Examining the validity of AHRQ's patient safety indicators (PSIs): is variation in PSI composite score related to hospital organizational factors?
Increasing use of Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) for hospital performance measurement intensifies the need to critically assess their validity. Our study examined the extent to which variation in PSI composite score is related to differences in hospital organizational structures or processes (i.e., criterion validity). In site visits to three Veterans Health Administration hospitals with high and three with low PSI composite scores ("low performers" and "high performers," respectively), we interviewed a cross-section of hospital staff. We then coded interview transcripts for evidence in 13 safety-related domains and assessed variation across high and low performers. Evidence of leadership and coordination of work/communication (organizational process domains) was predominantly favorable for high performers only. Evidence in the other domains was either mixed, or there were insufficient data to rate the domains. While we found some evidence of criterion validity, the extent to which variation in PSI rates is related to differences in hospitals' organizational structures/processes needs further study.
VA Boston Healthcare System, Boston, MA, USA marlena.shin@va.gov.
Marlena H
MH
Shin
VA Boston Healthcare System, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA.
Jennifer L
JL
Sullivan
VA Boston Healthcare System, Boston, MA, USA Boston University School of Medicine, Boston, MA, USA.
Amy K
AK
Rosen
Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA.
Jeffrey L
JL
Solomon
Lexington VA Medical Center, Lexington, KY, USA.
Edward J
EJ
Dunn
Boston University School of Public Health, Boston, MA, USA Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA VA eHealth Quality Enhancement Research Initiative, Bedford, MA, USA University of Massachusetts Medical School, Worcester, MA, USA.
Stephanie L
SL
Shimada
VA Boston Healthcare System, Boston, MA, USA VA Office of Academic Affiliations, Evaluation & Analytics, San Francisco, CA, USA.
Jennifer
J
Hayes
VA Boston Healthcare System, Boston, MA, USA Suffolk University, Sawyer Business School, Boston, MA, USA.
Peter E
PE
Rivard
D003430:Cross-Sectional Studies; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D061214:Patient Safety / Q000592:standards*; D010564:Personnel, Hospital; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards
Patient Safety Indicators; criterion validity; hospital; organizational factors; qualitative methods