title: Safety outcomes in the United States: trends and challenges in measurement.
abstract: OBJECTIVE
  To prepare Agency for Healthcare Research and Quality (AHRQ) for monitoring the impact of its own patient safety initiative, by exploring available outcomes data, assessing usability of measures, and estimating national trends in patient outcomes.
  
  
  METHODS
  Annual summary data on incidence of Joint Commission Sentinel Events, MEDMARX medication error events, and MDS measures of falls and pressure ulcers in nursing home residents. HCUP National Inpatient Sample (NIS) administrative claims data.
  
  
  METHODS
  Description and assessment of published summary data on selected safety measures. Analysis of selected Patient Safety Indicators (PSIs) and Utah–Missouri adverse event measures using HCUP NIS claims data (1994–2003).
  
  
  RESULTS
  Interpretation of safety outcome trends requires close attention to the characteristics of underlying data sources and measures. Encounter-based measures have been affected by changes in definitions and ICD-9 coding, as well as by changes in the structure of administrative datasets like HCUP NIS. Historical trends are mixed for the safety outcome measures reviewed, with some measures showing improvement, others deterioration, and still others remaining fairly stable.
  
  
  CONCLUSIONS
  Constructing national trends of safety outcomes is difficult because of limitations in available data sources and measures. Tracking growth in the adoption of safe practices could offer an important strategy for complementing existing safety measurement capabilities.
authors: RAND Health, 4570 Fifth Avenue, Pittsburgh, PA 15213, USA. michaelg@rand.org
authors: Michael D
authors: MD
authors: Greenberg
authors: Amelia M
authors: AM
authors: Haviland
authors: Hao
authors: H
authors: Yu
authors: Donna O
authors: DO
authors: Farley
mesh_terms: D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D019300:Medical Errors / Q000517:prevention & control* / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000639:trends*; D058996:Quality Improvement / Q000458:organization & administration / Q000639:trends*; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration / Q000639:trends*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016270:United States Agency for Healthcare Research and Quality