The Association Between Hospital Characteristics and Rates of Preventable Complications and Adverse Events

Thornlow, Deirdre; Stukenborg, George J.

doi:10.1097/01.mlr.0000199668.42261.a3

Cited by 67 publications

(48 citation statements)

References 24 publications

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“…4,9,10 Although our study was not designed to validate whether PSIs measure hospital safety or accurately capture adverse events, our findings heighten existing concerns regarding the use of PSIs as a safety measurement tool. A critical review of the use of administrative data for public reporting previously concluded that it is uncertain whether differences in PSI rates among hospitals reflect actual lower complication rates in hospitals.…”

Section: Discussionmentioning

confidence: 72%

“…8 Although validation studies of PSIs are ongoing, the few studies that have examined whether PSI performance is related to other measures of hospital quality have shown inconsistent relationships. 4,9,10 Given the increasing demands to grade hospital performance, we sought to determine whether the medical PSIs were related to widely used measures of have quality: process measures of care used by the Hospital Quality Alliance (HQA); in-hospital risk-adjusted mortality for common medical conditions; and selection as "America's Best" by the US News rating system. This information can help payers, policy makers, consumers, and others who use these data for hospital comparisons understand whether these metrics identify similar top-performing institutions.…”

Section: Introductionmentioning

confidence: 99%

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Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Isaac

Jha

2008

J GEN INTERN MED

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CONTEXT: 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.OBJECTIVE: 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. RESULTS: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. CONCLUSIONS: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.KEY WORDS: patient safety indicators (PSIs); hospital quality scores; unsafe medical care.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Isaac

Jha

2008

J GEN INTERN MED

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“…On the other hand, others have also reported no difference or worse outcomes at academic institutions. [25][26][27][28][29] However, the lack of multivariable adjustment may have precluded these findings. To the best of our knowledge, only two studies reported improved specific outcomes in academic institutions after multivariable adjustment.…”

Section: Discussionmentioning

confidence: 97%

Impact of academic affiliation on radical cystectomy outcomes in

Bianchi¹,

Trinh

Sun

et al. 2013

CUAJ

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Background: The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC). Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion. Results: Overall, 12 262 patients underwent RC. Of those, 7892 (64.4%) were from academic institutions. Patients treated at academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an academic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003). Interpretation: Even after adjusting for AHC, RCs performed at academic institutions are associated with better postoperative outcomes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of complications and prolonged length of stay.

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“…Although teaching hospitals treat more seriously ill patients, the risk-adjusted mortality of teaching hospitals has been reported to be less than that of non-teaching hospitals [3][4][5]. Teaching hospitals with higher teaching intensity have been shown to perform better in terms of patient safety [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan

Sato

Fushimi

2012

Health Policy

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The Association Between Hospital Characteristics and Rates of Preventable Complications and Adverse Events

Abstract: Hospital ownership and teaching status is not a consistent predictor of differences in rates of potentially preventable adverse events, and these characteristics explain little of the observed variation in the rates of these events across hospitals.

Cited by 67 publications

References 24 publications

Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Impact of academic affiliation on radical cystectomy outcomes in

Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan

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