Patient safety monitoring systems using regional administrative data

Abstract

The aim of this article is to present available strategies to develop healthcare safety systems by merging Hospital Discharge Records and medical malpractice claim data in available regional administrative archives of the Lombardy region (Italy).

Firstly, we illustrate the regional database collecting claims and demands of reimbursement declared by patients hospitalized in regional healthcare structures, then we discuss strategies to model the association between quality indicators, obtained by Hospital Discharge Records, and the incidence of clinical errors causing the patient's death or lesions.

As first result, the merged database evidences a limited temporal range covered by both informative systems (2004–2006), essentially imputable to a scarce data quality in Hospital Discharge Cards records before 2004 and to a high incidence of open claims in the claims database after 2004. Further, clinical errors show an extreme sparseness among involved Health structures.

The analysis, focused on the triennium 2004–2006, was performed in a cross-sectional perspective using Binomial Negative regression models. Results evidenced that re-admissions rate for the same Major Diagnostic Category and discharges against medical advice rate significantly affect the incidence of errors causing the patient's death, whereas unscheduled surgical readmission rate in operating room significantly affects the incidence of surgical error rate.