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Havranek MM, Rüter F, Bilger S, Dahlem Y, Oliveira L, Ehbrecht D, Moos RM, Westerhoff C, Beck T, Le Pogam MA. Validity of 16 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals. Int J Qual Health Care 2023; 35:0. [PMID: 37949115 PMCID: PMC10656600 DOI: 10.1093/intqhc/mzad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.
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Affiliation(s)
- Michael M Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne 6002, Switzerland
| | - Florian Rüter
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Selina Bilger
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Yuliya Dahlem
- University Hospital Zurich, Rämistrasse 100, Zurich 8006, Switzerland
| | - Leonel Oliveira
- University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Daniela Ehbrecht
- Zug Cantonal Hospital, Landhausstrasse 11, Zug 6340, Switzerland
| | - Rudolf M Moos
- Cantonal Hospital Winterthur, Brauerstrasse 15, Winterthur 8400, Switzerland
| | - Christian Westerhoff
- Hirslanden Private Hospital Group, Boulevard Lilienthal 2, Zurich 8152, Switzerland
| | - Thomas Beck
- University Hospital Berne (Inselspital), Freiburgstrasse, Berne 3010, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Unisanté (University Center for Primary Care and Public Health), University of Lausanne, Route de la Corniche 10, Lausanne 1010, Switzerland
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Lee K, Hwang J, Lee CM. The Usefulness of Present-on-Admission Data as an Indicator of Healthcare Quality Evaluation Using the Korean National Hospital Discharge in-Depth Injury Survey Data from 2006 to 2019. Risk Manag Healthc Policy 2023; 16:2309-2320. [PMID: 37953808 PMCID: PMC10637211 DOI: 10.2147/rmhp.s423555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality. Patients and Methods We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS). Results Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses. Conclusion All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.
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Affiliation(s)
- Kyunghee Lee
- Department of Healthcare Management, Eulji University of Korea, Seongnam, Republic of Korea
| | - Jieun Hwang
- College of Health and Welfare, Department of Health Administration, Dankook University, Cheonan, Republic of Korea
| | - Chang Min Lee
- Department of Gastroenterology, Changwon Hanmaeum Hospital, Changwon, Republic of Korea
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Zhang Z, Yang H, Luo M. Association Between Charlson Comorbidity Index and Community-Acquired Pressure Injury in Older Acute Inpatients in a Chinese Tertiary Hospital. Clin Interv Aging 2021; 16:1987-1995. [PMID: 34880605 PMCID: PMC8645800 DOI: 10.2147/cia.s338967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To explore the correlation between community-acquired pressure injury (CAPI) and comorbidities in elderly patients with emergency admission. PATIENTS AND METHODS Patients aged 65 years or above were enrolled from multiple departments, such as Internal Medicine, Surgery, Geriatrics, and Intensive Care Unit of Wuhan Third Hospital, which is affiliated to Wuhan University, from January to December 2020. Comorbidity data were extracted using the 10th edition of the International Classification of Diseases (ICD-10) from the hospital electronic medical record system, and the Charlson Comorbidity Index (CCI) was calculated using these data. Participants were divided into two groups according to whether pressure injury was present at admission. The baseline characteristics of the two groups were compared using Student's t-tests, Mann-Whitney U-tests, and chi-square tests. Univariate and multivariate logistic regression models were constructed to explore the relationship between CAPI and the CCI. Smooth curve fitting was used to show the relationship between the CCI and CAPI. By drawing the receiver operating characteristic curve, the CCI was used to predict CAPI. RESULTS A total of 5759 participants with an average age of 75.1 ± 7.6 were included in this population-based study. The prevalence of CAPI was 4.3%. In logistic regression analysis, there was a positive relationship between the CCI and CAPI after adjustment for sex, age, hypoproteinemia, and anemia (OR = 1.37, 95% CI = 1.29-1.45, p < 0.001, trend test p < 0.001). The area under the receiver operating characteristic curve was 0.75, and the maximum value of the Youden index was 0.35, with a critical value of 5.5. CONCLUSION The development of CAPI was positively correlated with the CCI. The risk of developing pressure injury increases with the number and severity of comorbidities. This study shows that the CCI has certain reference value in predicting CAPI.
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Affiliation(s)
- Zhili Zhang
- Department of Surgical, Wuhan Third Hospital Affiliated to Wuhan University, Wuhan, 430070, People's Republic of China
| | - Hongli Yang
- Department of Public Health, The First Community Health Service Center of Guanshan, Wuhan, 430073, People's Republic of China
| | - Man Luo
- Department of Nursing, Wuhan Third Hospital Affiliated to Wuhan University, Wuhan, 430070, People's Republic of China
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Abstract
OBJECTIVE The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU). METHODS A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP). RESULTS The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU). CONCLUSION Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.
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Affiliation(s)
- Stella Olivo
- 1 Department of Maternity. Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Cristina Canova
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, University of Padua, Padua, Italy
| | - Angela Peghetti
- 3 Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Maurilio Rossi
- 4 Azienda Ospedaliero-Universitaria Careggi di Firenze, Florence, Italy
| | - Renzo Zanotti
- 5 Laboratory of Nursing Studies, Public Health Section, Department of Medicine, University of Padova, Padua, Italy
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Aliyu S, Cohen B, Liu J, Larson E. Prevalence and risk factors for bloodstream infection present on hospital admission. J Infect Prev 2017; 19:37-42. [PMID: 29317913 DOI: 10.1177/1757177417720998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022] Open
Abstract
Background Bloodstream infection present on hospital admission (BSI-POA) is a major cause of morbidity and mortality. The purpose of this study was to measure prevalence and describe the risk factors of patients with BSI-POA and to determine the prevalence of resistance in isolates by admission source. Methods We conducted a retrospective cohort study of patients discharged from three hospitals in New York City between 2006 and 2014. BSI-POA was defined as BSI diagnosed within 48 h of hospitalisation. Results The prevalence for BSI-POA was 5307/315,010 discharges (1.7%). The odds of being admitted with BSI-POA were greatest among patients admitted with renal failure, chronic dermatitis, malignancies and prior hospitalisation. Odds ratios and 95% confidence intervals (CI) were 2.72 (95% CI = 2.56-2.88), 2.15 (95% CI = 1.97-2.34), 1.76 (95% CI = 1.64-1.88) and 1.59 (95% CI = 1.50-1.69), respectively. The largest proportion of BSI-POA presented with Staphylococcus aureus (48.4%), followed by Enterococcus faecalis/faecium (20.3%), Klebsiella pneumoniae (16.2%), Streptococcus pneumoniae (8.7%), Pseudomonas aeruginosa (4.2%) and Acinetobacter baumannii (2.2%). Overall, 44% of those admitted from nursing homes presented with antibiotic resistant strains versus 34% from other hospitals and 31% from private homes (P = 0.002). Conclusion Understanding the risk factors of patients who present to the hospital with BSI could enable timely interventions and better patient outcomes.
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Affiliation(s)
- Sainfer Aliyu
- School of Nursing, Columbia University, New York, NY, USA
| | - Bevin Cohen
- School of Nursing, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, USA
| | - Elaine Larson
- School of Nursing, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Hughes JS, Eisenhandler J, Goldfield N, Weinberg PG, Averill R. Postadmission sepsis as a screen for quality problems: a case-control study. Am J Med Qual 2013; 29:499-507. [PMID: 24226649 DOI: 10.1177/1062860613509002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present on admission (POA) indicator used with diagnosis codes listed in hospital discharge abstracts makes it possible to screen for possible in-hospital complications, which may in turn point to quality of care problems. A case-control study was performed among 382 patients from 30 New York State hospitals to see if lapses in quality were associated with the development of postadmission sepsis. Cases with hospital-acquired sepsis (labeled not POA) were compared with matched controls without sepsis. The authors found that central venous catheters and emergently inserted peripheral intravenous catheters were associated with subsequent development of sepsis. Urethral catheters were associated with sepsis for medical patients but not for surgical patients. Adherence to several process of care guidelines was incomplete but none occurred statistically significantly more frequently among sepsis cases than controls. Using discharge abstract diagnosis codes to determine the presence of postadmission complications shows promise for identifying areas for quality improvement.
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