How often are potential patient safety events present on admission?
BACKGROUND
Data fields that capture whether diagnoses are present on admission (POA)--distinguishing comorbidities from potential in-hospital complications--became part of the Uniform Bill for hospital claims in 2007. The AHRQ Patient Safety Indicators (PSIs) were initially developed as measures of potential patient safety problems that use routine administrative data without POA information. The impact of adding POA information to PSIs was examined.


METHODS
Data were used from California (CA) and New York (NY) Healthcare Cost and Utilization Project (HCUP) state inpatient databases for 2003, which include POA codes. Analysis was limited to 13 of 20 PSIs for which POA information was relevant, such as complications of anesthesia, accidental puncture, and sepsis.


RESULTS
In New York, 17% of cases revealed suspect POA coding, compared with 1%-2% in California. After suspect records were excluded, 92%-93% of secondary diagnoses in both CA and NY were POA. After incorporating POA information, most cases of decubitus ulcer (86%-89%), postoperative hip fracture (74%-79%), and postoperative pulmonary embolism/deep vein thrombosis (54%-58%) were no longer considered in-hospital patient safety events.


CONCLUSIONS
Three of 13 PSIs appear not to be valid measures of in-hospital patient safety events, but the remaining 10 appear to be potentially useful measures even in the absence of POA codes.
Houchens
Robert L
RL
Thomson Healthcare, Santa Barbara, California, USA. Bob.Houchens@thomson.com
Elixhauser
Anne
A
Romano
Patrick S
PS
D015897:Comorbidity; D003937:Diagnosis, Differential; D017052:Hospital Mortality; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D020379:Risk Adjustment / Q000379:methods; D017751:Safety Management; D014481:United States; D016270:United States Agency for Healthcare Research and Quality