title: Do pre-existing complications affect the failure to rescue quality measures?
abstract: BACKGROUND
  A project sponsored by the University Health System Consortium has addressed the inaccuracy and high variability across institutions concerning the use of the failure to rescue (FTR) quality indicator defined by the Agency for Healthcare Research and Quality (AHRQ). Results indicated that of the complications identified by the quality indicator, 29.5% were pre-existing upon hospital admission.
  
  
  OBJECTIVE
  The purpose of our study was to investigate the possible bias to FTR measures by including cases of complications that were pre-existing at admission.
  
  
  METHODS
  Hospital discharges between 1 January 1996 and 30 September 2007 were retrospectively gathered from administrative databases. Using definitions outlined by the AHRQ and the National Quality Forum (NQF), FTR rates were calculated. Using present on admission coding, FTR rates were recalculated to differentiate between the rates of pre-existing and that of acquired cases.
  
  
  RESULTS
  Using the AHRQ definition, the overall FTR rate was 11.60%. The FTR rate for patients with pre-existing complications was 8.85%, whereas patients with complications acquired during hospitalisation had an FTR rate of 18.46% (p<0.001). The NQF FTR rate was 9.93%. Pre-existing and acquired FTR rates using the NQF measure were 9.42% and 12.77%, respectively (p<0.001).
  
  
  CONCLUSIONS
  Current definitions of FTR measures meant to identify inhospital complications appear biased by the inclusion of problems at admission. Furthermore, many patients with these complications are excluded from the algorithms. When taking into account the timing of the "complications", these measures can be useful for internal quality control. However, it should be stressed that the usefulness of the measures to compare institutions will be dependent on coding practices of institutions. Validation using chart review may be required.
authors.affiliation: Division of Health Care Policy & Research, Department of Health Sciences Research Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. moriarty.james@mayo.edu
authors.forename: J P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: D M
authors.initials: DM
authors.lastname: Finnie
authors.forename: M G
authors.initials: MG
authors.lastname: Johnson
authors.forename: J M
authors.initials: JM
authors.lastname: Huddleston
authors.forename: J M
authors.initials: JM
authors.lastname: Naessens
mesh_terms: D006801:Humans; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D017211:Treatment Failure; D014481:United States; D016270:United States Agency for Healthcare Research and Quality