Introduction: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital acquired conditions (HACs) are publically reported metrics used to gauge the quality of healthcare provided by healthcare institutions. To better understand the prevalence of these events in hospitalized patients treated for ruptured cerebral aneurysms, we determined the incidence rates of PSIs and HACs among patients with a diagnosis of subarachnoid hemorrhage and procedure codes for either coiling or clipping in the Nationwide Inpatient Sample (NIS) database.
Methods: We queried the NIS, part of the AHRQ’s Healthcare Cost and Utilization Project (Rockville, MD), for all hospitalizations between 2002 and 2010 involving coiling or clipping of ruptured cerebral aneurysms. The incidence rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. We used the SAS statistical software package (Cary, NC, Version 9.3) to calculate incidence rates and perform multivariate analyses to determine the effects of patient variables on the probability of developing each indicator.
Results: There were 62,972 patient admissions with a diagnosis code of subarachnoid hemorrhage between the years of 2002 and 2010; 10,274 (16.3%) underwent clipping and 8,248 (13.1%) underwent endovascular coiling. A total of 6,547 PSI/HAC occurred within the 10,274 patients treated with clipping; at least one PSI/HAC occurred in 47.9% of these patients. There were 5,623 total PSI/HAC events among the 8,248 coiled patients; at least one PSI/HAC occurred in 51.0% of coiled patients. Age, gender, comorbidities, hospital size and hospital type had statistically significant associations with indicator occurrence. Compared to patients without events, those treated by either clipping or coiling and with at least one PSI during their hospitalization had significantly longer lengths of stay (p < 0.001), higher hospital costs (p<0.001), and higher in-hospital mortality rates (p<0.001).
Conclusions: These results estimate baseline national rates of PSIs and HACs in patients treated for ruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison to national data.
Patient Care: This research identifies the prevalence and risk factors for patient harm events within a subset of neurosurgical patients and establishes norms by which hospitals may gauge their own performance. Identification of risk factors for occurrence, as well as the financial consequences and morbidity associated with individual events, may enhance the quality of care provided to this patient population.
Learning Objectives: By the conclusion of this sessions, participants should be able to: 1) Describe the driving forces for pay-for-performance reimbursement; 2) Discuss the most widely used patient quality indicators, including the AHRQ PSIs and CMS HACs; 3) Discuss the prevalence of PSI/HACs within patients with aneurysmal subarachnoid hemorrhage; 4) Identify the effects of PSI/HACs on hospital cost, patient mortality, and length of stay.
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