Using Harm-Based Weights for the AHRQ Patient Safety for Selected Indicators Composite (PSI-90): Does It Affect Assessment of Hospital Performance and Financial Penalties in Veterans Health Administration Hospitals?
Using Harm-Based Weights for the AHRQ Patient Safety for Selected Indicators Composite (PSI-90): Does It Affect Assessment of Hospital Performance and Financial Penalties in Veterans Health Administration Hospitals?
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DOI：
10.1111/1475-6773.12596
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发表时间：
2016-12-01
影响因子：
3.4
通讯作者：
Shwartz, Michael
中科院分区：
文献类型：
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作者：
Chen, Qi;Rosen, Amy K.;Shwartz, Michael
Objective.为了评估医院的公共报告和按绩效付费的情况，由医疗保健研究和质量机构（AHRQ）选定指标的患者安全（PSI-90）综合措施测量，是否受到最近开发的基于危害的权重的影响。数据来源/研究设置。回顾性分析2012-2014年退伍军人健康管理局（VA）数据。研究设计。应用AHRQ PSI软件（v5.0）获得132家急性护理医院的原始基于体积的PSI-90评分。我们使用AHRQ开发的基于伤害的权重构建了一个修改后的PSI-90。我们比较了这两个PSI-90之间的公共报告和按绩效付费的医院概况，并评估了这些变化的模式。基于体积和基于伤害的PSI-90强相关（r = 0.67，p < .0001）。使用基于危害的PSI-90对公共报告的影响相对较小（即，5%的医院改变了分类），但它对按绩效付费的影响要大得多（例如，根据医疗保险医院获得性疾病减少计划，15%的医院将面临不同的经济处罚。由于特定PSI权重的变化，医院概况发生了系统性变化。PSI-90中基于伤害的权重的使用有可能显著改变按绩效付费计划下的支付。政策制定者应该仔细制定过渡计划，以指导医院通过任何用于按绩效付费的质量指标的变化。
Objective. To assess whether hospital profiles for public reporting and pay-for-performance, measured by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety for Selected Indicators (PSI-90) composite measure, were affected by using the recently developed harm-based weights.Data Sources/Study Setting. Retrospective analysis of 2012-2014 data from the Veterans Health Administration (VA).Study Design. The AHRQ PSI software (v5.0) was applied to obtain the original volume-based PSI-90 scores for 132 acute-care hospitals. We constructed a modified PSI-90 using the harm-based weights developed by AHRQ. We compared hospital profiles for public reporting and pay-for-performance between these two PSI-90s and assessed patterns in these changes.Principal Findings. The volume-based and the harm-based PSI-90s were strongly correlated (r = 0.67, p < .0001). The use of the harm-based PSI-90 had a relatively small impact on public reporting (i.e., 5 percent hospitals changed categorization), but it had a much larger impact on pay-for-performance (e.g., 15 percent of hospitals would have faced different financial penalties under the Medicare Hospital-Acquired Condition Reduction Program). Because of changes in weights of specific PSIs, hospital profile changes occurred systematically.Conclusions. Use of the harm-based weights in PSI-90 has the potential to significantly change payments under pay-for-performance programs. Policy makers should carefully develop transition plans for guiding hospitals through changes in any quality metrics used for pay-for-performance.