Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care
Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care
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DOI：
10.1016/j.surg.2016.05.032
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发表时间：
2016-10-01
期刊：
影响因子：
3.8
通讯作者：
Eiferman, Daniel S.
中科院分区：
文献类型：
--
作者：
Nguyen, Michelle C.;Moffatt-Bruce, Susan D.;Eiferman, Daniel S.
背景。医疗保健研究和质量机构患者安全指标11用于识别术后呼吸衰竭事件并检测质量改进的领域。本研究检验了患者安全指标11在识别临床有效的患者安全事件方面的准确性。评估了2013年7月至2015年7月期间由医疗保健研究机构和质量QI版本4.5（包括国际疾病分类-9代码）标记为患者安全指标11的所有病例。代码确诊病例由2名医生进行了独立审查。使用住院患者电子病历来确定每个病例术后呼吸衰竭的临床因素，以确定术后呼吸衰竭是否是不安全护理的结果。计算临床真阳性率和阳性预测值。本文回顾了166例术后呼吸衰竭病例；51例由于编码或文档错误而被重新编码和反转；115例患者符合卫生保健研究和质量机构对术后呼吸衰竭的定义。115例中有71例（61.7%）为假阳性，不反映不安全护理，而44例为真阳性，阳性预测值为38.3%。chi(2)分析并未揭示人口统计学、临床特征或手术方式与真阳性病例之间的关联。考虑到导致术后呼吸衰竭的不可预防的临床因素，医疗保健研究机构的管理编码数据和质量患者安全指标11不能准确识别接受不安全护理的患者。在纳入和排除标准修订之前，应重新考虑使用医疗保健研究和质量患者安全指标11作为医院绩效衡量标准。
Background. The Agency for Healthcare Research and Quality Patient Safety Indicator 11 is used to identify postoperative respiratory failure events and detect areas for quality improvement. This study examines the accuracy of Patient Safety Indicator 11 in identifying clinically valid patient safety events.Methods. All cases flagged for Patient Safety Indicator 11 from July 2013 to July 2015 by Agency for Healthcare Research and Quality QI Version 4.5 including International Classification of Diseases-9 codes were evaluated. Code-confirmed cases underwent independent review by 2 physicians. Inpatient electronic medical records were used to identify clinical factors for postoperative respiratory failure in each case to determine if postoperative respiratory failure was a result of unsafe care. The clinical true positive rate and positive predictive value were calculated.Results. A total of 166 postoperative respiratory failure cases were reviewed; 51 were recoded and reversed due to coding or documentation errors; 115 cases met the Agency for Healthcare Research and Quality definition of postoperative respiratory failure. A total of 71 (61.7%) of the 115 cases were false positives and did not reflect unsafe care, while 44 cases were true positives with a positive predictive value of 38.3 %. chi(2) analysis did not reveal an association between demographics, clinical characteristics, or operative procedure with true-positive cases.Conclusion. Administrative coding data for Agency for Healthcare Research and Quality Patient Safety Indicator 11 do not identify accurately patients who received unsafe care when taking into account unpreventable clinical factors causing postoperative respiratory failure. The use of Agency for Healthcare Research and Quality Patient Safety Indicator 11 as a hospital performance measure should be reconsidered until inclusion and exclusion criteria are revised.