1 / 17

VALIDATING AHRQ PATIENT SAFETY INDICATORS with the VA NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM POSTOPERATIVE ADVERS

VALIDATING AHRQ PATIENT SAFETY INDICATORS with the VA NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM POSTOPERATIVE ADVERSE EVENTS. Dennis Tsilimingras, M.D., M.P.H. Center for Health Quality, Outcomes, & Economic Research (Bedford VAMC) Boston University School of Public Health.

marlee
Download Presentation

VALIDATING AHRQ PATIENT SAFETY INDICATORS with the VA NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM POSTOPERATIVE ADVERS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. VALIDATING AHRQ PATIENT SAFETY INDICATORS with the VA NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM POSTOPERATIVE ADVERSE EVENTS Dennis Tsilimingras, M.D., M.P.H. Center for Health Quality, Outcomes, & Economic Research (Bedford VAMC) Boston University School of Public Health

  2. Co-Investigators • Patrick Romano, M.D., M.P.H.3, William Henderson, Ph.D.4,Peter Rivard, M.H.S.A.1,2,Susan Loveland, M.A.T.1,2,Shibei Zhao, M.P.H.1,2, Cindy Christiansen, Ph.D.1,2,Anne Elixhauser, Ph.D.5,Shukri Khuri, M.D.6, Amy K. Rosen, Ph.D.1,2 • 1Center for Health Quality, Outcomes, & Economic Research (Bedford VAMC) • 2Boston University School of Public Health • 3University of California at Davis • 4NSQIP Denver Data Analysis Center • 5Agency for Healthcare Research and Quality • 6Surgical Service, VA Boston Healthcare System Funding Organization: Department of Veterans Affairs HSR&D Project IIR 02-144-1

  3. Introduction • Patient Safety Indicators (PSIs): - developed by the UC-Stanford and AHRQ collaboration - purpose to screen for potential safety problems using ICD-9-CM codes - limitation: PSIs have not been validated in the past

  4. Research Objectives • To validate the AHRQ PSIs with postoperative adverse events in the VA National Surgical Quality Improvement Program (NSQIP). • To test alternative PSI definitions based on clinical information from NSQIP for the purpose of future refinement of the PSIs.

  5. Methods AHRQNSQIP Accepted PSIs:Postoperative Adverse Events: (1) Postoperative Sepsis (1) Systemic Sepsis (2) Postoperative Respiratory (2) Unplanned Intubation for Failure Respiratory Failure or Failure to Wean from Ventilator > 48hrs (3) Postoperative Pulmonary (3) Deep Vein Thrombosis Embolism or Deep Vein & Pulmonary Embolism Thrombosis (4) Postoperative Wound (4) Dehiscence Dehiscence (5) Postoperative Physiologic (5) Acute Renal Failure and Metabolic Derangements

  6. MethodsStudy Sample • VA administrative inpatient data from the Patient Treatment File (PTF): - from 130 VA hospitals - matched with NSQIP chart-abstracted records - FY 2001 (10/00 – 09/01) from both data sources

  7. Methods • NSQIP: - purpose is to provide reliable, valid, and comparative information regarding morbidity & mortality to all VA medical centers - employs trained nurse data collectors - collects preoperative patient characteristics and 30-day postoperative outcomes

  8. Methods • A hospitalization had a PSI if it met AHRQ’s administrative data definition that includes ICD-9-CM diagnostic and procedure codes. • A hospitalization had a NSQIP event if it met NSQIP’s clinical definition which was translated into ICD-9-CM diagnostic and procedure codes. • Our alternative definition was based on a translation of NSQIP clinical definitions into ICD-9-CM diagnostic & procedure codes.

  9. Methods • Using NSQIP as the “gold standard”: - measured the sensitivity & positive predictive value of “all” 5 AHRQ PSIs - using the current AHRQ PSI definition - compared with the best alternative PSI definition • These definitions were developed using PTF data and validated with NSQIP medical chart-abstracted data.

  10. Postoperative Respiratory Failure ICD-9-CM Definitions Diagnostic codes Procedure Codes AHRQ 518.81 & 518.84 NSQIP 518.5 96.04 & 96.70-96.72 Alternative 518.5, 518.81, & 96.04 & 96.70-96.72 518.84

  11. ResultsSample • 561,436 inpatient hospitalizations (PTF) • 101,548 with surgical Diagnostic Related Groups • 55,752 were matched with NSQIP data, which were used to calculate sensitivities and positive predictive values

  12. Results Sensitivity(%) PPV(%) Current AHRQ PSI Definition 32 44 Alternative PSI Definition (NSQIP) 37 45 Accepted PSIs: (1) Postoperative Sepsis (12,011 hospitalizations) (2) Postoperative Respiratory failure* (24,273 hospitalizations) *PSI includes diagnostic and procedure codes. Sensitivity(%) PPV(%) Current AHRQ PSI Definition 19 74 Alternative PSI Definition (NSQIP) 67 66

  13. Results (3) Postoperative Pulmonary Embolism or Deep Vein Thrombosis* (55,682 hospitalizations) (4) Postoperative Wound Dehiscence* (16,904 hospitalizations) *PSI includes diagnostic and procedure codes. Sensitivity(%) PPV(%) Current AHRQ PSI Definition 56 22 Alternative PSI Definition (NSQIP) 58 22 Sensitivity(%) PPV(%) Current AHRQ PSI Definition 29 72 Alternative PSI Definition (NSQIP) 61 57

  14. Results (5) Postoperative Physiologic and Metabolic Derangements* (27,722 hospitalizations) *PSI includes diagnostic and procedure codes. Sensitivity(%) PPV(%) Current AHRQ PSI Definition 44 54 Alternative PSI Definition (NSQIP) 48 63

  15. Results AHRQ PSI Our Results Best et al 2002 Results† Sens(%)PPV(%) Sens(%)PPV(%) Sepsis 37 45 40 29 Respiratory Failure 67 66 9 52 PE or DVT 58 22 PE 49 48 DVT 12 18 Dehiscence 61 57 25 23 Physiologic & Metabolic Derangements 48 63 16 4 Comparing our results with Best and colleagues. †Best et al. Identifying Patient Preoperative Risk Factors & Postoperative Adverse Events in Administrative Databases: Results from NSQIP. J Am Coll Surg. 2002;194:257-266.

  16. Conclusions • NSQIP clinical data are an excellent source for examining the validity of administrative-data-based indicators, such as the PSIs, as identifiers of potential inpatient surgical patient safety events. • All 5 PSIs were improved by a simple modification to perform better in the VA.

  17. Significance • PSIs may be a useful screening tool for identifying inpatient safety events that warrant further investigation. • Such a tool can be constructed with the incorporation of clinical data definitions to administrative data definitions. • The latest release of the AHRQ PSI software has incorporated certain findings from this study.

More Related