Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety.
Objective: Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging.Material and...
| Publicado en: | Journal of the American Medical Informatics Association Vol. 24; no. 2; pp. 310 - 316 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Oxford University Press / USA
Mar2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121346952&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 121346952 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10675027 FZ9 jtl: Journal of the American Medical Informatics Association issn: 10675027 maglogo: N pubinfo: dt: Mar2017 vid: 24 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 121346952 121346952 NLM27578751 121346952 10.1093/jamia/ocw126 NLM27578751 121346952 ppf: 310 ppct: 6 formats: tig: atl: Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety. aug: au: Hefner, Jennifer L. Huerta, Timothy R. McAlearney, Ann Scheck Barash, Barbara Latimer, Tina Moffatt-Bruce, Susan D. affil: Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA sug: subj: Algorithms Clinical Indicators Patient Safety Treatment Errors United States Agency for Healthcare Research and Quality Academic Medical Centers Retrospective Design Software Safety United States Human Validation Studies Comparative Studies Evaluation Research Multicenter Studies ab: Objective: Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging.Material and Methods: At a 6-hospital academic medical center, a retrospective analysis was conducted of all PSIs flagged in fiscal year 2014. A multidisciplinary PSI Quality Team reviewed each flagged PSI based on quarterly reports. The positive predictive value (PPV, the percent of clinically validated cases) was calculated for 12 PSI categories. The documentation for each reversed case was reviewed to determine the reasons for PSI reversal.Results: Of 657 PSI flags, 185 were reversed. Seven PSI categories had a PPV below 75%. Four broad categories of reasons for reversal were AHRQ algorithm limitations (38%), coding misinterpretations (45%), present upon admission (10%), and documentation insufficiency (7%). AHRQ algorithm limitations included 2 subcategories: an "incident" was inherent to the procedure, or highly likely (eg, vascular tumor bleed), or an "incident" was nonsignificant, easily controlled, and/or no intervention was needed.Discussion: These findings support previous research highlighting administrative data problems. Additionally, AHRQ algorithm limitations was an emergent category not considered in previous research. Herein we present potential solutions to address these issues.Conclusions: If, despite poor validity, US policy continues to rely on PSIs for incentive and penalty programs, improvements are needed in the quality of administrative data and the standardized PSI algorithms. These solutions require national motivation, research attention, and dissemination support. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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