title: Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicator Rates Among Veteran Dual Users.
abstract: This study compares rates of 11 Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) among 266 203 veteran dual users (ie, those with hospitalizations in both the Veterans Health Administration [VA] and the private sector through Medicare fee-for-service coverage) during 2002 to 2007. PSI risk-adjusted rates were calculated using the PSI software (version 3.1a). Rates of pressure ulcer, central venous catheter-related bloodstream infections, and postoperative sepsis, areas in which the VA has focused quality improvement efforts, were found to be significantly lower in the VA than in the private sector. VA had significantly higher rates for 7 of the remaining 8 PSIs, although the rates of only 2 PSIs (postoperative hemorrhage/hematoma and accidental puncture or laceration) remained higher in the VA after sensitivity analyses were conducted. A better understanding of system-level differences in coding practices and patient severity, poorly documented in administrative data, is needed before conclusions about differences in quality can be drawn.
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA qc2112@bu.edu.
authors: Qi
authors: Q
authors: Chen
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA Boston University School of Medicine, Boston, MA.
authors: Amresh
authors: A
authors: Hanchate
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA Boston University School of Management, Boston, MA.
authors: Michael
authors: M
authors: Shwartz
authors: Boston University School of Medicine, Boston, MA Boston University School of Public Health, Boston, MA Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA.
authors: Ann M
authors: AM
authors: Borzecki
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA Boston University School of Medicine, Boston, MA.
authors: Hillary J
authors: HJ
authors: Mull
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA.
authors: Marlena H
authors: MH
authors: Shin
authors: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA Boston University School of Medicine, Boston, MA.
authors: Amy K
authors: AK
authors: Rosen
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards*; D014493:United States Department of Veterans Affairs / Q000592:standards / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: coding variation; patient safety; patient safety indicators; quality measurements; quality of care