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1.
Jt Comm J Qual Patient Saf ; 44(6): 343-352, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29793885

RESUMO

BACKGROUND: Informed consent is a process of communication between clinician and patient that results in the patient's decision about whether to undergo a specific intervention. However, patients often do not understand the risks, benefits, and alternatives, even after signing a consent form. METHODS: Mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules implemented in four hospitals. Methods included staff and patient surveys, interviews, site visits, and pre- and posttests of the modules. RESULTS: A low proportion of clinicians reported using teach-back (40.0%) or high-quality decision aids (55.0%). Patients reported limited use of best practices, including being asked to teach-back (58.4%), having other options described (54.9%), viewing decision aids (37.4%), and finding the form very easy to understand (66.8%). Content of the training modules aligned well with identified deficiencies. Barriers to completing the modules included staff turnover, competing demands, and lack of accountability. Facilitators included committed champions with available time, motivation, and release time for staff to take modules. Knowledge increased for leaders (p <0.05) and staff (p <0.001) who completed the training modules. Hospitals reported the effects of piloting the modules included fostering dialogue and identifying opportunities for improvements, identifying and rectifying policy ambiguity and noncompliance, reinforcing the use of interpreter services, and using modules' strategies and tools to improve informed consent. CONCLUSION: Many opportunities exist for hospitals to improve their informed consent practices. AHRQ's two training modules, have face validity, addressed demonstrated deficiencies in hospitals' informed consent policies and processes, and stimulated improvement activity in motivated hospitals.


Assuntos
Comunicação , Administração Hospitalar/métodos , Consentimento Livre e Esclarecido , Capacitação em Serviço/organização & administração , Atitude do Pessoal de Saúde , Termos de Consentimento , Estudos Transversais , Técnicas de Apoio para a Decisão , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Administradores Hospitalares/educação , Humanos , Motivação , Pacientes/psicologia , Reorganização de Recursos Humanos , Melhoria de Qualidade/organização & administração , Medição de Risco , Fatores de Tempo , Estados Unidos , United States Agency for Healthcare Research and Quality/normas , Carga de Trabalho
2.
BMC Med Inform Decis Mak ; 17(1): 176, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258525

RESUMO

BACKGROUND: The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. METHODS: Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. RESULTS: Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems. CONCLUSIONS: Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated into materials to facilitate the implementation of perinatal safety initiatives.


Assuntos
Parto Obstétrico , Maternidades , Informática Médica/métodos , Segurança do Paciente , Melhoria de Qualidade , United States Agency for Healthcare Research and Quality , Adulto , Parto Obstétrico/normas , Feminino , Maternidades/normas , Humanos , Trabalho de Parto , Segurança do Paciente/normas , Assistência Perinatal/normas , Gravidez , Melhoria de Qualidade/normas , Estados Unidos , United States Agency for Healthcare Research and Quality/normas
3.
Med Care ; 54(12): 1105-1111, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27116111

RESUMO

BACKGROUND: The Agency for Health Care Research and Quality Patient Safety Indicators (PSIs) and Centers for Medicare and Medicaid Services Hospital-acquired Conditions (HACs) are increasingly being used for pay-for-performance and public reporting despite concerns over their validity. Given the potential for these measures to misinform patients, misclassify hospitals, and misapply financial and reputational harm to hospitals, these need to be rigorously evaluated. We performed a systematic review and meta-analysis to assess PSI and HAC measure validity. METHODS: We searched MEDLINE and the gray literature from January 1, 1990 through January 14, 2015 for studies that addressed the validity of the HAC measures and PSIs. Secondary outcomes included the effects of present on admission (POA) modifiers, and the most common reasons for discrepancies. We developed pooled results for measures evaluated by ≥3 studies. We propose a threshold of 80% for positive predictive value or sensitivity for pay-for-performance and public reporting suitability. RESULTS: Only 5 measures, Iatrogenic Pneumothorax (PSI 6/HAC 17), Central Line-associated Bloodstream Infections (PSI 7), Postoperative hemorrhage/hematoma (PSI 9), Postoperative deep vein thrombosis/pulmonary embolus (PSI 12), and Accidental Puncture/Laceration (PSI 15), had sufficient data for pooled meta-analysis. Only PSI 15 (Accidental Puncture and Laceration) met our proposed threshold for validity (positive predictive value only) but this result was weakened by considerable heterogeneity. Coding errors were the most common reasons for discrepancies between medical record review and administrative databases. POA modifiers may improve the validity of some measures. CONCLUSION: This systematic review finds that there is limited validity for the PSI and HAC measures when measured against the reference standard of a medical chart review. Their use, as they currently exist, for public reporting and pay-for-performance, should be publicly reevaluated in light of these findings.


Assuntos
Centers for Medicare and Medicaid Services, U.S./normas , Infecção Hospitalar/epidemiologia , Segurança do Paciente/normas , Indicadores de Qualidade em Assistência à Saúde/normas , United States Agency for Healthcare Research and Quality/normas , Hospitais/normas , Humanos , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes , Estados Unidos
4.
Med Care ; 54(4): 359-64, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26759981

RESUMO

BACKGROUND: Patient Safety Indicators (PSIs) are administratively coded identifiers of potentially preventable adverse events. These indicators are used for multiple purposes, including benchmarking and quality improvement efforts. Baseline PSI evaluation in high-risk surgeries is fundamental to both purposes. OBJECTIVE: Determine PSI rates and their impact on other outcomes in patients undergoing cranial neurosurgery compared with other surgeries. RESEARCH DESIGN: The Agency for Healthcare Research and Quality (AHRQ) PSI software was used to flag adverse events and determine risk-adjusted rates (RAR). Regression models were built to assess the association between PSIs and important patient outcomes. SUBJECTS: We identified cranial neurosurgeries based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in California, Florida, New York, Arkansas, and Mississippi State Inpatient Databases, AHRQ, 2010-2011. MEASURES: PSI development, 30-day all-cause readmission, length of stay, hospital costs, and inpatient mortality. RESULTS: A total of 48,424 neurosurgical patients were identified. Procedure indication was strongly associated with PSI development. The neurosurgical population had significantly higher RAR of most PSIs evaluated compared with other surgical patients. Development of a PSI was strongly associated with increased length of stay and hospital cost and, in certain PSIs, increased inpatient mortality and 30-day readmission. CONCLUSIONS: In this population-based study, certain accountability measures proposed for use as value-based payment modifiers show higher RAR in neurosurgery patients compared with other surgical patients and were subsequently associated with poor outcomes. Our results indicate that for quality improvement efforts, the current AHRQ risk-adjustment models should be viewed in clinically meaningful stratified subgroups: for profiling and pay-for-performance applications, additional factors should be included in the risk-adjustment models. Further evaluation of PSIs in additional high-risk surgeries is needed to better inform the use of these metrics.


Assuntos
Benchmarking , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Arkansas , California , Florida , Custos Hospitalares , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Mississippi , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , New York , Readmissão do Paciente/estatística & dados numéricos , Segurança do Paciente/normas , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/normas , Medição de Risco/estatística & dados numéricos , Crânio/cirurgia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality/normas
5.
J Nurs Adm ; 44(10 Suppl): S45-53, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25279513

RESUMO

OBJECTIVES: The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)--a hospital employee patient safety culture survey--and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)--a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related. METHODS: We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey's measures using data from 73 hospitals that administered both surveys during similar periods. RESULTS: Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P G 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend). CONCLUSIONS: This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.


Assuntos
Administração Hospitalar , Segurança do Paciente/estatística & dados numéricos , Satisfação do Paciente , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Pesquisas sobre Atenção à Saúde , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Cultura Organizacional , Análise de Regressão , Estados Unidos , United States Agency for Healthcare Research and Quality/normas
6.
Med Care ; 51(8): 722-30, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23703647

RESUMO

BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicator "death among surgical inpatients with serious treatable complications" (failure-to-rescue) uses rules to exclude complications presumed to be present-on-admission (POA). Like other administrative data-based quality measures, exclusion rules were developed with limited information on whether complications were POA. We examine whether the accuracy of failure-to-rescue exclusion rules can be improved with data with good POA indicators. METHODS: POA-coded data from 243,825 discharges from a large academic medical center were used to develop 3 failure-to-rescue exclusion rules. Data from 82,871 discharges from California hospitals screened for good POA coding practices was used as a validation sample. The AHRQ failure-to-rescue measure and 3 new measures based on alternative exclusion rules were compared on sensitivity, specificity, and C-statistics for prediction of POA status. Using data from the AHRQ HCUP National Inpatient Sample, the alternative specifications were tested for sensitivity to nurse staffing. RESULTS: The AHRQ exclusion rules had sensitivity of 18.5%, specificity 92.1%, and a C-statistic of 0.553. All POA-informed specifications of exclusion rules improved the C-statistic of the failure-to-rescue measure and its sensitivity, with modest losses of specificity. For all tested specifications, higher licensed hours and proportions of registered nurse were statistically significant and associated with lower risk of death. CONCLUSIONS: Failure-to-rescue is a robust quality measure, sensitive to nursing across alternative exclusion rule specifications. Despite expanded POA coding, exclusion-based rules are needed to analyze datasets not coded for POA, legacy datasets, and datasets with poor POA coding. POA-informed construction of exclusions significantly improves rules identifying POA complications.


Assuntos
Classificação Internacional de Doenças/normas , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Admissão do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , United States Agency for Healthcare Research and Quality/normas , Número de Leitos em Hospital , Mortalidade Hospitalar , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração , Risco Ajustado , Estados Unidos
10.
BMC Emerg Med ; 12: 15, 2012 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-23126473

RESUMO

BACKGROUND: Length of stay is an important indicator of quality of care in Emergency Departments (ED). This study explores the duration of patients' visits to the ED for which they are treated and released (T&R). METHODS: Retrospective data analysis and multivariate regression analysis were conducted to investigate the duration of T&R ED visits. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for 2008 were used in the analysis. RESULTS: The mean duration of T&R ED visit was 195.7 minutes. The average duration of ED visits increased from 8 a.m. until noon, then decreased until midnight at which we observed an approximately 70-minute spike in average duration. We found a substantial difference in mean duration of ED visits (over 90 minutes) between Mondays and other weekdays during the transition time from the evening of the day before to the early morning hours. Black / African American patients had a 21.4-minute longer mean duration of visits compared to white patients. The mean duration of visits at teaching hospitals was substantially longer than at non-teaching hospitals (243.8 versus 175.6 minutes). Hospitals with large bed size were associated with longer duration of visits (222.2 minutes) when compared to hospitals with small bed size (172.4 minutes) or those with medium bed size (166.5 minutes). The risk-adjusted results show that mean duration of visits on Mondays are longer by about 4 and 9 percents when compared to mean duration of visits on non-Monday workdays and weekends, respectively. CONCLUSIONS: The duration of T&R ED visits varied significantly by admission hour, day of the week, patient volume, patient characteristics, hospital characteristics and area characteristics.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Serviço Hospitalar de Emergência/normas , Etnicidade/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais/classificação , Hospitais/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Estados Unidos , United States Agency for Healthcare Research and Quality/normas , United States Agency for Healthcare Research and Quality/estatística & dados numéricos , Adulto Jovem
11.
Stud Health Technol Inform ; 160(Pt 2): 1055-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20841845

RESUMO

The U.S. Agency for Healthcare Research and Quality has created a public website to disseminate critical information regarding its health information technology initiative. The website is maintained by AHRQ's Natiomal Resource Center (NRC) for Health Information Technology. In the latest continuous quality improvement project, the NRC used the site's search logs to extract user-generated search phrases. The phrases were then compared to the site's controlled vocabulary with respect to language, grammar, and search precision. Results of the comparison demonstrate that search log data can be a cost-effective way to improve controlled vocabularies as well as information retrieval. User-entered search phrases were found to also share many similarities with folksonomy tags.


Assuntos
Classificação/métodos , Armazenamento e Recuperação da Informação/métodos , Informática Médica , Tecnologia Biomédica , Estados Unidos , United States Agency for Healthcare Research and Quality/normas , Vocabulário Controlado
12.
Health Serv Res ; 54(3): 613-622, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30474108

RESUMO

OBJECTIVE: To compare the Agency for Healthcare Research and Quality's Quality and Safety Review System (QSRS) and the proposed triadic structure for the 11th version of the International Classification of Disease (ICD-11) in their ability to capture adverse events in U.S. hospitals. DATA SOURCES/STUDY SETTING: One thousand patient admissions between 2014 and 2016 from three general, acute care hospitals located in Maryland and Washington D.C. STUDY DESIGN: The admissions chosen for the study were a random sample from all three hospitals. DATA COLLECTION/EXTRACTION METHODS: All 1000 admissions were abstracted through QSRS by one set of Certified Coding Specialists and a different set of coders assigned the draft ICD-11 codes. Previously assigned ICD-10-CM codes for 230 of the admissions were also used. PRINCIPAL FINDINGS: We found less than 20 percent agreement between QSRS and ICD-11 in identifying the same adverse event. The likelihood of a mismatch between QSRS and ICD-11 was almost twice that of a match. The findings were similar to the agreement found between QSRS and ICD-10-CM in identifying the same adverse event. When coders were provided with a list of potential adverse events, the sensitivity and negative predictive value of ICD-11 improved. CONCLUSIONS: While ICD-11 may offer an efficient way of identifying adverse events, our analysis found that in its draft form, it has a limited ability to capture the same types of events as QSRS. Coders may require additional training on identifying adverse events in the chart if ICD-11 is going to prove its maximum benefit.


Assuntos
Documentação/normas , Administração Hospitalar/estatística & dados numéricos , Classificação Internacional de Doenças/normas , Dano ao Paciente/estatística & dados numéricos , United States Agency for Healthcare Research and Quality/normas , Adulto , Idoso , District of Columbia , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Segurança do Paciente/normas , Gestão da Segurança/normas , Estados Unidos , United States Agency for Healthcare Research and Quality/estatística & dados numéricos
15.
J Clin Epidemiol ; 98: 98-104, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29409913

RESUMO

OBJECTIVES: Systematic reviews should provide balanced assessments of benefits and harms, while focusing on the most important outcomes. Selection of harms to be reviewed can be a challenge due to the potential for large numbers of diverse harms. STUDY DESIGN AND SETTING: A workgroup of methodologists from Evidence-based Practice Centers (EPCs) developed consensus-based guidance on selection and prioritization of harms in systematic reviews. Recommendations were informed by a literature scan, review of Evidence-based Practice Center reports, and interviews with experts in conducting reviews or assessing harms and persons representing organizations that commission or use systematic reviews. RESULTS: Ten recommendations were developed on selection and prioritization of harms, including routinely focusing on serious as well as less serious but frequent or bothersome harms; routinely engaging stakeholders and using literature searches and other data sources to identify important harms; using a prioritization process (formal or less formal) to inform selection decisions; and describing the methods used to select and prioritize harms. CONCLUSION: We provide preliminary guidance for a more structured approach to selection and prioritization of harms in systematic reviews.


Assuntos
Prática Clínica Baseada em Evidências/normas , Guias como Assunto , Dano ao Paciente , Revisões Sistemáticas como Assunto , United States Agency for Healthcare Research and Quality/normas , Tomada de Decisão Clínica , Humanos , Dano ao Paciente/efeitos adversos , Dano ao Paciente/classificação , Estados Unidos
17.
Am J Med Qual ; 32(1): 48-57, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26514154

RESUMO

This study investigates the relationship between inpatient quality of care as measured by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicator (PSI) composite and all-cause, hospital-wide, 30-day readmission rates. Discharge data from 4 statewide databases were analyzed. Linear, repeated-measures regressions were performed to predict hospital-level 30-day readmission rates. The mean readmission rate was 12.9%, and the mean PSI composite ratio was 0.95 among 524 hospitals with 2592 observations. In the hospital-level analysis, the risk-adjusted AHRQ PSI composite was not significantly associated with hospital 30-day readmission rate after controlling for hospital-level characteristics, patient case mix, and sociodemographics. Inpatient quality of care appears to have less influence on hospital readmission rates than do clinical and socioeconomic factors. However, these results suggest that a patient safety composite measure that includes postdischarge complications would provide more information to assist hospitals and communities in understanding the association between quality of care and readmission rates.


Assuntos
Coleta de Dados/métodos , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , United States Agency for Healthcare Research and Quality/normas , Coleta de Dados/normas , Humanos , Indicadores de Qualidade em Assistência à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Risco Ajustado , Fatores Socioeconômicos , Estados Unidos
18.
Health Serv Res ; 52(5): 1667-1684, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28369814

RESUMO

OBJECTIVE: To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health. DATA SOURCES: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases. STUDY DESIGN: Empirical analyses and structured panel reviews. METHODS: Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs). PRINCIPAL FINDINGS: ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated. CONCLUSIONS: The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Saúde Pública , Indicadores de Qualidade em Assistência à Saúde/normas , United States Agency for Healthcare Research and Quality/normas , Doença Aguda , Fatores Etários , Asma/diagnóstico , Asma/terapia , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Doença Crônica , Pesquisa sobre Serviços de Saúde , Humanos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Pobreza , Fatores Sexuais , Doenças Estomatognáticas/diagnóstico , Doenças Estomatognáticas/terapia , Estados Unidos
19.
Surgery ; 160(4): 858-868, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27528212

RESUMO

BACKGROUND: The Agency for Healthcare Research and Quality Patient Safety Indicator 11 is used to identify postoperative respiratory failure events and detect areas for quality improvement. This study examines the accuracy of Patient Safety Indicator 11 in identifying clinically valid patient safety events. METHODS: All cases flagged for Patient Safety Indicator 11 from July 2013 to July 2015 by Agency for Healthcare Research and Quality QI Version 4.5 including International Classification of Diseases-9 codes were evaluated. Code-confirmed cases underwent independent review by 2 physicians. Inpatient electronic medical records were used to identify clinical factors for postoperative respiratory failure in each case to determine if postoperative respiratory failure was a result of unsafe care. The clinical true-positive rate and positive predictive value were calculated. RESULTS: A total of 166 postoperative respiratory failure cases were reviewed; 51 were recoded and reversed due to coding or documentation errors; 115 cases met the Agency for Healthcare Research and Quality definition of postoperative respiratory failure. A total of 71 (61.7%) of the 115 cases were false positives and did not reflect unsafe care, while 44 cases were true positives with a positive predictive value of 38.3%. χ(2) analysis did not reveal an association between demographics, clinical characteristics, or operative procedure with true-positive cases. CONCLUSION: Administrative coding data for Agency for Healthcare Research and Quality Patient Safety Indicator 11 do not identify accurately patients who received unsafe care when taking into account unpreventable clinical factors causing postoperative respiratory failure. The use of Agency for Healthcare Research and Quality Patient Safety Indicator 11 as a hospital performance measure should be reconsidered until inclusion and exclusion criteria are revised.


Assuntos
Mortalidade Hospitalar/tendências , Complicações Pós-Operatórias/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Adulto , Idoso , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Medição de Risco , Gestão da Segurança , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Taxa de Sobrevida , Estados Unidos , United States Agency for Healthcare Research and Quality/normas
20.
Am J Psychiatry ; 162(4): 711-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15800143

RESUMO

OBJECTIVE: The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment. METHOD: Linked Medicare claims and survey data from the 1992-1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency. RESULTS: The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients' socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy. CONCLUSIONS: Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults.


Assuntos
Transtorno Depressivo/terapia , Pesquisa sobre Serviços de Saúde , Psicoterapia/estatística & dados numéricos , Fatores Etários , Idoso , Atenção à Saúde , Transtorno Depressivo/psicologia , Escolaridade , Cuidado Periódico , Feminino , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Medicare/estatística & dados numéricos , Probabilidade , Estados Unidos , United States Agency for Healthcare Research and Quality/normas , Revisão da Utilização de Recursos de Saúde
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