Validity of Selected AHRQ Patient Safety Indicators Based on VA National Surgical Quality Improvement Program Data

UC Davis Division of General Medicine and Center for Healthcare Policy and Research, 4150 V Street, PSSB Suite 2400, Sacramento, CA 95817, USA.
Health Services Research (Impact Factor: 2.78). 10/2008; 44(1):182-204. DOI: 10.1111/j.1475-6773.2008.00905.x
Source: PubMed


To examine the criterion validity of the Agency for Health Care Research and Quality (AHRQ) Patient Safety Indicators (PSIs) using clinical data from the Veterans Health Administration (VA) National Surgical Quality Improvement Program (NSQIP).
Fifty five thousand seven hundred and fifty two matched hospitalizations from 2001 VA inpatient surgical discharge data and NSQIP chart-abstracted data.
We examined the sensitivities, specificities, positive predictive values (PPVs), and positive likelihood ratios of five surgical PSIs that corresponded to NSQIP adverse events. We created and tested alternative definitions of each PSI.
FY01 inpatient discharge data were merged with 2001 NSQIP data abstracted from medical records for major noncardiac surgeries.
Sensitivities were 19-56 percent for original PSI definitions; and 37-63 percent using alternative PSI definitions. PPVs were 22-74 percent and did not improve with modifications. Positive likelihood ratios were 65-524 using original definitions, and 64-744 using alternative definitions. "Postoperative respiratory failure" and "postoperative wound dehiscence" exhibited significant increases in sensitivity after modifications.
PSI sensitivities and PPVs were moderate. For three of the five PSIs, AHRQ has incorporated our alternative, higher sensitivity definitions into current PSI algorithms. Further validation should be considered before most of the PSIs evaluated herein are used to publicly compare or reward hospital performance.

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Available from: Patrick S Romano, Oct 01, 2015
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    • "g fusion surgery has not been rigorously validated through a comparison of chart reviews . However , readmission , infections , mortality , and life - threaten - ing complications are part of the National Surgical Quality Improvement Program ( NSQIP ) , which has been used as the gold standard to improve the validity of patient safety indicators ( Romano et al . 2009 ) . Furthermore , our estimates for repeat surgery and mortality following fusion surgery are similar to those reported in both administrative and clinical studies ( Malter et al . 1998 ; Martin et al . 2007 , 2011 ; Juratli et al . 2009 ) . Future research efforts should focus on the validation and improvement of claims - based methods"
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    • "Consistent with previous work [14,15,24], we evaluated the effects of potentially confounding factors, i.e., race, insurance status, hospital surgical volume, obesity, bi-laterality (two primary procedures during the same surgery), chronic kidney disease, and hypercoagulable state (including cancer and genetic predisposition), by adding them, one at a time, to the crude model (with comorbidity exposure, age group, and sex). If the addition of a given factor did not change the odds ratios for the comorbidity exposure by more than 10%, it was deleted from the final model. "
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