Several studies have shown that hospitalized patients still have unacceptably high rates of harm and injury due in part to limited access for quality staff to obtain primary care data from electronic medical records. As a result, hospital incident reports do not capture most harm that occurs in hospitals. A new study published in the September special issue “Emerging Models of Care and Payment Delivery” of the Journal for Healthcare Quality showed that using administrative data, such as discharge abstracts, can gauge the quality of care and identify opportunities for improvement.
The purpose of the study was to develop a new global measure of harm, called whole patient measure of safety, that uses administrative claims data to measure the incidence of 14 “highly undesirable events” (HUEs). The goal is to determine the probability for a patient to complete a hospital stay without any HUEs and the central measurement question is “What proportion of hospitalized patients experience at least one HUE during their episode of care?” Data from 6.5 million discharge abstracts in 161 hospitals from July 1, 2008 to June 30, 2010 were studied.
Results of the analysis showed that the percent of hospitalizations with at least one HUE varied greatly among hospitals (13.32 to 1.99 percent) with a mean of 7.74 percent. Hospital-acquired infections were the most common HUE across all facilities and blood incompatibility was the least common. HAIs usually result in readmission within 72 hours, and half of the HAIs identified occurred in conjunction with other HUEs.
The study concluded that the new whole patient measure of safety provides a global assessment of what happens to hospitalized patients as they move through the care system. It assesses the entire care process and can augment patient assessment metrics for specific diseases and procedures. The measures can be used to help hospitals interested in understanding where the most egregious safety deficiencies exist by examining patients with multiple HUEs. Also, since hospital acquired conditions are not being reimbursed by payers, administrative data can be a valuable resource to help gauge potential liability and risk and identify opportunities for improvement.
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