Patient safety indicators for England from hospital administrative data: case-control analysis and comparison with US data

Abstract

, head of analysis and feedback unit 3 ABSTRACT Objective To assess the feasibility of deriving patient safety indicators for England from routine hospital data and whether they can indicate adverse outcomes for patients. Design Nine patient safety indicators developed by the United States Agency for Healthcare Research and Quality (AHRQ) were derived using hospital episode statistics for England for 2003-4, 2004-5, and 2005-6. A case-control analysis was undertaken to compare length of stay and mortality between cases (patients experiencing the particular safety event measured by an indicator) and controls matched for age, sex, health resource group (standard groupings of clinically similar treatments that use similar levels of healthcare resource), main specialty, and trust. Comparisons were undertaken with US data. Setting All NHS trusts in England. Participants Inpatients in NHS trusts. Results There was fair consistency in national rates for the nine indicators across three years. For all but one indicator, hospital stays were longer in cases than in matched controls (range 0.2-17.1 days, P<0.001). Mortality in cases was also higher than in controls (5.7-27.1%, P<0.001), except for the obstetric trauma indicators. Excess length of stay and mortality in cases was greatest for postoperative hip fracture and sepsis. England's rates were lower than US rates for these indicators. Increased length of stay in cases was generally greater in England than in the US. Excess mortality was also higher in England than in the US, except for the obstetric trauma indicators where there were few deaths in both countries. Differences between England and the US in excess length of stay and mortality were most marked for postoperative hip fracture. Conclusions Hospital administrative data provide a potentially useful low burden, low cost source of information on safety events. Indicators can be derived with English data and show that cases have poorer outcomes than matched controls. These data therefore have potential for monitoring safety events. Further validation, for example, of individual cases, is needed and levels of event recording need to improve. Differences between England and the US might reflect differences in the depth of event coding and in health systems and patterns of healthcare provision.

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

“…We lacked current data; however, PSI and readmission rates have remained relatively stable over time, suggesting that use of more recent data would not have affected our results. [39][40][41][42] In addition, use of administrative data is always subject to coding inaccuracies. For example, some PSI events were likely to be present on admission, and some of the conditions that were incorporated as comorbidities could have been complications of care.…”

Indicadores de segurança do paciente para hospitais de pacientes agudos: revisão sistemática

“…Juntos, os três projetos desenvolveram um total de 44 indicadores de segurança, 13 dos quais são originários do estudo da AHRQ e foram selecionados pela OECD e pelo projeto SimPatIE (Tabela 5). Após o desenvolvimento, os 20 PSI da AHRQ têm sido os mais estudados, utilizados em pesquisas, relatos públicos e comparações entre hospitais 3,4 . Resultados preliminares do teste sobre a validade de critério de cinco PSI 42 mostram variações nos seus valores preditivos positivos (percentual de casos identificados que realmente apresentam o evento) (Tabela 5).…”

“…Estudos em hospitais de vários países mostram a associação entre a ocorrência de eventos adversos, incidentes que ocasionam danos aos pacientes 2 , e o aumento do tempo de permanência, da mortalidade e do gasto hospitalar 3,4 . Estimativas dos países desenvolvidos indicam que pelo menos 5% dos pacientes admitidos em hospitais contraem uma infecção 1 .…”

Misadventures to patients during surgical and medical care in England and Wales: an analysis of deaths and hospital episodes

“…As an indicator of healthcare quality, routine data offer high specificity but low sensitivity 4 and the coverage of external cause coding within HES data is known to be low. 13 Large numbers of false-negatives may therefore lead to artificially low estimated rates.…”

“…4,5 Our aim was to explore the incidence of injury due to misadventures during surgical and medical care in England and Wales by age and to examine recent trends.…”