title: Examining the impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration: the case of readmissions.
abstract: BACKGROUND
  By focusing primarily on outcomes in the inpatient setting one may overlook serious adverse events that may occur after discharge (eg, readmissions, mortality) as well as opportunities for improving outpatient care.
  
  
  OBJECTIVE
  Our overall objective was to examine whether experiencing an Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) event in an index medical or surgical hospitalization increased the likelihood of readmission.
  
  
  METHODS
  We applied the Agency for Healthcare Research and Quality PSI software (version 4.1.a) to 2003-2007 Veterans Health Administration inpatient discharge data to generate risk-adjusted PSI rates for 9 individual PSIs and 4 aggregate PSI measures: any PSI event and composite PSIs reflecting "Technical Care," "Continuity of Care," and both surgical and medical care (Mixed). We estimated separate logistic regression models to predict the likelihood of 30-day readmission for individual PSIs, any PSI event, and the 3 composites, adjusting for age, sex, comorbidities, and the occurrence of other PSI(s).
  
  
  RESULTS
  The odds of readmission were 23% higher for index hospitalizations with any PSI event compared with those with no event [confidence interval (CI), 1.19-1.26], and ranged from 22% higher for Iatrogenic Pneumothorax (CI, 1.03-1.45) to 61% higher for Postoperative Wound Dehiscence (CI, 1.27-2.05). For the composites, the odds of readmission ranged from 15% higher for the Technical Care composite (CI, 1.08-1.22) to 37% higher for the Continuity of Care composite (CI, 1.26-1.50).
  
  
  CONCLUSIONS
  Our results suggest that interventions that focus on minimizing preventable inpatient safety events as well as improving coordination of care between and across settings may decrease the likelihood of readmission.
authors.affiliation: Center for Leadership, Organization and Management Research (COLMR), VA Boston Healthcare System, Boston, MA 02130, USA. akrosen@bu.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Susan
authors.initials: S
authors.lastname: Loveland
authors.forename: Marlena
authors.initials: M
authors.lastname: Shin
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: Amresh
authors.initials: A
authors.lastname: Hanchate
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.forename: Ann
authors.initials: A
authors.lastname: Borzecki
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000706:statistics & numerical data*; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*