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Transcript of Presentation on the results to date of the Federal Partnership for Patients (PfP) program, and...
Understanding the Data behind the National Landscape of Safety:
Have We Really Improved?
Consumers Advancing Patient Safety
Safety Across the Board Signature Learning Series
July 2015 Webinar
Welcome
Guest Speaker: Noel Eldridge, MSCenter for Quality Improvement and Patient Safety Agency for Healthcare Research and [email protected]
Moderator: Marty Hatlie, J.D.Project Patient [email protected]
Estimating and Measuring
Patient Safety at the National Level: Interim Update on 2013 Annual Hospital-Acquired
Condition Rate and Estimates of Cost Savings and
Deaths Averted From 2010 to 2013
Presentation for Consumers Advancing Patient Safety (CAPS) Webinar,
Understanding the Data Behind the National Landscape of Safety:
Have We Really Improved?
Noel Eldridge, MS
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality
July 30, 2015
Outline
• Background
• Pre-launch Partnership for Patients (PfP) Hospital-Acquired Condition (HAC) projections based on reviewing the literature► HAC incidence, preventability, PfP goal, cost, & lethality
• Measuring the 9 PfP HACs and “All-Other” HACs (rates or counts on 28 HACs) through Interim 2013 data► Estimating results based on measured HACs and pre-launch
projections of preventability, cost, & mortality
The PfP Report through Interim 2013 data is online at: http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html,
The Washington Post Fact Checker article: http://www.washingtonpost.com/blogs/fact-checker/wp/2015/05/12/the-
most-popular-fact-checks-of-april-2/
4
AHRQ Data Analysis Earns
Geppetto Checkmark
• President Obama uses
AHRQ analysis in remarks
on 5th anniversary of ACA
► “Fact Checker” awards Geppetto
Checkmark
► One of three Geppettos awarded*
► Most popular “Fact Check” for April
2015
• AHRQ analysis published
in December 2014 on the
impact of the Partnership for
Patients
Significant omissions and/or
exaggerations
Fact Checker, by Glenn Kessler
One Pinocchio
Some shading of facts
The Geppetto Checkmark
“the truth, the whole truth, and nothing but
the truth”
Two Pinocchios
Significant omissions
Three Pinocchios
Significant factual errors
*97 “Fact Checker” articles published
January 2015 through April 15, 2015
5
Why is the 2013 Data Still
“Interim?”
• The Federal Government does not yet have national
data on how many patients were discharged from
hospitals in 2013 (We do have Medicare fee-for-service
data, because that’s what we pay for directly)
• The best all-payer data comes from the Healthcare Cost
and Utilization Project (HCUP), which is voluntary (47
States and DC participate) and combines State data
► Without these data we can’t compute the Patient
Safety Indicators or surgical site infections, which are
approximately 5% and 2% of the PfP HAC total,
respectively
• We expect to release the final 2013 PfP HAC data in
September 20156
Goals for the
Partnership for Patients
• In August 2010, AHRQ and other HHS agencies were
assigned the task of developing a national patient safety
initiative. Direction came from the Office of Health
Reform and CMS
• As announced by HHS Secretary Sebelius in April 2011,
the Partnership for Patients had two main goals:
1) To reduce preventable HACs by 40%
2) To reduce 30-day hospital readmissions by 20%
• The new CMS Center for Medicare & Medicaid
Innovation (CMMI) was assigned to lead the program. In
December 2011, CMS selected and funded 26 Hospital
Engagement Networks to work with hospitals nationwide7
Context for the PfP
HAC Goals (1 of 2)
• Prior to and at launch we used estimates for
HACs (not measurements)
1. HAC estimates and preventabilities were based on:
Peer-reviewed and other publications
Internal data from AHRQ, CDC, and CMS (MPSMS,
PSIs, NHSN, and “non-payment HACs”)
HHS OIG reports
Consensus review of the various estimates collected
8
Context for the PfP
HAC Goals (2 of 2)
• Prior to and at launch we used estimates for
HACs (not measurements)
2. The percent reduction goal for each HAC was
based on data from large and successful projects
undertaken for each HAC
Cost per HAC and mortality per HAC estimates were
also developed
9
Pre-launch HACs and Estimates
• The nine types of HAC’s selected for the focus of the program were:1. Adverse Drug Event
2. Urinary Tract Infection
3. Central Line-Associate Bloodstream
4. Injury From Fall
5. Obstetrical Adverse Event
6. Pressure Ulcer
7. Surgical Site Infection
8. Ventilator-Associated Pneumonia
9. Venous Thromboembolism
► All Other HACs
10
Pre-launch HACs and
Estimates (cont’d)
• Exactly how we would measure these HACs was
not planned prior to launch, and “measurability”
was not a major factor in the selection of types
of HACs
• The main considerations in selection were:
► The harm that the HACs cause (considering incidence
and average harm per HAC) and
► Whether there was sufficient information on how to
implement a prevention program for each type of HAC
11
Partnership for Patients "Pre-launch"
Estimates of Cases and Preventability and
Goals for Prevention
PFP Hospital Acquired
Condition (HAC)
PFP Total
Cases
Estimate
PFP
Preventability
Estimate
PFP
Preventable
HACs
Estimate
PFP Reduction
Goal (of
Preventable
HACs)
PFP HAC
Reduction
Goal
PFP HACs
Remaining
if Goal Met
Adverse Drug Event1,900,000 50% 950,000 50% 475,000 1,425,000
Catheter-Associated Urinary
Tract Infection530,000 40% 212,000 50% 106,000 424,000
Central Line-Associated
Bloodstream Infection40,000 50% 20,000 50% 10,000 30,000
Injury from Fall200,000 25% 50,000 50% 25,000 175,000
Obstetrical Adverse Event380,000 30% 114,000 50% 57,000 323,000
Pressure Ulcer250,000 50% 125,000 50% 62,500 187,500
Surgical Site Infection110,000 35% 38,500 20% 7,700 102,300
Ventilator-Associated
Pneumonia40,000 50% 20,000 50% 10,000 30,000
Venous Thromboembolism
(post-surgery)100,000 40% 40,000 50% 20,000 80,000
All Other HACs2,430,000 44% 1,069,200 25% 267,300 2,162,700
Totals 5,980,000 44.1% 2,638,700 39.4% 1,040,500 4,939,500
17.4% 12
Partnership for Patients "Pre-launch"
Estimates of Cost and Death per HAC
PFP Hospital Acquired
Condition (HAC)
PFP HAC
Reduction
Goal
Additional
Inpatient
Cost per
HAC
Savings in Year
Goal is Met
(not rounded)
Deaths per
HAC
Deaths Prevented
in Year Goal is Met
(not rounded)
Adverse Drug Event 475,000 $5,000 $2,375,000,000 0.0204 9,675
Catheter-Associated Urinary
Tract Infection106,000 $1,000 $106,000,000 0.0233 2,470
Central Line-Associated
Bloodstream Infection10,000 $17,000 $170,000,000 0.1850 1,850
Injury from Fall
(originally $30,000)25,000 $7,234 $180,850,000 0.0550 1,375
Obstetrical Adverse Event 57,000 $3,000 $171,000,000 0.0015 84
Pressure Ulcer
(originally $43,000)62,500 $17,286 $1,080,375,000 0.0723 4,519
Surgical Site Infection 7,700 $21,000 $161,700,000 0.0282 217
Venous Thromboembolism
(post-surgery)20,000 $8,000 $160,000,000 0.1438 2,876
Ventilator-Associated
Pneumonia10,000 $21,000 $210,000,000 0.1040 1,040
All Other HACs 267,300 $17,000 $4,544,100,000 0.0454 12,133
Totals 1,040,500 $9,159,025,000 36,239
Total for a 3-year PFP
(@25%, 50%, 100%)1,820,875 $16,028,293,750 63,419
Total for a 4-year PFP
(@25%, 50%, 75%, 100%)2,601,250 $22,897,562,500 90,598
13
14
Establishing the Measured
2010 HAC Baseline and
HAC Data through CY 2013 (Interim)
15
Measuring the Nine HACs
1. Adverse Drug Events (ADE)(from Medicare Patient Safety Monitoring System - MPSMS)
2. Catheter-Associated Urinary Tract Infections (CAUTI)(from MPSMS)
3. Central Line-Associated Bloodstream Infections (CLABSI)(from
MPSMS)
4. Injuries from Falls and Immobility (from MPSMS)
5. Obstetric Adverse Events (from Patient Safety Indicators - PSIs)
6. Pressure Ulcers (from MPSMS)
7. Surgical Site Infections (SSI)(from CDC’s National Healthcare Safety
Network [NHSN] – special calculation)
8. Venous Thromboembolism (VTE)(from MPSMS)
9. Ventilator-Associated Pneumonia (VAP)(from MPSMS)
• “All Other HACs” (10 from MPSMS and 4 from PSIs)
The nine HACs total about 80 percent of measured 2010 HACs
(as opposed to about 60 percent of the pre-launch estimated HACs)16
17
Good Measures but not Perfect
• We have good measures for the 9 HACs, but they are not perfect; for example:► VTE measure is post-op only
► ADE measures miss many ADEs – e.g., those due to opioids or allergies, etc.
► CAUTIs or CLABSIs caused by inpatient processes but manifesting post-discharge cannot be counted
► SSI measure covers only 17 selected procedures
► OB measures count injuries to mother only
• The measures for the 9 HACs and All Others do not represent every case of ADE, VTE, SSI, OB event, etc., but they do capture a consistent set of events every year and can be used to track the overall national trend in occurrence of HACs
18
2010 Baseline and 2011, 2012, and
2013 (Interim) HAC Data & Goal
PFP Hospital-Acquired Condition2010
Baseline 2011 2012 Interim 2013 PFP Goal
Percent change
from 2010 to date
(2013 MPSMS, 2012
NHSN& PSI)
Adverse Drug Events (ADE) 49.5 48.7 41.9 40.3 40.8 -19%
Catheter-Associated Urinary Tract
Infections (CAUTI)12.2 11.3 10.6 8.8 10.1 -28%
Central Line-Associated
Bloodstream Infections (CLABSI)0.55 0.52 0.51 0.28 0.45 -49%
Falls 7.9 7.8 7.2 7.2 6.5 -9%
Obstetric Adverse Events 2.5 2.5 2.4 2.4 2.1 -6%
Pressure Ulcers 40.3 40.4 39.4 32.5 33.2 -19%
Surgical Site Infections (SSI) 2.9 2.5 2.5 2.4 2.4 -24%
Ventilator-Associated Pneumonias
(VAP)1.2 1.1 1.0 1.1 1.0 -4%
Venous Thromboembolisms (VTE)
(Corrected May 2014)0.85 0.72 0.99 0.71 0.70 -17%
All Other HACs 27.3 26.7 25.7 25.1 22.5 -8%
Totals 145 142 132 121 120 -17%
19
Putting the Numbers in Context
• Where does 145/1000 discharges (for 2010) come from?
► 4,757,000 HACs (in 2010)
► 32,750,000 discharges (patients >17 years old)
► Equals 145.25 HACs per 1000 discharges
► 121 HACs (in 2013) is based on 3,957,200 HACs for 32,750,000
discharges
• Is 145 HACs per 1000 discharges the same as 14.5% of
patients having HACs?
► No. Some patients have more than one HAC, so it might be 11
or 12% of patients having 1 or more HAC
20
HACs and Hospital Discharges
• Our 2010 baseline data estimates are:► 4,757,000 HACs
► Approximately 2,100,000 preventable HACs (44%)
• Among:► 32,750,000 discharges (>17 y.o.)
• This means:► 145 HACs per 1,000 discharges
► 64 Preventable HACs per 1,000 discharges (44% of 145)
► 40% Goal for 2014 is to prevent about 25 of these 64 HACs
21
Interim* 2013 AHRQ National Scorecard
on HACs Compared to 2010 Baseline
• 17% Preliminary reduction in 2013 HACs
► from 4,757,000 to 3,960,000
► from 145 per 1,000 discharges to 121 per 1,000
discharges
► Very close to PFP Goal of 120 (goal for 2014)
• $8B in estimated associated cost savings for 2013
► $12B for 2013, 2012, and 2011 combined
• Estimated associated reductions in deaths due to HACs
► ~35,000 for 2013
► ~50,000 for 2013, 2012, and 2011 combined
*Based on final MPSMS-based 2013 HACs, preliminary 2013 NHSN-based
HAC, and temporary re-use of 2012 data for 2013 PSI-based HACs 22
Details of HAC Changes for 2010 and 2013
and Estimates of Associated Results
PfP Hospital-Acquired
Condition
2010
Measured
Baseline for
HACs
(rounded)
2013
Measured
HACs
(rounded)
Measured
Reduction in
HACs (2010
vs. 2013)
Percent
Reduction in
Measured HACs
(From 2010 to
2013)
Projected Cost Savings
in 2013: Based on
Measured Reductions
of HACs in 2013 vs.
2010
Projected Reductions
in Deaths in 2013:
Based on Measured
Reductions of HACs
in 2013 vs. 2010
Adverse Drug Events 1,621,000 1,320,000 301,000 19% $1,505,000,000 6,020
Catheter-Associated
Urinary Tract Infections
400,000 290,000 110,000 28% $110,000,000 2,563
Central Line-Associated
Bloodstream Infections
18,000 9,200 8,800 49% $149,600,000 1,628
Falls 260,000 240,000 20,000 8% $144,680,000 1,100
Obstetric Adverse
Events (2012 data used
in lieu of 2013)
82,000 77,000 5,000 6% $15,000,000 7
Pressure Ulcers 1,320,000 1,060,000 260,000 20% $4,420,000,000 18,824
Surgical Site Infections 96,000 78,000 18,000 19% $378,000,000 508
Ventilator-Associated
Pneumonias
38,000 37,000 1,000 3% $21,000,000 144
(Post-op) Venous
Thromboembolisms
28,000 23,000 5,000 18% $40,000,000 520
All Other HACs (2013
MPSMS data and 2012
PSI data)
894,000 823,000 71,000 8% $1,207,000,000 3,216
Totals 4,757,000 3,957,200 799,800 17% $7,990,280,000 34,530
23
24
Thanks for Your Patience
Any Questions?
25
Backup Slides
26
Background and Key Concepts
1. HHS had no pre-existing standardized way to track and trend the overall patient safety
status or rate of adverse events/hospital-acquired conditions at U.S. hospitals starting in
2010, which is what was needed for PfP
2. For PfP we couldn’t develop new measures, because we needed data for HACs going
back to before the PfP was announced, so we could establish a pre-launch “baseline”
3. What we developed for PfP to measure HACs might be considered a “market basket”-
type rate
► It is based on 28 different measures of types of adverse events or HACs; it’s not an
“all-cause harm” rate
4. We needed an all-payer rate, so we developed methods to produce incidence rates of
HACs to represent all discharges from short-stay acute care hospitals for patients 18 y.o.
and over
5. For 2011 and 2012, we’ve “normalized” the HAC rates and counts to make them all “as if”
the same number of 18+ y.o. patients were discharged in 2011 and 2012 as was the case
in 2010 (32,750,000: estimated from HCUP)
► Rates and counts won’t go up or down because of changes in discharges 2010-2014
6. In addition to use in the PfP, the bottom-line rate of HACs per 1,000 discharges that
we’ve developed is included in the “Annual Progress Report to Congress: National
Strategy for Quality Improvement in Health Care” as the “Incidence of measurable
hospital-acquired conditions”
27
Estimated HAC-Associated Cumulative Reductions in Costs
and Deaths: 2011, 2012, and Interim 2013 Data
24%
2%
2%3%
0.3%
40%
8%
1%
0.3%
20%
Estimated Cost Savings, by Hospital-Acquired Condition
(HAC), 2010 to 2013
23%
9%
4%
5%
0.03%
40%
3%
2%
1%
13%
Estimated Deaths Averted, by Hospital-Acquired Condition (HAC), 2010 to 2013
Adverse Drug Events
Catheter-Associated UrinaryTract Infections
Central Line-AssociatedBloodstream Infections
Falls
Obstetric Adverse Events
Pressure Ulcers
Surgical Site Infections
Ventilator-AssociatedPneumonias
(Post-op) VenousThromboembolisms
All Other HACs
28
Key Corrections to the Raw Data
• Weighting (to properly “balance” HAC rates across 4 admitting diagnosis-groups or “conditions”)
• “Conversion” (from rates within “4-conditions”*, to rates representing “all-conditions”)
*Note: The “4-conditions” are those available in the CMS IQR sample starting in 2009 that are used for MPSMS: CHF, AMI, PNEU, and SCIP
29
Calculating the AHRQ
National Scorecard (“Incidence of Measurable Hospital-Acquired Conditions”)
1. MPSMS weighted rate based on 4 conditions Yellow
2. “Factors” or “Ratios” for MPSMS rates (including use
of MPSMS 2005-2006 and 2009-2010 data) Orange
3. HCUP 2012 discharges Green
4. CDC NHSN’s special PfP calculation of SSIs (for 17
operations) Blue
5. Patient Safety Indicators (for OB Adverse Events and
as part of “All-Other HACs” calculation) Pink
6. Normalize to 2010 discharges Purple
7. Calculate 2012 HAC Rates Gray
8. Round 2012 numbers (HAC counts and rate)
30
Table With Color-Coded Inputs
PFP Hospital-
Acquired
Condition Source Measure
2012 (full CY)
Weighted HAC
Rate per 1,000
Discharges
(MPSMS only)
MPSMS Factor
to Convert 4-
Conditions Data
to All-
ConditionsData
2012 (18+ y.o.)
Discharges
2012 PFP HACs
(Unrounded and
not Normalized)
2012 PFP HACs
Normalized with
2010 Discharges
(Unrounded
HACs Rate)
2012
Normalized
PFP HAC
Rate
2012 PFP HACs
Normalized with
2010 Discharges
(Rounded HACs)
MPSMS ADE Associated with Digoxin 0.30 1.08 30,636,000 9,922 10,606 0.32 11,000
MPSMS ADE Associated with Hypoglycemic Agents 30.17 0.77 30,636,000 711,114 760,184 23.21 760,000
MPSMS ADE Associated with IV Heparin 8.71 0.50 30,636,000 132,511 141,655 4.33 140,000
MPSMS ADE Associated with LMWH and Factor Xa Inhibitor 17.29 0.55 30,636,000 291,551 311,669 9.52 310,000
MPSMS ADE Associated with Warfarin 7.26 0.62 30,636,000 138,731 148,304 4.53 150,000
MPSMS Total ADE (sum of 5 above) 30,636,000 1,283,829 1,372,418 41.91 1,372,000
CAUTI MPSMS Catheter Associated Urinary Tract Infections 14.40 0.73 30,636,000 324,224 346,596 10.58 350,000
CLABSI MPSMS Blood Stream Infections Associated with Central Venous Catheters 0.79 0.64 30,636,000 15,538 16,610 0.51 17,000
Falls MPSMS In-hospital Patient Falls 8.51 0.84 30,636,000 219,408 234,548 7.16 230,000
Obstetric
Adverse EventsPSI
OB Trauma in Vaginal Delivery with (PSI 18) and without Instrument
(PSI 19)NA NA 30,636,000 72,385 77,380 2.36 77,000
Pressure Ulcer MPSMS Hospital Acquired Pressure Ulcers 46.44 0.85 30,636,000 1,207,864 1,291,211 39.43 1,300,000
Surgical Site
InfectionNHSN SSIs for 17 procedures in 2010 w/CDC data NA NA 30,636,000 76,882 82,187 2.51 82,000
VAP MPSMS Ventilator Associated Pneumonia 2.10 0.49 30,636,000 31,355 33,519 1.02 34,000
VTE MPSMS Postoperative Venous Thromboembolic Events 2.37 0.42 30,636,000 30,375 32,471 0.99 32,000
MPSMS Femoral Artery Puncture for Catheter Angiographic Procedures 2.36 0.83 30,636,000 60,378 64,545 1.97 65,000
MPSMS AE associated with Hip Joint Replacements 3.38 0.28 30,636,000 28,541 30,510 0.93 31,000
MPSMS AE associated with Knee Joint Replacements 2.86 0.28 30,636,000 24,776 26,486 0.81 26,000
MPSMS Contrast Nephropathy Associated with Catheter Angiography 11.39 0.46 30,636,000 160,801 171,897 5.25 170,000
MPSMS Hospital Acquired MRSA 0.36 0.79 30,636,000 8,752 9,356 0.29 9,400
MPSMS Hospital Acquired Vancomycin Resistant Enterococcus (VRE) 0.14 0.72 30,636,000 3,159 3,377 0.10 3,400
MPSMS Hospital Acquired Antibiotic Associated C diff 4.06 0.81 30,636,000 101,165 108,146 3.30 110,000
MPSMS Mechanical Complications Associated with Central Venous Catheters 4.92 0.76 30,636,000 114,641 122,552 3.74 120,000
MPSMS Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries 3.88 0.46 30,636,000 54,592 58,360 1.78 58,000
MPSMS Postoperative Pneumonia 6.82 0.45 30,636,000 94,277 100,782 3.08 100,000
PSI Iatrogenic Pneumothorax (PSI 6) NA NA 30,636,000 11,251 12,027 0.37 12,000
PSI Post-op Hemorrhage or Hematoma (PSI 9) NA NA 30,636,000 18,339 19,604 0.60 20,000
PSI Post-op Respiratory Failure (PSI 11) NA NA 30,636,000 46,750 49,976 1.53 50,000
PSI Accidental Puncture or Laceration (PSI 15) NA NA 30,636,000 61,305 65,535 2.00 66,000
MPSMS &
PSITotal All Other HACs (sum of 14 above) 30,636,000 788,728 843,153 25.75 843,000
Total HACs 4,050,588 4,330,094 4,337,000
PFP Measured HACs per 1,000 discharges 132.22 132.22 132
Adverse Drug
Event
All Other
Hospital-
Acquired
Conditions
PFP Measured Hospital Acquired Conditions/Measures Information on 2012 Measured and Normalized HACS
31
List of MPSMS Factors
MPSMS Measure Factor
Cases in MPSMS
Sample per Case
Among All 18+ Pts
ADE Associated with Digoxin 1.08 0.93
Hospital-Acquired Pressure Ulcers 0.85 1.18
In-hospital Patient Falls 0.84 1.19
Femoral Artery Puncture for Catheter Angiographic Procedures 0.83 1.20
ADE Hospital-Acquired Antibiotic Associated C diff 0.81 1.23
Hospital-Acquired MRSA 0.79 1.26
ADE Associated with Hypoglycemic Agents 0.77 1.30
Mechanical Complications Associated with Central Venous Catheters 0.76 1.31
Catheter-Associated Urinary Tract Infections 0.73 1.36
Hospital-Acquired Vancomycin-Resistant Enterococcus 0.72 1.39
Blood Stream Infections Associated with Central Venous Catheters 0.64 1.55
ADE Associated with Warfarin 0.62 1.60
ADE Associated with LMWH and Factor Xa Inhibitor 0.55 1.82
ADE Associated with IV Heparin 0.50 2.01
Ventilator-Associated Pneumonia 0.49 2.05
Contrast Nephropathy Associated with Catheter Angiography 0.46 2.17
Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries 0.46 2.18
Postoperative Pneumonia 0.45 2.22
Postoperative Venous Thromboembolic Events 0.42 2.39
Knee Joint Replacements 0.28 3.54
Hip Joint Replacements 0.28 3.62
Unweighted Average 0.64 1.57
32
Details on Measurement of “All-Other” HACs (2010)
33
All
Other
HACs
Type of HAC Source Events
Femoral Artery Puncture for Catheter Angiographic Procedures MPSMS 76,000
AE associated with Hip Joint Replacements MPSMS 30,000
AE associated with Knee Joint Replacements MPSMS 29,000
Contrast Nephropathy Associated with Catheter Angiography MPSMS 230,000
Hospital Acquired MRSA MPSMS 15,000
Hospital Acquired Vancomycin Resistant Enterococcus (VRE) MPSMS 13,000
Hospital Acquired Antibiotic Associated C difficile MPSMS 87,000
Mechanical Complications Associated with Central Venous Catheters MPSMS 110,000
Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries MPSMS 43,000
Postoperative Pneumonia MPSMS 97,000
Iatrogenic Pneumothorax (PSI 6) PSI 13,000
Post-op Hemorrhage or Hematoma (PSI 9) PSI 21,000
Post-op Respiratory Failure (PSI 11) PSI 50,000
Accidental Puncture or Laceration (PSI 15) PSI 77,000
Total All Other HACs (sum of 14 above) MPSMS
& PSI
894,000
Summary of How the 2010 PFP HAC Rate
Was Calculated, Noel Eldridge, AHRQ, 5/16/12 DRAFT #1
1. The rate 2010 of PFP HACs is calculated based on the following variables:
a. The rate of 21 MPSMS adverse events in the 4-patient-group MPSMS (IQR) sample, expressed as a rate per the whole sample population, rather than as a rate per the subpopulation that has the opportunity to experience the adverse event. For example, the CLABSI rate, like all the rates, uses all patients in the denominator, not just the patients who received a central line in the hospital. MPSMS data are used for 7 of the 9 targeted HACs, and for 10 of the 14 all-other HACs. In addition, this rate is weighted to include 25% of each of the four patient groups in the sample, i.e., there is a 25% contribution from each set of patients in the sample (HF, AMI, Pneumonia, and SCIP patients). This weighting will be repeated with the data from 2011 to 2013 too, in order to increase the validity of comparing the data from 2010 to the other years. [M]
b. The number of events captured by PSI 18 and 19 on obstetric injury, and the number of 4 other PSIs (numbers 6, 9, 11, and 15) included among the “all other” HACs. [P]
c. The number of surgical site infections computed by CDC based on NHSN data for 17 selected operations: the 12 “SCIP” procedures and 5 others. [N]
d. The number of annual hospital discharges in patients 18 years and older, as measured by HCUP. [D]
e. Factors calculated to compensate for the fact that the rates of adverse events in the MPSMS sample are likely to be different than in the all-diagnosis 18 years and older hospital population. This factor is based on the measured ratio between the MPSMS adverse event rate in the all-diagnosis inpatient population and MPSMS adverse event rate in the 4-patient-group population in 2005 and 2006, which is the most recent year for which we have all-diagnosis MPSMS data. (The sample used for MPSMS from 2002-2006 was a Medicare FFS population, since 2009 it has been the 4-patient-group population.) The factor was calculated for each MPSMS measure and varied from .28 to 1.08, with 14 of 21 factors being between .4 and .8 and the arithmetic mean of the factors being .64. [f]
2. Thus, the count of measured HACs in 2010= (M*f*D) + P +N, with (M*f*D) computed 21 times for the 21 different measures, 6 different P counts for the 6 PSIs, and N computed once by CDC staff based on their NHSN data on SSIs, the numbers of the 17 operations, and HCUP data.
3. And the rate of measured HACs = ((M*f*D) + P +N)/D
A more thorough (June 2014) version of this information (and more) is on-line at: http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html
34
Comparison of PfP Projections, PfP Measured Data, & Jha et al‘s WHO Study Estimates
for 2009 in BMJ Quality and Safety (18 September 2013)
See: http://qualitysafety.bmj.com/content/22/10/809.short
35
PfP Final Data for 2010
(calculated in 2012)
Data (2013 for 2009) from WHO-funded
study published in BMJ Quality and Safety -
Analysis/Summary by Noel Eldridge 9/24/13
Pre-launch
Estimate of
2010
National
HACs
2010 Final
Measured
Data
(Rounded)
Pre-
launch
Estimate
as a
Percent
2010
Final
Data as
a
Percent
WHO-based
estimate (Jha,
et al, in BMJ
2013)
Jha's 95%
Confidence
Interval
Estimate for
USA (based
rates and
32,750,000
discharges)
Adverse
Drug Events
1,900,000 1,621,000 5.8% 4.9% 5% 2.7 to 7.2% 1,637,500
CAUTI 530,000 400,000 1.6% 1.2% 1.10% .8 to 1.5% 360,250
CLABSI 40,000 18,000 0.12% 0.05% 0.40% .2 to .6% 131,000
Falls 200,000 260,000 0.6% 0.8% 1.10% .3 to 2.0% 360,250
Obstetric
Adverse Events380,000 82,000 1.2% 0.3% No data No data
Pressure
Ulcers
250,000 1,320,000 0.8% 4.0% 2.40% .8 to 4.7% 786,000
Surgical Site
Infections
110,000 96,000 0.3% 0.3% No data No data
VAP 40,000 38,000 0.12% 0.12% 0.80% .7 to 1.1% 262,000
VTE 100,000 16,000 0.31% 0.05% 3.30% 1.9 to 4.8% 1,080,750
All Other
HACs
2,430,000 894,000 7.4% 2.7% No data No data
Totals 5,980,000 4,745,000 4,617,750Rate (for
32,750,000
discharges)
182.6 144.9 141.0
Potential Next Steps to Consider at a
Hospital, Hospital-System, or HEN level(excerpted from a May 2014 presentation on potential disparities in patient safety data)
1. Review local medication safety measures associated with hypoglycemic events (use of insulin and related drugs)o Are non-white patients exposed to these events at a higher rate?
o Are non-white patients experiencing these events at a higher rate?
2. Review local pressure ulcer measureso Are there disparities in the measured rates of low-stage (I and II) and higher
stage (III, IV and “unstageable”) events that may be partially due to skin color?
3. Review local obstetric adverse event rateso Do rates differ for different racial/ethnic groups?
4. Review HAI rates, especially CAUTIo Are rates higher in groups of patients who often have English as a second
language?
5. Is the “Do Not Resuscitate” (DNR) status being documented equally well for all groups? If so, do the decisions patients make vary by group?
Two new (October 2014) publications to consider on HAIs, see:http://journals.cambridge.org/action/displayIssue?jid=ICE&volumeId=35&seriesId=0&issueId=S3 36
Discussion
Dr. Knitasha Washington
CAPS
Noel Eldridge, MS
AHRQ
Marty Hatlie, J.D.
PPC
Thank you for joining us today!
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