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Data Show Fleeting Success: Improvement Teams Should Address Root Causes. Qual Manag Health Care 2022; 31:242-243. [PMID: 35170582 DOI: 10.1097/qmh.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Zabinski Z, Black BS. The deterrent effect of tort law: Evidence from medical malpractice reform. JOURNAL OF HEALTH ECONOMICS 2022; 84:102638. [PMID: 35691073 DOI: 10.1016/j.jhealeco.2022.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/26/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
We examine whether caps on noneconomic damages in medical malpractice cases affect in-hospital patient safety. We use Patient Safety Indicators - measures of adverse events - as proxies for safety. In difference-in-differences ("DiD") analyses of five states that adopt caps during 2003-2005, we find that multiple measures of non-fatal patient safety events worsen after cap adoption relative to control states. DiD inference can be unreliable with a small number of treated units. We therefore develop a randomization inference-based test for inference with few treated units but multiple correlated outcomes and confirm the robustness of our results with this nonparametric approach. We also provide evidence that the decline in patient safety is unlikely to be driven by patient selection.
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Affiliation(s)
| | - Bernard S Black
- Northwestern University, Pritzker School of Law and Kellogg School of Management
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Li KD, Hakam N, Sadighian MJ, Holler JT, Nabavizadeh B, Amend GM, Fang R, Meeks W, Makarov D, Breyer BN. Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census. Urology 2021; 156:117-123. [PMID: 34331999 DOI: 10.1016/j.urology.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/17/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Raymond Fang
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - William Meeks
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - Danil Makarov
- Population Health and Health Policy, New York University School of Medicine Veterans Affairs New York Harbor Healthcare System-Brooklyn, Brooklyn, NY
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Tedesco D, Moghavem N, Weng Y, Fantini MP, Hernandez-Boussard T. Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013. J Patient Saf 2021; 17:e327-e334. [PMID: 32217926 PMCID: PMC8194008 DOI: 10.1097/pts.0000000000000615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. METHODS This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ's PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013. RESULTS Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (-3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives. CONCLUSIONS National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.
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Affiliation(s)
- Dario Tedesco
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Nuriel Moghavem
- Department of Neurology, Stanford School of Medicine, Stanford University, Palo Alto
| | - Yingjie Weng
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Tina Hernandez-Boussard
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
- Department of Surgery, Stanford University, Stanford, California
- Department of Biomedical Data Sciences, Stanford University, Stanford, California
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Bellver Oliver M, Escrig-Sos J, Rotellar Sastre F, Moya-Herráiz Á, Sabater-Ortí L. Outcome quality standards for surgery of colorectal liver metastasis. Langenbecks Arch Surg 2020; 405:745-756. [PMID: 32577822 DOI: 10.1007/s00423-020-01908-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI. MATERIAL AND METHODS A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%. RESULTS The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60 months (84%, > 77%; and 34%, > 25%, respectively). CONCLUSIONS Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.
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Affiliation(s)
- Manuel Bellver Oliver
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain.
| | - Javier Escrig-Sos
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain
| | - Fernando Rotellar Sastre
- HPB and Liver Transplant Unit, General and Digestive Surgery, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Ángel Moya-Herráiz
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain
| | - Luis Sabater-Ortí
- Department of Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico, University of Valencia, Valencia, Spain
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von Itzstein MS, Gupta A, Mara KC, Khanna S, Gerber DE. Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis. Lung 2019; 197:593-599. [PMID: 31367886 DOI: 10.1007/s00408-019-00255-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database. METHODS Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4. RESULTS A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1 days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9-8.9; P < 0.001). CONCLUSIONS The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.
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Affiliation(s)
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kristin C Mara
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - David E Gerber
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, USA.
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, USA.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390-9093, USA.
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8852, Dallas, TX, 75390-8852, USA.
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Januel JM. [The vision of nursing provided by Léonie Chaptal: a strategic mistake in the development of nursing science in France ?]. Rech Soins Infirm 2019:6-12. [PMID: 29436805 DOI: 10.3917/rsi.131.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The issue of the development of the discipline displayed by nursing sciences in France is crucial, especially since the Law of Modernization of the Health System has established a legal framework for advanced practice since 2016. This article presents a discussion on the important role that Léonie Chaptal has played in the development of nursing care in France, based on a purely professional vision, guaranteeing the subordination of the nurses to the medical physicians the in the spirit of the law of November 30, 1892 which had established a stranglehold of medical profession on health. We have drawn from this discussion some lessons that we consider essential for the future development of a true discipline of nursing in France, in the context of the deep organizational transformation initiated by the health system.
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Abstract
OBJECTIVES Patient transfers between hospitals are becoming more common in the United States. Disease-specific studies have reported varying outcomes associated with transfer status. However, even as national quality improvement efforts and regulations are being actively adopted, forcing hospitals to become financially accountable for the quality of care provided, surprisingly little is known about transfer patients or their outcomes at a population level. This population-wide study provides timely analyses of the characteristics of this particularly vulnerable and sizable inpatient population. We identified and compared characteristics and outcomes of transfer and nontransfer patients. METHODS With the use of the 2009 Nationwide Inpatient Sample, a nationally representative sample of U.S. hospitalizations, we examined patient characteristics, in-hospital adverse events, and discharge disposition for transfer versus nontransfer patients in this observational study. RESULTS We identified 1,397,712 transfer patients and 31,692,211 nontransfer patients. Age, sex, race, and payer were significantly associated with odds of transfer (P < 0.05). Transfer patients had higher risk-adjusted inpatient mortality (4.6 versus 2.1, P < 0.01), longer length of stay (13.3 versus 4.5, P < 0.01), and fewer routine disposition discharges (53.6 versus 68.7, P < 0.01). In-hospital adverse events were significantly higher in transfer patients compared with nontransfer patients (P < 0.05). CONCLUSIONS Our results suggest that transfer patients have inferior outcomes compared with nontransfer patients. Although they are clinically complex patients and assessing accountability as between the transferring and receiving hospitals is methodologically difficult, transfer patients must nonetheless be included in quality benchmark data to assess the potential impact this population has on hospital outcome profiles. With hospital accountability and value-based payments constituting an integral part of health care reform, documenting the quality of care delivered to transfer patients is essential before accurate quality assessment improvement efforts can begin in this patient population.
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Hauck KD, Wang S, Vincent C, Smith PC. Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals. Med Care 2017; 55:125-130. [PMID: 27753744 PMCID: PMC5266418 DOI: 10.1097/mlr.0000000000000631] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. RESULTS The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. DISCUSSION The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.
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Affiliation(s)
- Katharina D. Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford
| | - Peter C. Smith
- Imperial College Business School, Imperial College London, London, UK
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Nguyen MC, Moffatt-Bruce SD, Strosberg DS, Puttmann KT, Pan YL, Eiferman DS. 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. Surgery 2016; 160:858-868. [PMID: 27528212 DOI: 10.1016/j.surg.2016.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
Abstract
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%. χ(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.
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Affiliation(s)
- Michelle C Nguyen
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH.
| | | | - David S Strosberg
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Kathleen T Puttmann
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Yangshu L Pan
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
| | - Daniel S Eiferman
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH
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Moffatt-Bruce SD, Nguyen MC, Fann JI, Westaby S. Our New Reality of Public Reporting: Shame Rather Than Blame? Ann Thorac Surg 2016; 101:1255-61. [PMID: 27000567 DOI: 10.1016/j.athoracsur.2016.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/25/2022]
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Jean RA, DeLuzio MR, Kraev AI, Wang G, Boffa DJ, Detterbeck FC, Wang Z, Kim A. Analyzing Risk Factors for Morbidity and Mortality after Lung Resection for Lung Cancer Using the NSQIP Database. J Am Coll Surg 2016; 222:992-1000.e1. [DOI: 10.1016/j.jamcollsurg.2016.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Torosyan Y, Hu Y, Hoffman S, Luo Q, Carleton B, Marinac-Dabic D. An in silico framework for integrating epidemiologic and genetic evidence with health care applications: ventilation-related pneumothorax as a case illustration. J Am Med Inform Assoc 2016; 23:711-20. [PMID: 27107435 DOI: 10.1093/jamia/ocw031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To illustrate an in silico integration of epidemiologic and genetic evidence that is being developed at the Center for Devices and Radiological Health/US Food and Drug Administration as part of regulatory research on postmarket device performance. In addition to using conventional epidemiologic evidence from registries, this innovative approach explores the vast potential of open-access omics databases for identifying genetic evidence pertaining to devices. MATERIAL AND METHODS A retrospective analysis of Agency for Healthcare Research and Quality (AHRQ)/Healthcare Cost and Utilization Project (HCUPNet) data (2002-2011) was focused on the ventilation-related iatrogenic pneumothorax (Vent-IP) outcome in discharges with mechanical ventilation (MV) and continuous positive airway pressure (CPAP). The derived epidemiologic evidence was analyzed in conjunction with pre-existing genomic data from Gene Expression Omnibus/National Center for Biotechnology Information and other databases. RESULTS AHRQ/HCUPNet epidemiologic evidence showed that annual occurrence of Vent-IP did not decrease over a decade. While the Vent-IP risk associated with noninvasive CPAP comprised about 0.5%, the Vent-IP risk due to longer-term MV reached 2%. Along with MV posing an independent risk for Vent-IP, female sex and white race were found to be effect modifiers, resulting in the highest Vent-IP risk among mechanically ventilated white females. The Vent-IP risk was also potentiated by comorbidities associated with spontaneous pneumothorax (SP) and fibrosis. Consistent with the epidemiologic evidence, expression profiling in a number of animal models showed that the expression of several collagens and other SP/fibrosis-related genes was modified by ventilation settings. CONCLUSION Integration of complementary genetic evidence into epidemiologic analysis can lead to a cost- and time-efficient discovery of the risk predictors and markers and thus can facilitate more efficient marker-based evaluation of medical product performance.
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Affiliation(s)
- Yelizaveta Torosyan
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA
| | - Yuzhi Hu
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Hoffman
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qianlai Luo
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bruce Carleton
- Pharmaceutical Outcomes Programme, BC Children's Hospital; Division of Translational Therapeutics, Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Danica Marinac-Dabic
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA
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Langlois S. Developing an appreciation of patient safety: analysis of interprofessional student experiences with health mentors. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:88-94. [PMID: 26975744 PMCID: PMC4839017 DOI: 10.1007/s40037-016-0258-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION A critical task for health profession educators is to foster student appreciation of patient quality and safety issues. Although instructional methods vary, few focus on the direct communication of the patient experience to students. This qualitative study explores the experiences and learning of health profession students participating in a Safety Module in the Health Mentor Programme. METHODS Small interprofessional groups of students were paired with a health mentor, an individual experiencing chronic health challenges. Students followed a 90-minute, semi-structured interview format exploring issues regarding quality care and safety. Following the interviews, students participated in a facilitated asynchronous online discussion and completed a reflective practice paper. An inductive thematic analysis of both of these text-based datasets revealed emerging themes. RESULTS Themes identified in the data included: Patient partnerships as critical to optimal care; consideration of a variety of safety issues; importance of advocacy in promoting safety; improvement of future practice enabled through patient perspectives on clinical error; and embracing of interprofessional communication and collaboration. CONCLUSIONS The findings suggest that engagement with the health mentor narratives facilitated students' appreciation of quality and safety issues related to patient care.
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Affiliation(s)
- Sylvia Langlois
- Centre for Interprofessional Education, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.
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Rinke ML, Bundy DG, Abdullah F, Colantuoni E, Zhang Y, Miller MR. State-Mandated Hospital Infection Reporting Is Not Associated With Decreased Pediatric Health Care-Associated Infections. J Patient Saf 2015; 11:123-34. [PMID: 24681422 PMCID: PMC4177525 DOI: 10.1097/pts.0000000000000056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES State governments increasingly mandate public reporting of central line-associated blood stream infections (CLABSIs). This study tests if hospitals located in states with state-mandated, facility-identified, pediatric-specific public CLABSI reporting have lower rates of CLABSIs as defined by the Agency for Healthcare Research and Quality's Pediatric Quality Indicator 12 (PDI12). METHODS Utilizing the Kids' Inpatient Databases from 2000 to 2009, we compared changes in PDI12 rates across three groups of states: states with public CLABSI reporting begun by 2006, states with public reporting begun by 2009 and never-reporting states. In the baseline period (2000-2003), no states mandated public CLABSI reporting. A multivariable, hospital-level random intercept, logistic regression was performed comparing changes in PDI12 rates in states with public reporting to changes in PDI12 rates in never-reporting states. RESULTS 4,705,857 discharge records were eligible for PDI12. PDI12 rates significantly decreased in all reporting groups, comparing baseline to the post-public reporting period (2009): Never Reporters 88% decrease (95% CI, 86%-89%), Reporting Begun by 2006 90% decrease (95% CI, 83%-94%), and Reporting Begun by 2009 74% decrease (95% CI, 72%-76%). The Never Reporting Group had comparable decreases in PDI12 rates to the Reporting Begun by 2006 group (P = 0.4) and significantly larger decreases in PDI12 rates compared to the Reporting Begun by 2009 group (P < 0.001), despite having no states with public reporting. CONCLUSIONS Public CLABSI reporting alone appears to be insufficient to affect administrative data-based measures of pediatric CLABSI rates or children may be inadequately targeted in current public reporting efforts.
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Affiliation(s)
- Michael L. Rinke
- Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, NY
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yiyi Zhang
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marlene R. Miller
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Children’s Hospital Association, Alexandria, Virginia
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Andrews RM. Statewide Hospital Discharge Data: Collection, Use, Limitations, and Improvements. Health Serv Res 2015; 50 Suppl 1:1273-99. [PMID: 26150118 PMCID: PMC4545332 DOI: 10.1111/1475-6773.12343] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To provide an overview of statewide hospital discharge databases (HDD), including their uses in health services research and limitations, and to describe Agency for Healthcare Research and Quality (AHRQ) Enhanced State Data grants to address clinical and race-ethnicity data limitations. PRINCIPAL FINDINGS Almost all states have statewide HDD collected by public or private data organizations. Statewide HDD, based on the hospital claim with state variations, contain useful core variables and require minimal collection burden. AHRQ's Healthcare Cost and Utilization Project builds uniform state and national research files using statewide HDD. States, hospitals, and researchers use statewide HDD for many purposes. Illustrating researchers' use, during 2012-2014, HSR published 26 HDD-based articles on health policy, access, quality, clinical aspects of care, race-ethnicity and insurance impacts, economics, financing, and research methods. HDD have limitations affecting their use. Five AHRQ grants focused on enhancing clinical data and three grants aimed at improving race-ethnicity data. CONCLUSION ICD-10 implementation will significantly affect the HDD. The AHRQ grants, information technology advances, payment policy changes, and the need for outpatient information may stimulate other statewide HDD changes. To remain a mainstay of health services research, statewide HDD need to keep pace with changing user needs while minimizing collection burdens.
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Affiliation(s)
- Roxanne M Andrews
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and QualityRockville, MD
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18
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Gallego B, Magrabi F, Concha OP, Wang Y, Coiera E. Insights into temporal patterns of hospital patient safety from routinely collected electronic data. Health Inf Sci Syst 2015; 3:S2. [PMID: 25870757 PMCID: PMC4383060 DOI: 10.1186/2047-2501-3-s1-s2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The last two decades have seen an unprecedented growth in initiatives aimed to improve patient safety. For the most part, however, evidence of their impact remains controversial. At the same time, the healthcare industry has experienced an also unprecedented growth in the amount and variety of available electronic data. METHODS In this paper, we provide a review of the use of routinely collected electronic data in the identification, analysis and surveillance of temporal patterns of patient safety. RESULTS Two important temporal patterns of the safety of hospitalised patients were identified and discussed: long-term trends related to changes in clinical practice and healthcare policy; and shorter term patterns related to variations in workforce and resources. We found that consistency in reporting is intrinsically related to availability of large-scale, fit-for-purpose data. Consistent reported trends of patient harms included an increase in the incidence of post-operative sepsis and a decrease in central-line associated bloodstream infections. Improvement in the treatment of specific diseases, such as cardiac conditions, has also been demonstrated. Linkage of hospital data with other datasets provides essential temporal information about errors, as well as information about unsuspected system deficiencies. It has played an important role in the measurement and analysis of the effects of off-hours hospital operation. CONCLUSIONS Measuring temporal patterns of patient safety is still inadequate with electronic health records not yet playing an important role. Patient safety interventions should not be implemented without a strategy for continuous monitoring of their effect.
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Affiliation(s)
- Blanca Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington NSW 2052, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington NSW 2052, Australia
| | - Oscar Perez Concha
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington NSW 2052, Australia
| | - Ying Wang
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington NSW 2052, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Kensington NSW 2052, Australia
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Assareh H, Ou L, Chen J, Hillman K, Flabouris A, Hollis SJ. Geographic variation of failure-to-rescue in public acute hospitals in New South Wales, Australia. PLoS One 2014; 9:e109807. [PMID: 25310260 PMCID: PMC4195695 DOI: 10.1371/journal.pone.0109807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 09/14/2014] [Indexed: 12/21/2022] Open
Abstract
Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.
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Affiliation(s)
- Hassan Assareh
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Epidemiology, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lixin Ou
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenneth Hillman
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthas Flabouris
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephanie J. Hollis
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation & South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009. PLoS One 2014; 9:e96164. [PMID: 24788787 PMCID: PMC4006895 DOI: 10.1371/journal.pone.0096164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/03/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. METHODS We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. RESULTS The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. CONCLUSIONS The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities.
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Wang Y, Eldridge N, Metersky ML, Verzier NR, Meehan TP, Pandolfi MM, Foody JM, Ho SY, Galusha D, Kliman RE, Sonnenfeld N, Krumholz HM, Battles J. National trends in patient safety for four common conditions, 2005-2011. N Engl J Med 2014; 370:341-51. [PMID: 24450892 PMCID: PMC4042316 DOI: 10.1056/nejmsa1300991] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown. METHODS We used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. RESULTS The study included 61,523 patients hospitalized for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% confidence interval [CI], 0.7 to 1.9), the proportion of patients with one or more adverse events declined from 26.0% to 19.4% (difference, 6.6 percentage points; 95% CI, 3.3 to 10.2), and the number of adverse events per 1000 hospitalizations declined from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0). Among patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4), the proportion of patients with one or more adverse events declined from 17.5% to 14.2% (difference, 3.3 percentage points; 95% CI, 1.0 to 5.5), and the number of adverse events per 1000 hospitalizations declined from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7). Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates. CONCLUSIONS From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. (Funded by the Agency for Healthcare Research and Quality and others.).
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Affiliation(s)
- Yun Wang
- From Qualidigm, Wethersfield (Y.W., M.L.M., N.R.V., T.P.M., M.M.P., J.M.F., S.-Y.H., D.G.), the Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington (M.L.M.), and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (Y.W., H.M.K.), the Department of Health Policy and Management, Yale School of Public Health (H.M.K.), and the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program (H.M.K.) and the Section of General Internal Medicine (T.P.M., D.G., H.M.K.), Department of Internal Medicine, Yale University School of Medicine, New Haven - all in Connecticut; the Department of Biostatistics, Harvard School of Public Health (Y.W.), and the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (J.M.F.) - all in Boston; and the Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville (N.E., J.B.), and the Centers for Medicare and Medicaid Services, Department of Health and Human Services, Baltimore (R.E.K., N.S.) - both in Maryland
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Morton JM, Nguyen N. Letter to the editor: Response to JAMA article which did not accept these letters delineating numerous problems with the published study. Surg Obes Relat Dis 2013; 9:831. [PMID: 24079903 DOI: 10.1016/j.soard.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Qasim M, Andrews RM. Despite Overall Improvement In Surgical Outcomes Since 2000, Income-Related Disparities Persist. Health Aff (Millwood) 2013; 32:1773-80. [DOI: 10.1377/hlthaff.2013.0194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mehwish Qasim
- Mehwish Qasim ( ) is a doctoral candidate in the Department of Health Management and Policy, University of Iowa, in Iowa City
| | - Roxanne M. Andrews
- Roxanne M. Andrews is a senior health services researcher at the Agency for Healthcare Research and Quality, in Rockville, Maryland
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Spetz J, Harless DW, Herrera CN, Mark BA. Using minimum nurse staffing regulations to measure the relationship between nursing and hospital quality of care. Med Care Res Rev 2013; 70:380-99. [PMID: 23401064 PMCID: PMC11067728 DOI: 10.1177/1077558713475715] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This study tests whether changes in licensed nurse staffing led to changes in patient safety, using the natural experiment of 2004 California implementation of minimum staffing ratios. We calculated counts of six patient safety outcomes from California Patient Discharge Data from 2000 through 2006, using the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI) software. For patients experiencing nonmortality-related PSIs, we measured mean lengths of stay. We estimated difference-in-difference equations of changes in PSIs using Poisson models and calculated the marginal impact of nurse staffing on outcomes from fixed-effect Poisson regressions. Licensed nurse staffing increased in the postregulation period, except for hospitals in the highest quartile of preregulation staffing. Growth in registered nurse staffing was associated with improvement for only one PSI and reduced length of stay for one PSI. Higher registered nurse staffing per patient day had a limited impact on adverse events in California hospitals.
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Affiliation(s)
- Joanne Spetz
- Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118, USA.
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Sukumar S, Roghmann F, Trinh VQ, Sammon JD, Gervais MK, Tan HJ, Ravi P, Kim SP, Hu JC, Karakiewicz PI, Noldus J, Sun M, Menon M, Trinh QD. National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA. BMJ Open 2013; 3:bmjopen-2013-002843. [PMID: 23804313 PMCID: PMC3696870 DOI: 10.1136/bmjopen-2013-002843] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national trends after major cancer surgery. DESIGN Retrospective, cross-sectional analysis of a weighted-national estimate from the Nationwide Inpatient Sample (NIS) undergoing major oncological procedures (colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy and prostatectomy). The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were utilised to identify trends in hospital-acquired adverse events. SETTING Secondary and tertiary care, US hospitals in NIS PARTICIPANTS: A weighted-national estimate of 2 508 917 patients (>18 years, 1999-2009) from NIS. PRIMARY OUTCOME MEASURES Hospital-acquired adverse events. RESULTS 324 852 patients experienced ≥1-PSI event (12.9%). Patients with ≥1-PSI experienced higher rates of in-hospital mortality (OR 19.38, 95% CI 18.44 to 20.37), prolonged length of stay (OR 4.43, 95% CI 4.31 to 4.54) and excessive hospital-charges (OR 5.21, 95% CI 5.10 to 5.32). Patients treated at lower volume hospitals experienced both higher PSI events and failure-to-rescue rates. While a steady increase in the frequency of PSI events after major cancer surgery has occurred over the last 10 years (estimated annual % change (EAPC): 3.5%, p<0.001), a concomitant decrease in failure-to-rescue rates (EAPC -3.01%) and overall mortality (EAPC -2.30%) was noted (all p<0.001). CONCLUSIONS Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.
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Affiliation(s)
- Shyam Sukumar
- Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA
| | - Florian Roghmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
| | - Vincent Q Trinh
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Jesse D Sammon
- Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA
| | - Mai-Kim Gervais
- Division of General Surgery, University of Montreal Health Center, Montreal, Canada
| | - Hung-Jui Tan
- Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Praful Ravi
- Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA
| | - Simon P Kim
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jim C Hu
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Joachim Noldus
- Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Mani Menon
- Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, Michigan, USA
| | - Quoc-Dien Trinh
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a meta-analysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot meta-analyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research.
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Kavanagh KT, Cimiotti JP, Abusalem S, Coty MB. Moving healthcare quality forward with nursing-sensitive value-based purchasing. J Nurs Scholarsh 2012; 44:385-95. [PMID: 23066956 PMCID: PMC3558794 DOI: 10.1111/j.1547-5069.2012.01469.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. DESIGN AND METHODS Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. FINDINGS Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. CONCLUSIONS Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. CLINICAL RELEVANCE NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.
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Abstract
The English National Health Service (NHS) announced a new programme to incentivize use of the NHS Safety Thermometer (NHS ST) in the NHS Operating Framework for 2012/13. For the first time, the NHS is using the Commissioning for Quality and Innovation (CQUIN) scheme, a contract lever, to incentivize ALL providers of NHS care to measure four common complications (harms) using the NHS ST in a proactive way on one day per month. This national CQUIN scheme provides financial reward for the collection of baseline data with a view to incentivizing the achievement of improvement goals in later years. In this paper, we describe the rationale for this large-scale data collection, the purpose of the instrument and its potential contribution to our current understanding of patient safety. It is not a comprehensive description of the method or preliminary data. This will be published separately. The focus of the NHS ST on pressure ulcers, falls, catheters and urine infection and venous thromboembolism is broadly applicable to patients across all healthcare settings, but is specifically pertinent to older people who, experiencing more healthcare intervention, are at risk of not one but multiple harms. In this paper, we also describe an innovative patient-level composite measure of the absence of harm from the four identified, termed as “harmfreecare” which is unique to the NHS ST and is under development to raise standards for patient safety.
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Davis MM, Gross CP, Clancy CM. Building a bridge to somewhere better: linking health care research and health policy. Health Serv Res 2012; 47:329-36. [PMID: 22239661 PMCID: PMC3393014 DOI: 10.1111/j.1475-6773.2011.01373.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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