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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3032 — Using AHRQ Patient Safety Indicators to Identify Vulnerable Populations in the VA

Author List:
Weeks WB (VA Outcomes Group, NCPS, VAQS, Dartmouth Medical School)
West AN (VA Outcomes Group, NCPS)
Summerall EL (VA Quality Scholars Fellowship Program)
Bagian JP (National Center for Patient Safety)

Objectives:
The Agency for Healthcare Research and Quality (AHRQ) has developed patient safety indicators (PSIs) to evaluate the performance of health care systems. For older New York veterans who were enrolled in the VA, we wanted to assess whether PSI rates differed for inpatient care received in the VA compared to that received in the private sector. Further, we considered whether lack of enrollment in Medicare was associated with higher PSI rates.

Methods:
We conducted a retrospective analysis of 181,275 male New York State residents aged 65 and older who were enrolled in the VA system between 1998 and 2000. We used AHRQ’s SAS-encoded algorithms to calculate risk-adjusted PSI rates (expressed as the number of adverse events per 1000 exposures), and we calculated 95% confidence intervals to compare private sector to VA care. Within each system, we compared rates for patients currently enrolled versus not enrolled in Medicare.

Results:
When we compared VA to private sector care, risk-adjusted PSI rates for 12 of 15 indicators did not differ significantly. VA care showed a substantially higher rate of post-operative sepsis (95% CI for VA: 17.8-29.2; private: 4.1-9.8) but lower rates for decubitus ulcer (VA: 18.5-22.2; private: 27.2-29.9) and infection due to medical care (VA: 1.1-1.98; private: 1.99-2.7). Compared to Medicare enrollees, older VA patients without Medicare coverage had higher rates of failure to rescue (without Medicare coverage: 322-429; with Medicare coverage: 150-183), decubitus ulcer (without: 26.2-40.8; with: 17.4-21.2), death in low mortality DRGs (without: 20.0-33.7; with: 1.0-4.1), and post-operative metabolic derangement (without: 3.5-11.7; with: 0.6-2.6). VA patients without Medicare coverage also had higher rates of dementia, drug dependence, and schizophrenia (p<.001 for all). Comparisons of hospitalizations in the private sector revealed no effects for Medicare enrollment.

Implications:
In general, older enrolled veterans who use VA care experience adverse medical events at rates similar to those who use the private sector. For care provided within the VA, however, lack of enrollment in Medicare is a marker of greater vulnerability to adverse events.

Impacts:
Concentrating patient safety improvement efforts on vulnerable populations may be an efficient way to reduce rates of adverse events and improve outcomes.


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