Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units

2015 ◽  
Vol 26 (6) ◽  
pp. 2951-2961 ◽  
Author(s):  
Vincent S Staggs
Keyword(s):  
Parametric Bootstrap ◽  
Adverse Outcomes ◽  
Hospital Quality ◽  
Quality Measure ◽  
Fall Rate ◽  
Nursing Unit ◽  
Injurious Falls ◽  
Fall Rates ◽  
Reliability Methods ◽  
Two Measures

The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes.

scholarly journals Comparison of the fall rate and structure of recent T-7 XBT manufactured by Sippican and TSK

2010 ◽  
Vol 7 (5) ◽  
pp. 1811-1847 ◽  
Author(s):  
S. Kizu ◽  
C. Sukigara ◽  
K. Hanawa
Keyword(s):  
Quadratic Form ◽  
Water Entry ◽  
Rate Coefficients ◽  
Fall Rate ◽  
Current Standard ◽  
Expendable Bathythermograph ◽  
Structural Differences ◽  
Fall Rates ◽  
The Difference ◽  
Temperature Depth

Abstract. The fall rate of recent T-7 expendable bathythermograph (XBT) is evaluated based on a series of concurrent measurement with a calibrated Conductivity Temperature Depth profiler (CTD) in the sea east of Japan. An emphasis is placed on comparing the fall rates of T-7 produced by the two present manufacturers, the Lockheed Martin Sippican Inc., and the Tsurumi Seiki Co. Ltd., which have been believed to be identical but had never been compared directly. It is found that the two manufacturers' T-7 fall at rates different by about 3.5%. The Sippican T-7 falls slower than the current standard equation by Hanawa et al. (1995) gives by about 2.1%, and the TSK T-7 falls faster than it tells by about 1.4%. The fall-rate coefficients estimated based on the present sea test by applying the equation of traditional quadratic form, d(t)=at−bt2 where d is depth in meters and t is the time elapsed, since the water entry of the probe, in seconds, are a=6.553 and b=0.00221 for the LMS T-7, and a=6.803 and b=0.00242 for the TSK T-7. By detail examination of the probes, it is revealed that the two companies' T-7 have different total weight and many structural differences. Because the difference in the fall rate is about twice larger than the difference in weight (about 2%), it is inferred that those structural differences give sizable impact to the difference in their fall rates. Our results clearly show that the recent T-7 of the two companies needs to be discriminated.

scholarly journals Comparison of the fall rate and structure of recent T-7 XBT manufactured by Sippican and TSK

Ocean Science ◽  
2011 ◽  
Vol 7 (2) ◽  
pp. 231-244 ◽  
Author(s):  
S. Kizu ◽  
C. Sukigara ◽  
K. Hanawa
Keyword(s):  
Quadratic Form ◽  
Rate Equation ◽  
Total Weight ◽  
Rate Coefficients ◽  
Fall Rate ◽  
Expendable Bathythermograph ◽  
Structural Differences ◽  
Fall Rates ◽  
The Difference ◽  
Temperature Depth

Abstract. The fall rate of recent T-7 expendable bathythermograph (XBT; 760 m) is evaluated based on a series of concurrent measurement with a calibrated Conductivity Temperature Depth profiler (CTD) in the sea east of Japan. An emphasis is placed on comparing the fall rates of T-7 produced by the two present manufacturers, the Lockheed Martin Sippican Inc., and the Tsurumi Seiki Co. Ltd., which have been believed to be identical but had never been compared directly. It is found that the two manufacturers' T-7 fall at rates different by about 3.5%. The Sippican T-7 falls slower than given by the fall-rate equation (FRE) of Hanawa et al. (1995) by about 2.1%, and the TSK T-7 falls faster by about 1.4%. The fall-rate coefficients estimated based on the sea test by applying the equation of traditional quadratic form, d(t)=at−bt2 where d is depth in meters and t is the time elapsed, in seconds, are a=6.553 (m s−1) and b=0.00221 (m s−2) for the LMS T-7, and a=6.803 (m s−1) and b=0.00242 (m s−2) for the TSK T-7. By detail examination of the probes, we found that the two companies' T-7 have different total weight and many structural differences. Because the difference in the fall rate is about twice larger than the difference in weight (about 2%), it is inferred that the structural differences give sizable impact to the difference in their fall rates. Our results clearly show that the recent T-7 of the two companies needs to be discriminated.

Good Catch! Using Interdisciplinary Teams and Team Reflexivity to Improve Patient Safety

2018 ◽  
Vol 43 (3) ◽  
pp. 414-439 ◽  
Author(s):  
Roni Reiter-Palmon ◽  
Victoria Kennel ◽  
Joseph Allen ◽  
Katherine J. Jones
Keyword(s):  
Patient Safety ◽  
Fall Risk ◽  
Improve Patient Safety ◽  
Interdisciplinary Teams ◽  
Innovation Implementation ◽  
Practical Applications ◽  
Team Innovation ◽  
Safety Outcome ◽  
Injurious Falls ◽  
Fall Rates

Interdisciplinary teams play an important role implementing innovations that facilitate the quality and safety of patient care. This article examined the role of reflexivity in team innovation implementation and its association with an objective patient safety outcome, inpatient fall rates (a fall is an unintended downward displacement of a patient’s body to the ground or other object). In this study, we implemented, supported, and evaluated interdisciplinary teams intended to decrease fall risk in 16 small rural hospitals. These hospitals were part of a collaborative that sought to increase knowledge and facilitate reflexivity about fall event reporting and fall risk reduction structures and processes. We assessed team reflexivity at the start and at the end of the 2-year intervention and innovation implementation at the end of the intervention. The 16 hospitals reported objective fall event data and patient days throughout the project, which we used to calculate comparative rates for assisted, unassisted, and injurious falls. The results suggest that teams benefited from the intervention, increasing reflexivity from the start of the project to the end, which was related to innovation implementation and decreases in fall rates. Theoretical and practical applications of the results are discussed.

scholarly journals Changing Expendable Bathythermograph Fall Rates and Their Impact on Estimates of Thermosteric Sea Level Rise

2008 ◽  
Vol 21 (21) ◽  
pp. 5657-5672 ◽  
Author(s):  
Susan E. Wijffels ◽  
Josh Willis ◽  
Catia M. Domingues ◽  
Paul Barker ◽  
Neil J. White ◽  
...  
Keyword(s):  
Sea Level Rise ◽  
Sea Level ◽  
Decadal Variability ◽  
Heat Content ◽  
Time History ◽  
Global Ocean ◽  
Fall Rate ◽  
Rate Minimum ◽  
Fall Rates

Abstract A time-varying warm bias in the global XBT data archive is demonstrated to be largely due to changes in the fall rate of XBT probes likely associated with small manufacturing changes at the factory. Deep-reaching XBTs have a different fall rate history than shallow XBTs. Fall rates were fastest in the early 1970s, reached a minimum between 1975 and 1985, reached another maximum in the late 1980s and early 1990s, and have been declining since. Field XBT/CTD intercomparisons and a pseudoprofile technique based on satellite altimetry largely confirm this time history. A global correction is presented and applied to estimates of the thermosteric component of sea level rise. The XBT fall rate minimum from 1975 to 1985 appears as a 10-yr “warm period” in the global ocean in thermosteric sea level and heat content estimates using uncorrected data. Upon correction, the thermosteric sea level curve has reduced decadal variability and a larger, steadier long-term trend.

Pediatric Readmissions as a Hospital Quality Measure

JAMA ◽  
2013 ◽  
Vol 309 (4) ◽  
pp. 396 ◽  
Author(s):  
Rajendu Srivastava ◽  
Ron Keren
Keyword(s):  
Hospital Quality ◽  
Quality Measure

scholarly journals Reducing Fall Among Acute Rehabilitation Patients Through Implementation of a Video Monitoring System

2021 ◽  
Author(s):  
◽  
Priscila Alfonso
Keyword(s):  
Improve Patient Safety ◽  
Clinical Care ◽  
Video Monitoring ◽  
Fall Rate ◽  
Practice Recommendation ◽  
Practice Problem ◽  
Fall Rates ◽  
Continuous Use ◽  
Acute Rehabilitation ◽  
Improve Patient

Practice Problem: Falls are a significant healthcare issue that leads to substantial patient suffering and exorbitant health care expense. The Centers for Medicare and Medicaid Services (CMS) identify falls as preventable and not eligible for reimbursement. PICOT: The PICOT question that guided this project was: for acute rehabilitation inpatients (P), will the continuous use of video monitoring (VM) (I) compared to using bed alarms (C), decrease the fall rate by 10% (O) within six weeks of implementation (T)? Evidence: The practice recommendation for using a VM system as a primary intervention or part of a multifactorial comprehensive fall prevention strategy was recommended in the literature to improve patient safety and outcomes. Intervention: VM surveillance was used to decrease the prevalence of falls in moderate to high fall risk traumatic brain injury (TBI) patients on a rehabilitation unit. VM technicians verbally refocused patients and quickly alerted staff to potential falls. Outcome: The intervention achieved a 49% reduction in the hospital fall rate per 1,000 patient days, 65% in the rehabilitation fall rate per 1,000 patient days, 100% reduction in the TBI fall rate per 1,000 patient days, and a 30% reduction in cost for 1:1 sitter. Conclusion: This clinical project demonstrated support for the use of live VM surveillance to decrease fall rates on a TBI unit. As a result, this evidence-based project (EBP) project was recognized as improving the organization's clinical care.

scholarly journals Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment Models

2021 ◽  
Vol 4 (5) ◽  
pp. e218512
Author(s):  
Elizabeth W. Triche ◽  
Xin Xin ◽  
Sydnie Stackland ◽  
Danielle Purvis ◽  
Alexandra Harris ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Hospital Quality ◽  
Quality Measure ◽  
Medicare Claims ◽  
Present On Admission

scholarly journals Improved Processing Speed Is a Potential Mechanism by Which Exercise Reduces Falls

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 235-235
Author(s):  
Teresa Liu-Ambrose ◽  
Jennifer Davis ◽  
Ryan Falck ◽  
Karim Khan
Keyword(s):  
Processing Speed ◽  
Exercise Program ◽  
Digit Symbol ◽  
Potential Mechanism ◽  
Mediation Analyses ◽  
Injurious Falls ◽  
Home Based ◽  
Injurious Fall ◽  
Fall Rates ◽  
Significant Mediator

Abstract A 12-month trial demonstrated the Otago Exercise Program (OEP), a home-based exercise program of strength and balance retraining exercises, significantly reduced the rate of subsequent falls among 344 older adults receiving care after a fall (JAMA, 2019). A significant improvement in processing speed, as measured by the Digit Symbol Substitute Test (DSST), was also observed. Given the DSST is a predictor of falls, we conducted mediation analyses to determine whether improved DSST mediated the effects of OEP on rate of: 1) total falls; 2) non-injurious falls; 3) mild injurious falls; and 4) severe injurious falls over the 12-month trial. Our causal mediation analyses were conducted using the mediation package in R, using quasi-Bayesian estimates and 95% confidence intervals. Compared with usual care, OEP significantly reduced the rate of total falls (IRR= 0.64; 95% CI: 0.44, 0.91; p= 0.013) and mild injurious falls (IRR= 0.49; 95% CI: 0.31, 0.77; p= 0.002). Improved DSST score was also associated with lower mild injurious fall rates (IRR= 0.95; 95% CI: [0.91, 0.99]; p= 0.014). Formal mediation analyses showed that improved DSST was a significant mediator of the effect of OEP on the rate of mild injurious falls (95% CI: -0.15, 0.00; p= 0.036). Improved processing speed may be a mechanism by which exercise reduces mild injurious falls.

A National Comparison of Rural/Urban Pressure Ulcer and Fall Rates

2017 ◽  
Vol 22 (2) ◽  
Author(s):  
Marianne Baernholdt ◽  
Ivora Hinton ◽  
Guofen Yan ◽  
Wenjun Xin ◽  
Emily Cramer ◽  
...  
Keyword(s):  
National Database ◽  
Urban Hospital ◽  
Nursing Unit ◽  
Rural And Urban ◽  
Care Processes ◽  
Hospital Acquired Conditions ◽  
National Comparison ◽  
Fall Rates ◽  
Hospital Acquired ◽  
Nursing Quality

Despite recent decline in hospital acquired conditions (HACs), rates for pressure ulcers (PURs) and falls (FRs) remain at levels that require improvement. Contextual factors and care processes may impact HACs. Using the National Database of Nursing Quality Indicators (NDNQI®) this study examined differences in care processes and community, hospital, and nursing unit characteristics that influence PURs and FRs in 4238 rural and urban nursing units. This article reports on the study methods, noting results that demonstrated differences across all characteristics. The discussion considers the findings and implications in the context of rural or urban location. Many areas identified may be useful to implement multilevel improvement strategies tailored specifically to a rural or urban hospital.

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