assess the accuracy of diagnostic tests. Accuracy refers to the amount of agreement between the results of the test under evaluation (index test) and the results of a reference standard or test. The generally recommended approach is to use a prospective cohort design in patients who are suspected of having the disease of interest, in which each individual undergoes the index and same reference standard tests. This approach presents several challenges, including the problems that can arise with the verification of the index test results by the preferred reference standard test, the choice of cutoff value in case of a continuous index test result, and the determination of how to translate accuracy results to recommendations for clinical use. This first in a series of 4 reports presents an overview of the designs of single-test accuracy studies and the concepts of specificity, sensitivity, posterior probabilities (i.e., predictive values) for the presence of target disease, ROC curves, and likelihood ratios, all illustrated with empirical data from a study on the diagnosis of suspected deep venous thrombosis. Limitations of the concept of the diagnostic accuracy for a single test are also highlighted. CONCLUSIONS The prospective cohort design in patients suspected of having the disease of interest is the optimal approach to estimate the accuracy of a diagnostic test. However, the accuracy of a diagnostic index test is not constant but varies across different clinical contexts, disease spectrums, and even patient subgroups.

scholarly journals Effect modification of FADS2 polymorphisms on the association between breastfeeding and intelligence: results from a collaborative meta-analysis

2017 ◽  
Author(s):  
Fernando Pires Hartwig ◽  
Neil Martin Davies ◽  
Bernardo Lessa Horta ◽  
Tarunveer S. Ahluwalia ◽  
Hans Bisgaard ◽  
...  
Keyword(s):  
De Novo ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Breastfeeding Duration ◽  
Large Individual ◽  
Environment Interaction ◽  
Primary Analysis ◽  
Interaction Coefficients ◽  
Individual Level ◽  
Z Scores

AbstractBackgroundAccumulating evidence suggests that breastfeeding benefits the children’s intelligence. Long-chain polyunsaturated fatty acids (LC-PUFAs) present in breast milk may explain part of this association. Under a nutritional adequacy hypothesis, an interaction between breastfeeding and genetic variants associated with endogenous LC-PUFAs synthesis might be expected. However, the literature on this topic is controversial.Methods and FindingsWe investigated this Gene×Environment interaction in a de novo meta-analysis involving >12,000 individuals in the primary analysis, and >45,000 individuals in a secondary analysis using relaxed inclusion criteria. Our primary analysis used ever breastfeeding, FADS2 polymorphisms rs174575 and rs1535 coded assuming a recessive effect of the G allele, and intelligence quotient (IQ) in Z scores. Using random effects meta-analysis, ever breastfeeding was associated with 0.17 (95% CI: 0.03; 0.32) higher Z scores in IQ, or about 2.1 points. There was no strong evidence of interaction, with pooled covariate-adjusted interaction coefficients (i.e., difference between genetic groups of the difference in IQZ scores comparing ever with never breastfed individuals) of 0.12 (95% CI: −0.19; 0.43) and 0.06 (95% CI: −0.16; 0.27) for the rs174575 and rs1535 variants, respectively. Secondary analyses corroborated these results. In studies with >5.85 and <5.85 months of breastfeeding duration, pooled estimates for the rs174575 variant were 0.50 (95% CI: −0.06; 1.06) and 0.14 (95% CI: −0.10; 0.38), respectively, and 0.27 (95% CI: −0.28; 0.82) and −0.01 (95% CI: −0.19; 0.16) for the rs1535 variant. However, between-group comparisons were underpowered.ConclusionsOur findings do not support an interaction between ever breastfeeding and FADS2 polymorphisms. However, our subgroup analysis raises the possibility that breastfeeding supplies LC-PUFAs requirements for cognitive development (if such threshold exists) if it lasts for some (currently unknown) time. Future studies in large individual-level datasets would allow properly powered subgroup analyses and would improve our understanding on the role of breastfeeding duration in the breastfeeding×FADS2 interaction.

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