title: Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.
abstract: BACKGROUND
  The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors.
  
  
  METHODS
  The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed.
  
  
  RESULTS
  Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions.
  
  
  CONCLUSIONS
  These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality.
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S Huntington Avenue (152M), Boston, MA 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: hillary.mull@va.gov.
authors.forename: Hillary J
authors.initials: HJ
authors.lastname: Mull
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA, USA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Borzecki
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S Huntington Avenue (152M), Boston, MA 02130, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Loveland
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hickson
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S Huntington Avenue (152M), Boston, MA 02130, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: MacDonald
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S Huntington Avenue (152M), Boston, MA 02130, USA.
authors.forename: Marlena H
authors.initials: MH
authors.lastname: Shin
authors.affiliation: VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Cevasco
authors.affiliation: Department of Surgery, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S Huntington Avenue (152M), Boston, MA 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
mesh_terms: D006753:Hospital Records; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
keywords: Administrative data; Adverse surgical events; Patient Safety Indicators; VA Surgical Quality Improvement Program; Veterans Health Administration