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  • The Prevalence of Patient Safety Indicators and Hospital Acquired Conditions in Patients With Ruptured Cerebral Aneurysms: Establishing Standard Performance Measures Using the Nationwide Inpatient Sam

    Final Number:
    1210

    Authors:
    Kyle Michael Fargen MD MPH; Dan Neal MS; Maryam Rahman MD MS; Brian Lim Hoh MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    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.

    References: 1. Agency for Healthcare Research and Quality quality indicators. Journal 2012: 2. Hospital Compare. U.S. Department of Health and Human Services. Journal 2012: 3. Hospital Value-Based Purchasing Program: Fact sheet. Journal 4. Hospital-acquired conditions Journal 2012: 5. Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 60:243-248, 6. Agresti ACoull BA: Approximate is better than ''Exact'' for interval estimation of binomial proportions. Am Stat 52:119-126, 1998 7. Bahl V, Thompson MA, Kau TY, Hu HMCampbell DA, Jr.: Do the AHRQ patient safety indicators flag conditions that are present at the time of hospital admission? Med Care 46:516-522, 2008 8. Chang DC, Handly N, Abdullah F, Efron DT, Haut ER, Haider AH, et al: The occurrence of potential patient safety events among trauma patients: are they random? Ann Surg 247:327-334, 2008 9. Elixhauser A, Steiner C, Harris DRCoffey RM: Comorbidity measures for use with administrative data. Med Care 36:8-27, 1998 10. Pronovost PJ, Marsteller JAGoeschel CA: Preventing bloodstream infections: a measurable national success story in quality improvement. Health Aff (Millwood) 30:628-634, 11. Rahman M, Whiting JH, Fauerbach LL, Archibald LFriedman WA: Reducing ventriculostomy-related infections to near zero: the eliminating ventriculostomy infection study. Jt Comm J Qual Patient Saf 38:459-464, 12. Rhee D, Zhang Y, Papandria D, Ortega GAbdullah F: Agency for Healthcare Research and Quality pediatric indicators as a quality metric for surgery in children: do they predict adverse outcomes? J Pediatr Surg 47:107-111, 2012 13. Rosen AK, Rivard P, Zhao S, Loveland S, Tsilimingras D, Christiansen CL, et al: Evaluating the patient safety indicators: how well do they perform on Veterans Health Administration data? Med Care 43:873-884, 2005 14. Sedman A, Harris JM, 2nd, Schulz K, Schwalenstocker E, Remus D, Scanlon M, et al: Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals. Pediatrics 115:135-145, 2005 15. Vartak S, Ward MMVaughn TE: Do postoperative complications vary by hospital teaching status? Med Care 46:25-32, 2008 16. Zhan CMiller MR: Administrative data based patient safety research: a critical review. Qual Saf Health Care 12 Suppl 2:ii58-63, 2003

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