title: Using Harm-Based Weights for the AHRQ Patient Safety for Selected Indicators Composite (PSI-90): Does It Affect Assessment of Hospital Performance and Financial Penalties in Veterans Health Administration Hospitals?
abstract: OBJECTIVE
  To assess whether hospital profiles for public reporting and pay-for-performance, measured by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety for Selected Indicators (PSI-90) composite measure, were affected by using the recently developed harm-based weights.
  
  
  METHODS
  Retrospective analysis of 2012-2014 data from the Veterans Health Administration (VA).
  
  
  METHODS
  The AHRQ PSI software (v5.0) was applied to obtain the original volume-based PSI-90 scores for 132 acute-care hospitals. We constructed a modified PSI-90 using the harm-based weights developed by AHRQ. We compared hospital profiles for public reporting and pay-for-performance between these two PSI-90s and assessed patterns in these changes.
  
  
  RESULTS
  The volume-based and the harm-based PSI-90s were strongly correlated (r = 0.67, p < .0001). The use of the harm-based PSI-90 had a relatively small impact on public reporting (i.e., 5 percent hospitals changed categorization), but it had a much larger impact on pay-for-performance (e.g., 15 percent of hospitals would have faced different financial penalties under the Medicare Hospital-Acquired Condition Reduction Program). Because of changes in weights of specific PSIs, hospital profile changes occurred systematically.
  
  
  CONCLUSIONS
  Use of the harm-based weights in PSI-90 has the potential to significantly change payments under pay-for-performance programs. Policy makers should carefully develop transition plans for guiding hospitals through changes in any quality metrics used for pay-for-performance.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.|Department of Surgery, Boston University School of Medicine, Boston, MA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical Center, Bedford, MA.|Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.|Department of Internal Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Ann
authors.initials: A
authors.lastname: Borzecki
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.|Department of Operations and Technology Management, Boston University School of Management, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
mesh_terms: D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D061214:Patient Safety / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012052:Reimbursement, Incentive / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D058014:Veterans Health
keywords: Patient safety; composite measures; hospital profiling; performance assessment