Examining the Impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration

Rosen, Amy K.; Loveland, Susan; Shin, Marlena; Shwartz, Michael; Hanchate, Amresh; Chen, Qi; Kaafarani, Haytham M.A.; Borzecki, Ann M.

doi:10.1097/mlr.0b013e318270c0f7

Cited by 53 publications

(54 citation statements)

References 29 publications

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“…These may contribute to the huge variation in conclusions with regard to the validity of readmission rates found in the literature. Different studies in different patient groups and conditions come to the conclusion that lower quality of hospital care is linked to a higher number of readmissions [71]–[94]. Especially safety-related events (such as postoperative complications) show a relation with readmissions [71], [95].…”

Section: Resultsmentioning

confidence: 99%

Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

et al. 2014

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Introduction Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care.Methods We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013.Results The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity.ConclusionsAlthough readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.

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Section: Resultsmentioning

confidence: 99%

Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

et al. 2014

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“…We propose that the higher rate of mortality after a patient safety event may partially explain the higher overall mortality noted after a weekend admission [1]. In addition to mortality, others have shown increased risk of readmission [30] and increased cost [31] for those patients who experience a patient safety event. Thus, efforts to reduce these safety events would theoretically reduce its consequences on readmission, cost, and mortality.…”

Section: Discussionmentioning

confidence: 97%

Do patient safety indicators explain increased weekend mortality?

Ricciardi

Nelson

Francone

et al. 2016

Journal of Surgical Research

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“…Since we were interested in how the PPR measure potentially improves upon the CMS all-cause pneumonia readmission measure, we used CMS methods, as described in previous work, to identify all VA acute index discharges with a principal diagnosis of pneumonia during FY07 through FY10 associated with a VA readmission within 30 days 4 16. Although the PPR measure also excludes certain admissions as ineligible because they require “follow-up care that is intrinsically clinically complex and …preventability is difficult to assess” (eg, admissions for ‘major or metastatic malignancy’),8 we retained these PPR-ineligible cases to be consistent with CMS methods, which include these cases.…”

Section: Methodsmentioning

confidence: 99%

Do pneumonia readmissions flagged as potentially preventable by the 3M PPR software have more process of care problems? A cross-sectional observational study

Borzecki¹,

Chen

Restuccia

et al. 2015

BMJ Qual Saf

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BackgroundIn the USA, administrative data-based readmission rates such as the Centers for Medicare and Medicaid Services’ all-cause readmission measures are used for public reporting and hospital payment penalties. To improve this measure and identify better quality improvement targets, 3M developed the Potentially Preventable Readmissions (PPRs) measure. It matches clinically related index admission and readmission diagnoses that may indicate readmissions resulting from admission- or post-discharge-related quality problems.ObjectiveTo examine whether PPR software-flagged pneumonia readmissions are associated with poorer quality of care.MethodsUsing a retrospective observational study design and Veterans Health Administration (VA) data, we identified pneumonia discharges associated with 30-day readmissions, and then flagged cases as PPR–yes or PPR–no using the PPR software. To assess quality of care, we abstracted electronic medical records of 100 random readmissions using a tool containing explicit care processes organised into admission work-up, in-hospital evaluation/treatment, discharge readiness and post-discharge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases by total and section-specific mean scores using t tests and effect size (ES) to characterise the clinical significance of findings.ResultsOur abstraction sample was selected from 11 278 pneumonia readmissions (readmission rate=16.5%) during 1 October 2005–30 September 2010; 77% were flagged as PPR–yes. Contrary to expectations, total and section mean quality scores were slightly higher, although non-significantly, among PPR–yes (N=77) versus PPR–no (N=23) cases (respective total scores, 71.2±8.7 vs 65.8±11.5, p=0.14); differences demonstrated ES >0.30 overall and for admission work-up and post-discharge period sections.ConclusionsAmong VA pneumonia readmissions, PPR categorisation did not produce the expected quality of care findings. Either PPR–yes cases are not more preventable, or preventability assessment requires other data collection methods to capture poorly documented processes (eg, direct observation).

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Examining the Impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration

Abstract: Our results suggest that interventions that focus on minimizing preventable inpatient safety events as well as improving coordination of care between and across settings may decrease the likelihood of readmission.

Cited by 53 publications

References 29 publications

Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

Do patient safety indicators explain increased weekend mortality?

Do pneumonia readmissions flagged as potentially preventable by the 3M PPR software have more process of care problems? A cross-sectional observational study

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