title: Tracking rates of Patient Safety Indicators over time: lessons from the Veterans Administration.
abstract: BACKGROUND
  The Patient Safety Indicators (PSIs), developed by the Agency for Healthcare Research and Quality, are useful screening tools for highlighting areas in which quality should be further investigated and providing useful benchmarks for tracking progress.
  
  
  OBJECTIVE
  Our objectives were to: 1) provide a descriptive analysis of the incidence of PSI events from 2001 to 2004 in the Veterans Health Administration (VA); 2) examine trends in national PSI rates at the hospital discharge level over time; and 3) assess whether hospital characteristics (eg, teaching status, number of beds, and degree of quality improvement implementation) and baseline safety-related hospital performance predict future hospital safety-related performance.
  
  
  METHODS
  We examined changes in risk-adjusted PSI rates at the discharge level, calculated the correlation between hospitals' risk-adjusted PSI rates in 2001 with subsequent years, and developed generalized linear models to examine predictors of hospitals' 2004 risk-adjusted PSI rates.
  
  
  RESULTS
  Risk-adjusted rates of 2 of the 15 PSIs demonstrated significant trends over time. Rates of iatrogenic pneumothorax increased over time, whereas rates of failure to rescue decreased. Most PSIs demonstrated consistent rates over time. After accounting for patient and hospital characteristics, hospitals' baseline risk-adjusted PSI rates were the most important predictors of their 2004 risk-adjusted rates for 8 PSIs.
  
  
  CONCLUSIONS
  The PSIs are useful tools for tracking and monitoring patient safety events in the VA. Future research should investigate whether trends reflect better or worse care or increased attention to documenting patient safety events.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VAMC (152), Bedford, Massachusetts 01730, USA. akrosen@bu.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Shibei
authors.initials: S
authors.lastname: Zhao
authors.forename: Peter
authors.initials: P
authors.lastname: Rivard
authors.forename: Susan
authors.initials: S
authors.lastname: Loveland
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.forename: Anne
authors.initials: A
authors.lastname: Elixhauser
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D005260:Female; D006739:Hospital Administration; D006801:Humans; D007049:Iatrogenic Disease; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D011030:Pneumothorax / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data* / Q000639:trends*; D012449:Safety; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data* / Q000639:trends*