The authors estimated the impact of potentially preventable patient safety events, identi- fied by Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs), on patient outcomes: mortality, length of stay (LOS), and cost. The PSIs were applied to all acute inpatient hospitalizations at Veterans Health Administration (VA) facil- ities in fiscal 2001. Two methods—regression analysis and multivariable case matching— were used independently to control for patient and facility characteristics while predicting the effect of the PSI on each outcome. The authors found statistically significant (p < .0001) excess mortality, LOS, and cost in all groups with PSIs. The magnitude of the excess varied considerably across the PSIs. These VA findings are similar to those from a previously published study of nonfederal hospitals, despite differences between VA and non-VA systems. This study contributes to the literature measuring outcomes of medical errors and provides evidence that AHRQ PSIs may be useful indicators for comparison across delivery systems.
Agency for Healthcare Research and Quality. ( 2002). Technical review—Measures of patient safety based on hospital administrative data: The patient safety indicators (02-0038). Retrieved July 24, 2007, from http://www.ahrq.gov/clinic/tp/hospdatp.htm
2.
Agency for Healthcare Research and Quality. ( 2003). Patient safety indicators SAS software documentation, Version 2.1 Rev 1. Rockville, MD: Author.
3.
Agency for Healthcare Research and Quality. ( 2005). Guide to patient safety indicators, Version 2.1 Rev. 3, January 2005. Retrieved May 10, 2005, from http://www.qualityindicators.ahrq.gov/psi_download.htm
4.
Allareddy, V., & Konety, B.R. (2006). Characteristics of patients and predictors of in-hospital mortality after hospitalization for head and neck cancers. Cancer, 106(11), 2382-2388.
5.
Asch, S.M., McGlynn, E.A., Hogan, M.M., Hayward, R.A., Shekelle, P., Rubenstein, L., et al. (2004). Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Annals of Internal Medicine, 141(12), 938-945.
6.
Baldwin, L.M., MacLehose, R.F., Hart, L.G., Beaver, S.K., Every, N., & Chan, L. (2004). Quality of care for acute myocardial infarction in rural and urban US hospitals. Journal of Rural Health, 20(2), 99-108.
7.
Barnett, P.G. (2003). Determination of VA health care costs. Medical Care Research and Review, 60(3 Suppl.), 124S-141S.
8.
Bates, D.W., Miller, E.B., Cullen, D.J., Burdick, L., Williams, L., Laird, N., et al. (1999). Patient risk factors for adverse drug events in hospitalized patients. Archives of Internal Medicine, 159(21), 2553-2560.
9.
Bates, D.W., Spell, N., Cullen, D.J., Burdick, E., Laird, N., Petersen, L.A., et al. (1997). The costs of adverse drug events in hospitalized patients. Journal of theAmerican Medical Association, 277(4), 307-311.
10.
Berlowitz, D.R., Brandeis, G.H., Anderson, J.J., Ash, A.S., Kader, B., Morris, J.N., et al. (2001). Evaluation of a risk-adjustment model for pressure ulcer development. Journal of the American Geriatrics Society, 49(7), 872-876.
11.
Birkmeyer, J.D., Siewers, A.E., Finlayson, E.V., Stukel, T.A., Lucas, F.L., Batista, I., et al. (2002). Hospital volume and surgical mortality in the United States. New England Journal of Medicine, 346(15), 1128-1137.
12.
Birkmeyer, J.D., Stukel, T.A., Siewers, A.E., Goodney, P.P., Wennberg, D.E., & Lucas, L. (2003). Surgeon volume and operative mortality in the United States. New England Journal of Medicine, 349(22), 2117-2127.
13.
Boehmer, U., Kressin, N.R., Berlowitz, D.R., Christiansen, C.L., Kazis, L.E., & Jones, J.A. (2002). Self-reported vs. administrative race/ethnicity data and study results. American Journal of Public Health , 92(9), 1471-1473.
14.
Campbell, R.R., Bradham, D.D., Sanchez-Anguiano, A., Werner, D.H., Spehar, A.M., French, D., et al. (2005). Developing a Veterans Health Administration (VHA) serious injury surveillance system that includes adverse event hospitalizations . In K. Henriksen, J. B. Battles, E. Marks, & D. I. Lewin (Eds.), Advances in patient safety: From research to implementation (Vol. 1, pp. 259-273). Rockville, MD: Agency for Healthcare Research and Quality .
15.
Carbonell, A.M., Lincourt, A.E., Kercher, K.W., Matthews, B.D., Cobb, W.S., Sing, R.F., et al. (2005). Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93,578 patients. Surgical Endoscopy, 19(6), 767-773.
16.
Classen, D.C., Pestotnik, S.L., Evans, R.S., Lloyd, J.F., & Burke, J.P. (1997). Adverse drug events in hospitalized patients: Excess length of stay, extra costs, and attributable mortality. Journal of theAmerican Medical Association, 277(4), 301-306.
17.
Donabedian, A. (1980). Explorations in quality assessment and monitoring, Vol. 1: The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
18.
Dudley, R.A., Johansen, K.L., Brand, R., Rennie, D.J., & Milstein, A. (2000). Selective referral to high-volume hospitals: Estimating potentially avoidable deaths. Journal of the American Medical Association, 283, 1159-1166.
19.
Elixhauser, A., Steiner, C., & Fraser, I. (2003). Volume thresholds and hospital characteristics in the United States. Health Affairs, 22(2), 167-177.
20.
Elixhauser, A., Steiner, C., Harris, R., & Coffey, R.M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36(1), 8-27.
21.
Encinosa, W.E., & Hollinger, F.J. (2005). What happens after a patient safety event? Medical expenditures and outcomes in Medicare. In K. Henriksen, J. B. Battles , E. Marks, & D. I. Lewin (Eds.), Advances in patient safety: From research to implementation (Vol. 1, pp. 423-436). Rockville, MD: Agency for Healthcare Research and Quality and Department of Defense.
22.
Foster, D.A. (2006, June). Consequences and costs of medical injuries in Medicare inpatients. Paper presented at Academy Health annual research meeting, Seattle, WA.
23.
Halm, E.A., Lee, C., & Chassin, M.R. (2002). Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Annals of Internal Medicine, 137(6), 511-520.
24.
Iezzoni, L. I. (Ed.). (2003). Risk adjustment for measuring health care outcomes (3rd ed.). Chicago: Health Administration Press.
25.
Iezzoni, L.I., Daley, J., Heeren, T., Foley, S.M., Fisher, E.S., Duncan, C., et al. (1994). Identifying complications of care using administrative data. Medical Care, 32(7), 700-714.
26.
Jencks, S.F., Williams, D.K., & Katy, T.L. (1988). Assessing hospital-associated deaths from discharge data. Journal of theAmerican Medical Association, 260(15), 2240-2247.
27.
Jha, A.K., Perlin, J.B., Kizer, K.W., & Dudley, R.A. (2003). Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. New England Journal of Medicine, 348(22), 2218-2226.
28.
Joshi, A.V., D'Souza, A.O., & Madhavan, S.S. (2004). Differences in hospital length-of-stay, charges, and mortality in CHF patients. Congestive Heart Failure, 10(2), 76-84.
29.
Kane, R.L., Bershadsky, B., Weinert, C., Huntington, S., Riley, W., Bershadsky, J., et al. (2005). Estimating the patient care costs of teaching in a teaching hospital. American Journal of Medicine, 118(7), 767-772.
30.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.
31.
Kressin, N.R., Chang, B.H., Hendricks, A., & Kazis, L.E. (2003). Agreement between VA administrative data and patients' self-reports of race/ethnicity. American Journal of Public Health, 93(10), 1734-1737.
32.
Miller, M., Elixhauser, A., Zhan, C., & Meyer, G. (2001). Patient safety indicators: Using administrative data to identify potential patient safety concerns. Health Services Research, 36(6), 110-132.
33.
Polancich, S., Restrepo, E., & Prosser, J. (2006). Cautious use of administrative data for decubitus ulcer outcome reporting. American Journal of Medical Quality , 21(4), 262-268.
34.
Remus, D., & Fraser, I. (2004). Guidance for using the AHRQ quality indicators for hospital-level public reporting or payment. Rockville, MD: Agency for Healthcare Research and Quality and U.S. Department of Health and Human Services.
35.
Rivard, P., Elwy, A.R., Loveland, S., Zhao, S., Tsilimingras, D., Elixhauser, A., et al. (2005). Applying patient safety indicators (PSIs) across healthcare systems: Achieving data comparability. In K. Henriksen, J. B. Battles , E. Marks, & D. I. Lewin (Eds.), Advances in patient safety: From research to implementation (Vol. 2, pp. 7-25). Rockville, MD: Agency for Healthcare Research and Quality and Department of Defense.
36.
Romano, P.S. (2003). Asking too much of administrative data?American College of Surgeons, 196, 337-338.
37.
Romano, P.S., Geppert, J.J., Davies, S., Miller, M.R., Elixhauser, A., & McDonald, K.M. (2003). A national profile of patient safety in U.S. hospitals. Health Affairs, 22(2), 154-166.
38.
Rosen, A.K., Loveland, S., Anderson, J., Rothendler, J., Hankin, C.S., Rakovski, C.C., et al. (2001). Evaluating diagnosis-based case-mix measures: How well do they apply to the VA population?Medical Care , 39(7), 692-704.
39.
Rosen, A.K., Rivard, P., Zhao, S., Loveland, S., Tsilimingras, D., Christiansen, C.L., et al. (2005). Evaluating the patient safety indicators: How well do they perform on VA data?Medical Care, 43(9), 873-884.
40.
Rosen, A.K., Zhao, S., Rivard, P.E., Loveland, S., Montez, M.E., Elixhauser, A., & et al. (2006). Tracking rates of patient safety indicators over time: Lessons from the VA. Medical Care, 44(9), 850-861.
41.
Rosenthal, G.E., Sarazin, M.V., & Hannan, E.L. (2003). In-hospital mortality following coronary artery bypass graft surgery in Veterans Health Administration and private sector hospitals. Medical Care, 41(4), 522-535.
42.
Rothschild, J.M., Federico, F.A., Gandhi, T.K., Kaushal, R., Williams, D.H., & Bates, D.W. (2002). Analysis of medication-related malpractice claims: Causes, preventability, and cost. Archives ofInternal Medicine , 162(21), 2414-2420.
43.
Shufelt, J.L., Hannan, E.L., & Gallagher, B.K. (2005). The postoperative hemorrhage and hematoma patient safety indicator and its risk factors. American Journal of Medical Quality, 20(4), 210-218.
44.
Taylor, D.H., Whellan, D.J., & Sloan, F.A. (1999). Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. New England Journal of Medicine, 340, 293-299.
45.
Thomas, E.J., & Petersen, L.A. (2003). Measuring errors and adverse events in health care. Journal of General Internal Medicine , 18(1), 61-67.
46.
Thomas, J.W., Bates, E.W., Hofer, T., Perkins, A., Foltz-Murphy, N., & Webb, C. (1998). Interpreting risk-adjusted length-of-stay patterns for VA hospitals. Medical Care, 36(12), 1660-1675.
47.
Thornlow, D.K., & Stukenborg, G.J. (2006). The association between hospital characteristics and rates of preventable complications and adverse events. Medical Care,44(3), 265-269.
48.
Wagner, T.H., Chen, S., & Barnett, P.G. (2003). Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA. Medical Care Research and Review, 60(3 Suppl.), 15S-36S.
49.
Weeks, W.B., Foster, T., Wallace, A.E., & Stalhandske, E. (2001). Tort claims analysis in the Veterans Health Administration for quality improvement. Journal of Law, Medicine & Ethics, 29(3-4), 335-345.
50.
Weeks, W.B., & Wallace, A.E. (2003). Broadening the business case for patient safety [Letter]. Archives ofInternal Medicine, 163, 1112.
51.
Younis, M.Z. (2004). Length of hospital stay of Medicare patients in the post-prospective-payment-system era. Journal of Health Care Finance, 31(1), 23-30.
52.
Yu, W., Ravelo, A., Wagner, T.H., Phibbs, C.S., Bhandari, A., Chen, S., et al. (2003). Prevalence and costs of chronic conditions in the VA health care system. Medical Care Research and Review , 60(3 Suppl.), 146S-167S.
53.
Yuan, Z., Cooper, G.S., Einstadter, D., Cebul, R.D., & Rimm, A.A. (2000). The association between hospital type and mortality and length of stay: A study of 16.9 million hospitalized Medicare beneficiaries . Medical Care, 38(2), 231-245.
54.
Zhan, C., Kelley, E., Yang, H.P., Keyes, M., Battles, J., Borotkanics, R.J., et al. (2005). Assessing patient safety in the United States: Challenges and opportunities. Medical Care, 43(3 Suppl.), 142-147.
55.
Zhan, C., & Miller, M.R. (2003a). Administrative data based patient safety research: A critical review. Quality and Safety in Health Care, 12, 58ii-63ii.
56.
Zhan, C., & Miller, M.R. (2003b). Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. Journal of theAmerican Medical Association, 290(14), 1868-1874.
