Impact of date stamping on patient safety measurement in patients undergoing CABG: experience with the AHRQ Patient Safety Indicators.
Impact of date stamping on patient safety measurement in patients undergoing CABG: experience with the AHRQ Patient Safety Indicators.
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DOI：
10.1186/1472-6963-8-176
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发表时间：
2008-08-13
影响因子：
2.8
通讯作者：
Dick AW
中科院分区：
文献类型：
--
作者：
Glance LG;Li Y;Osler TM;Mukamel DB;Dick AW
医疗保健研究和质量局（AHRQ）的患者安全指标（PSIs）提供了有关潜在可预防不良事件的医院风险调整率的信息。虽然设计用于处理常规管理数据，但尚不清楚PSI是否能够准确区分并发症和预先存在的疾病。本研究的目的是检查AHRQ PSI是否准确测量医院并发症发生率，使用入院时现状（POA）代码的数据来区分并发症和既存疾病。使用1998-2000年加州住院患者数据库对加州接受孤立CABG手术的患者进行回顾性队列研究。我们使用POA中的信息作为金标准，计算了选定的AHRQ PSI的阳性预测值，并使用组内相关系数评估了在有和没有POA修改器中包含的信息的情况下，医院风险调整PSI率之间的一致性水平。假阳性错误率（定义为1减去阳性预测值）大于或等于20%，其中4/8例受检PSI为：褥疮性溃疡、抢救失败、术后生理和代谢紊乱、术后肺栓塞或深静脉血栓形成。两两比较医院风险调整的PSI率，有和没有POA的信息，表现出几乎完美的协议的八个PSI的。对于褥疮、抢救失败和术后肺栓塞或DVT，组内相关系数范围为0.63至0.79。对于一些AHRQ患者安全性指标，根据POA指标是否用于区分既存疾病和并发症，风险调整后的不良事件发生率存在显著差异。POA指标的使用将提高AHRQ PSI作为不良结果衡量标准的准确性。
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) provide information on hospital risk-adjusted rates for potentially preventable adverse events. Although designed to work with routine administrative data, it is unknown whether the PSIs can accurately distinguish between complications and pre-existing conditions. The objective of this study is to examine whether the AHRQ PSIs accurately measure hospital complication rates, using the data with present-on-admission (POA) codes to distinguish between complications and pre-existing conditions Retrospective cohort study of patients undergoing isolated CABG surgery in California conducted using the 1998–2000 California State Inpatient Database. We calculated the positive predictive value of selected AHRQ PSIs using information from the POA as the gold standard, and the intra-class correlation coefficient to assess the level of agreement between the hospital risk-adjusted PSI rates with and without the information contained in the POA modifier. The false positive error rate, defined as one minus the positive predictive value, was greater than or equal to 20% for four of the eight PSIs examined: decubitus ulcer, failure-to-rescue, postoperative physiologic and metabolic derangement, and postoperative pulmonary embolism or deep venous thrombosis. Pairwise comparison of the hospital risk-adjusted PSI rates, with and without POA information, demonstrated almost perfect agreement for five of the eight PSI's. For decubitus ulcer, failure-to-rescue, and postoperative pulmonary embolism or DVT, the intraclass-correlation coefficient ranged between 0.63 to 0.79. For some of the AHRQ Patient Safety Indicators, there are significant differences in the risk-adjusted rates of adverse events depending on whether the POA indicator is used to distinguish between pre-existing conditions and complications. The use of the POA indicator will increase the accuracy of the AHRQ PSIs as measures of adverse outcomes.
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影响因子：
3
作者：
Naessens, James M.;Campbell, Claudia R.;Culbertson, Richard
通讯作者：
Culbertson, Richard
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
3
作者：
IEZZONI, LI;DALEY, J;COFFMAN, GA
通讯作者：
COFFMAN, GA
DOI：
10.7326/0003-4819-127-8_part_2-199710151-00048
发表时间：
1997-10-15
影响因子：
39.2
作者：
Iezzoni, LI
通讯作者：
Iezzoni, LI
影响因子：
3.4
作者：
Glance, Laurent G.;Dick, Andrew W.;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.