Eugene Wen

Canadian Institute for Health Information, Ottawa, Ontario, Canada

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Publications (7)9.63 Total impact

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    ABSTRACT: In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used.
    Revue d Épidémiologie et de Santé Publique 09/2011; 59(5):341-50. · 0.69 Impact Factor
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    ABSTRACT: To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ). A retrospective cross-sectional study. Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006. Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat. Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821-0.966). However, there was substantial systematic variation in rates across countries. This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. 'birth trauma', 'complications of anesthesia') may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine databases.
    International Journal for Quality in Health Care 04/2009; 21(4):272-8. · 1.79 Impact Factor
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    Greg Webster, Eugene Wen
    Canadian Medical Association Journal 12/2008; 179(10):1036-7; author reply 1037. · 6.47 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 04/2008; 56(1):33-33. · 0.69 Impact Factor
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    ABSTRACT: In 2005, the Canadian Institute for Health Information (CIHI) began a methodological journey to develop a Canadian version of the hospital standardized mortality ratio (HSMR). For two years, CIHI worked with hospitals, regional authorities and measurement experts to define the most appropriate methodology given Canadian datasets and systems of care. In November 2007, we made the findings publicly available for regional health authorities and larger facilities. In their lead article, Penfold et al. discuss their views regarding some methodological issues and potential limitations of the HSMR to monitor quality of care and, in particular, as a patient safety indicator. Here we respond to their specific concerns and maintain that the HSMR remains an important tool in the arsenal of information hospitals can use to focus the discussion of patient safety/quality improvement, monitor the provision of care over time and identify opportunities for improvement.
    HealthcarePapers 02/2008; 8(4):26-36; discussion 69-75.
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    ABSTRACT: Objective: The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSIs) for use with ICD-9-CM data. Many countries have adopted ICD-10 for coding hospital diagnoses. We conducted this study to develop an internationally harmonized ICD-10 coding algorithm for the AHRQ PSIs. Methods: The AHRQ PSI Version 2.1 has been translated into ICD-10-AM (Australian Modification), and PSI Version 3.0a has been independently translated into ICD-10-GM (German Modification). We converted these two country-specific coding algorithms into ICD-10-WHO (World Health Organization version) and combined them to form one master list. Members of an international expert panel—including physicians, professional medical coders, disease classification specialists, health services researchers, epidemiologists, and users of the PSI—independently evaluated this master list and rated each code as either “include,” “exclude,” or “uncertain,” following the AHRQ PSI definitions. After summarizing the independent rating results, we held a face-to-face meeting to discuss codes for which there was no unanimous consensus and newly proposed codes. A modified Delphi method was employed to generate a final ICD-10 WHO coding list. Results: Of 20 PSIs, 15 that were based mainly on diagnosis codes were selected for translation. At the meeting, panelists discussed 794 codes for which consensus had not been achieved and 2,541 additional codes that were proposed by individual panelists for consideration prior to the meeting. Three documents were generated: a PSI ICD-10-WHO version-coding list, a list of issues for consideration on certain AHRQ PSIs and ICD-9-CM codes, and a recommendation to WHO to improve specification of some disease classifications. Conclusion: An ICD-10-WHO PSI coding list has been developed and structured in a manner similar to the AHRQ manual. Although face validity of the list has been ensured through a rigorous expert panel assessment, its true validity and applicability should be assessed internationally.
    Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment), Edited by Kerm Henriksen, James B Battles, Margaret A Keyes, Mary L Grady, 01/2008; Agency for Healthcare Research and Quality.
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    ABSTRACT: Caesarean section rates have risen in recent years, sparking renewed debate about the circumstances under which such deliveries are being, and should be, performed. Some commentators suggest that increasing rates may, in part, be explained by women in higher-income brackets requesting elective caesareans (the so-called "too posh to push" hypothesis). After adjusting for maternal age, Canadian data do not support this theory. In fact, age-adjusted caesarean section rates were significantly lower in Canada's highest-income neighbourhoods than in the lowest-income areas in 2002-03.
    Healthcare policy = Politiques de sante 10/2005; 1(1):48-54.