Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Patient safety indicators (PSIs) are screening tools that use administrative data to identify potential complications of care and are being increasingly used as measures of hospital safety. It is unknown whether PSIs are related to standard quality metrics.
To examine the relationship between select PSIs and measures of hospital quality.
Design, Setting, and Participants
We used the 2003 MedPAR dataset to examine the performance of 4,504 acute-care hospitals on four medical PSIs among Medicare enrollees.
Main Outcome Measures
We used bivariate and multivariate techniques to examine the relationship between PSI performance and quality scores from the Hospital Quality Alliance program, risk-adjusted mortality rates, and selection as a top hospital by US News & World Report.
We found inconsistent and usually poor associations among the PSIs and other hospital quality measures with the exception of “failure to rescue,” which was consistently associated with better performance on all quality measures tested. For example, hospitals in the top quartile of failure to rescue performance had a 0.9% better summary performance score in acute myocardial infarction (AMI) processes and a 22% lower mortality rate in AMI compared to hospitals in the bottom quartile of failure to rescue (p < 0.01 for both comparisons). Death in low mortality DRG, decubitus ulcer, and infection due to medical care generally had poor or often inverse relationships with the other quality measures.
With the exception of failure to rescue, we found poor or inverse relationships between PSIs and other measures of healthcare quality. Whether the lack of relationship is due to the limitations of the PSIs is unknown, but suggests that PSIs need further validation before they are employed broadly.
- Kohn LT, Corrigan J, Donaldson M, eds. To Err is Human: Building a Safer Health Care System. In Washington, D.C.: National Academy Press: 1999.
- Brennan TA, Leape LL, Laird NM, et al.. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6.
- AHRQ Quality Indicators - Guide to Patient Safety Indicators. In Rockville, MD, Agency for Healthcare Research and Quality, 2003.
- Romano PS, Geppert JJ, Davies S, Miller MR, Elixhauser A, McDonald KM. A national profile of patient safety in U.S. hospitals. Health Aff (Millwood). 2003;22(2):154–66. CrossRef
- National Healthcare Quality Report, 2005. In Rockville, MD, AHRQ, 2005.
- Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290(14):1868–74. CrossRef
- HealthGrades Quality Study: Fourth Annual Patient Safety in American Hospitals Study. In 2007.
- Premier Hospital Quality Incentive Demonstration. In 2004.
- Thornlow DK, Stukenborg GJ. The association between hospital characteristics and rates of preventable complications and adverse events. Med Care. 2006;44(3):265–9. CrossRef
- Miller MR, Pronovost P, Donithan M, et al. Relationship between performance measurement and accreditation: implications for quality of care and patient safety. Am J Med Qual. 2005;20(5):239–52. CrossRef
- Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27. CrossRef
- AHRQ Quality Indicators - Guidance for Using the AHRQ Quality Indicators for Hospital-level Public Reporting or Payment. In Rockville, MD, AHRQ, 2004.
- United States Department of Health and Human Services: Hospital Compare. Availlable at: http://www.hospitalcompare.hhs.gov/
- Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals-the Hospital Quality Alliance program. N Engl J Med. 2005;353(3):265–74. CrossRef
- Kahn CN 3rd, Ault T, Isenstein H, Potetz L, Gelder SV. Snapshot of Hospital Quality Reporting and Pay-For-Performance Under Medicare. Health Aff (Millwood). 2006;25(1):149–62.
- Inpatient Quality Indicators - 3M™ APR™ DRG Limited License Grouper. In
- AHRQ Quality Indicators - Guide to Inpatient Quality Indicators: Quality of Care in Hospitals - Volume, Mortality, and Utilization. Rockville, MD, AHRQ, 02-RO204; 2002.
- Mcfarlane E, Murphy J, Olmsted MG, Drozd EM, Hill C. America’s Best Hospitals: 2006 Methodology.
- Zhan C, Miller MR. Administrative data based patient safety research: a critical review. Qual Saf Health Care. 2003;12(Suppl 2):ii58–ii63.
- Weingart SN, Iezzoni LI, Davis RB, et al. Use of administrative data to find substandard care: validation of the complications screening program. Med Care. 2000;38(8):796–806. CrossRef
- Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI. Identification of in-hospital complications from claims data. Is it valid? Med Care. 2000;38(8):785–95.
- Iezzoni LI. Finally present on admission but needs attention. Med Care. 2007;45(4):280–2. CrossRef
- McDonald KM, Davies SM, Geppert J, Romano PS. Why rescue the administrative data version of the “failure to rescue” quality indicator. Med Care. 2007;45(4):277–9. CrossRef
- Hsia DC, Krushat WM, Fagan AB, Tebbutt JA, Kusserow RP. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med. 1988;318(6):352–5.
- Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. Quality of care in U$S$ hospitals as reflected by standardized measures, 2002–2004. N Engl J Med. 2005;353(3):255–64. CrossRef
- Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?
Journal of General Internal Medicine
Volume 23, Issue 9 , pp 1373-1378
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient safety indicators (PSIs)
- hospital quality scores
- unsafe medical care
- Industry Sectors
- Author Affiliations
- 1. VA Boston Healthcare System, Boston, MA, USA
- 2. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
- 3. Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, USA