title: Establishing standard performance measures for adult stroke patients: a nationwide inpatient sample database study.
abstract: BACKGROUND
  The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are used to evaluate the safety and quality of health care provided by health care systems and individual facilities. To understand better the incidence of PSIs and HACs in hospitalized patients with stroke, we determined the rates of these events among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database.
  
  
  METHODS
  We queried the NIS for all hospitalizations involving ischemic stroke. We determined the incidence of various PSIs and HACs by searching the hospital records for International Classification of Diseases, 9th edition, codes indicating each PSI or HAC. Statistical analysis was performed with SAS statistical software package.
  
  
  RESULTS
  There were 903,647 hospitalizations involving stroke in the NIS database for years 2002-2010. Among these hospitalizations, 137,161 (15.2%) patients experienced ≥1 Agency for Healthcare Research and Quality PSIs. The most common PSIs included postoperative respiratory failure (9.44%), sepsis (4.43%), and pressure ulcer (2.19%). Of stroke patients, 28,323 (3.13%) experienced ≥1 HACs. The most common HACs included falls and trauma (2.51%) and stage III and IV pressure ulcers (0.43%). Increasing comorbidity score (P ≤ 0.001) was associated with increased likelihood of all PSIs and HACs. The presence of PSIs or HACs resulted in increased length of stay, increased hospital charges, and an increase in mortality rates (P < 0.0001).
  
  
  CONCLUSIONS
  Our results estimate baseline national incidence rates of PSIs and HACs in patients with stroke. These data may be used to determine individual institutional improvements or success by comparison.
authors.affiliation: Department of Neurosurgery, University of Florida, Gainesville, Florida, USA. Electronic address: Maryam.rahman@neurosurgery.ufl.edu.
authors.forename: Maryam
authors.initials: M
authors.lastname: Rahman
authors.forename: Dan
authors.initials: D
authors.lastname: Neal
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D005260:Female; D006276:Health Facility Size; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D016270:United States Agency for Healthcare Research and Quality
keywords: AHRQ; Agency for Healthcare Research and Quality; CI; CMS; CVL; Centers for Medicare and Medicaid Services; Central venous line; Confidence interval; HAC; Hospital-acquired condition; ICD-9; IOM; Institute of Medicine; International Classification of Diseases, 9th edition; NIS; Nationwide Inpatient Sample; OR; Odds ratio; PPV; PSI; Patient safety indicator; Patient safety indicators; Pay for performance; Positive predictive value; Stroke