Application of patient safety indicators internationally: a pilot study among seven countries.
OBJECTIVE
To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ).


METHODS
A retrospective cross-sectional study.


METHODS
Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006.


METHODS
Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat.


RESULTS
Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821-0.966). However, there was substantial systematic variation in rates across countries.


CONCLUSIONS
This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. 'birth trauma', 'complications of anesthesia') may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine databases.
Drösler
Saskia E
SE
Faculty of Industrial Engineering and Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld, Germany. saskia.droesler@hsnr.de
Klazinga
Niek S
NS
Romano
Patrick S
PS
Tancredi
Daniel J
DJ
Gogorcena Aoiz
Maria A
MA
Hewitt
Moira C
MC
Scobie
Sarah
S
Soop
Michael
M
Wen
Eugene
E
Quan
Hude
H
Ghali
William A
WA
Mattke
Soeren
S
Kelley
Edward
E
D000465:Algorithms; D003430:Cross-Sectional Studies; D006801:Humans; D038801:International Classification of Diseases; D038622:Internationality; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration*