Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment?

Rosen AK, Chen Q, Borzecki AM, Shin M, Itani KM, Shwartz M. Using estimated true safety event rates versus flagged safety event rates: does it change hospital profiling and payment? Health services research. 2014 Oct 1; 49(5):1426-45.

Related HSR&D Project(s)

• SDR 07-002 – Validating the Patient Safety Indicators in the VA: A Multi-faceted Approach

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: To assess whether use of the AHRQ Patient Safety Indicator (PSI) composite measure versus modified composite measures leads to changes in hospital profiles and payments. DATA SOURCES/STUDY SETTING: Retrospective analysis of 2010 Veterans Health Administration discharge data. STUDY DESIGN: We used the AHRQ PSI software (v4.2) to obtain PSI-flagged events and composite scores for all 151 hospitals in the database (n = 517,814 hospitalizations). We compared the AHRQ PSI composite to two modified composites that estimated "true safety events" from previous chart abstraction findings: one with modified numerators based on the positive predictive value (PPV) of each PSI, and one with similarly modified numerators but whose denominators were based on the expected fraction of PSI-eligible cases that remained after removing those PSIs that were present-on-admission (POA). PRINCIPAL FINDINGS: Although a small percentage (5-6 percent) of hospitals changed outlier status based on modified PSI composites, some of these changes were substantial; 30 and 19 percent of hospitals changed 20 ranks after adjustment for PPVs and POA flags, respectively. We estimate that 33 percent of hospitals would see a change of at least 10 percent in performance payments. CONCLUSIONS: Changes in hospital profiles and payments would be substantial for some hospitals if the PSI composite score used weights reflecting the relative prevalence of true versus flagged events.