A set of "highly undesirable events" identified through administrative data may be useful as a global measure of hospital quality, according to a study in the Journal for Healthcare Quality.
Researchers designed and tested a whole-patient measure of safety comprising 14 highly undesirable events — negative quality or safety events identified by the quality and cost framework of CMS and the Agency for Healthcare Research and Quality, with some modifications:
• Air embolism
• Blood incompatibility
• Pressure ulcer
• Falls and trauma
• Catheter-associated urinary tract infection
• Central venous catheter-related bloodstream infections
• Manifestations of poor glycemic control
• Mild admission risk of mortality and expired (i.e., a patient died whose admission risk of mortality was very low)
• Death in low-mortality diagnosis-related group
• Deep vein thrombosis/pulmonary embolism (any case)
• Iatrogenic pneumothorax
• Accidental puncture or laceration
• All-cause readmission within 72 hours
• Hospital-acquired infection/Surgical Care Improvement Project
The authors noted this set is not intended to be definitive, but instead can be customized by hospitals and health systems.
Among more than 6.5 million patient discharges from 161 hospitals from 2008 through 2010, an average 7.74 percent included at least one highly undesirable event. However, the rate varied greatly among hospitals, ranging 13.32 percent from the lowest to highest rate.
While this global measure of safety has some weaknesses, including an inability to assess the value of the data, it may be a useful measure of hospitals' overall quality. "To the extent that the administrative data are reliable and valid, the [whole-patient measure of safety] approach could be used to help determine whether hospitals are meeting a minimum level of safe care and to identify hospitals where improvement in critical areas of care delivery (now linked to revenue) is needed," the authors wrote.
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