Does the Complications Screening Program flag cases with process of care problems? Using explicit criteria to judge processes.
BACKGROUND
The Complications Screening Program (CSP) aims to identify 28 potentially preventable complications of hospital care using computerized discharge abstracts, including demographic information, diagnosis and procedure codes.


OBJECTIVE
To validate the CSP as a quality indicator by using explicit process of care criteria to determine whether hospital discharges flagged by the CSP experienced more process problems than unflagged discharges.


METHODS
The (CSP was applied to computerized hospital discharge abstracts from Mledicare beneficiaries > 65 years old admitted in 1994 to hospitals in California and Connecticut for major surgery or medical treatment. ()f 28 CSP complications, 17 occurred sufficient frequently to study. Discharges flagged (cases) and unflagged (controls) by the (CSP were sampled and photocopied medical records were obtained. Physicians specified detailed, objective, explicit criteria, itemizing 'key steps' in processes of care that could potentially have prevented or caused complications. Trained nurses abstracted medical records using these explicit criteria. Process problem rates between cases and controls were compared.


RESULTS
The final sample included 740 surgical and 416 medical discharges. Rates of process problems were high, ranging from 24.4 to 82.5% across CSP screens for surgical cases. Problems were lower for medical cases, ranging from 2.0 to 69.1% across CSP screens. Problem rates were 45.7% for surgical and 5.0% for medical controls. Rates of problems did not differ significantly across flagged and unflagged discharges.


CONCLUSIONS
The CSP did not flag discharges with significantly higher rates of explicit process problems than unflagged discharges. Various initiatives throughout the USA use techniques similar to the CSP to identify complications of care. Based on these CSP findings, such approaches should be evaluated cautiously.
Iezzoni
L I
LI
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. liezzoni@bidmc.harvard.edu
Davis
R B
RB
Palmer
R H
RH
Cahalane
M
M
Hamel
M B
MB
Mukamal
K
K
Phillips
R S
RS
Banks
N J
NJ
Davis
D T
DT
D000368:Aged; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D003237:Connecticut / Q000453:epidemiology; D003628:Database Management Systems; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D006278:Medicare / Q000592:standards; D010351:Patient Discharge; D017064:Process Assessment, Health Care; D011366:Professional Review Organizations; D019984:Quality Indicators, Health Care; D018571:Sentinel Surveillance; D014481:United States