Overview IMECCHI’s patient · 11/10/2009 · 9684 OTHER AND UNSPECIFIED GENERAL ANESTHETICS 9687...
Transcript of Overview IMECCHI’s patient · 11/10/2009 · 9684 OTHER AND UNSPECIFIED GENERAL ANESTHETICS 9687...
Overview IMECCHI’s patient
safety indicator projects
Hude QuanAssociate Professor
University of Calgary
Outlines
• Administrative data for studying patient
safety
• Administrative data definition
• Piloting the method
• Validation study
• Next step
Organization for Economic
Co-operation and Development
Five priority areas selected by OECD countries.
– patient safety
– mental health care
– cardiac care
– diabetes care
– primary care and prevention.
Purpose of OECD
• To raise questions about quality of
health care across countries
• Initial attention
• Patient centeredness
• To be representative of the main
disease and risk groups
ICD-9-CM PSI
http://www.ahrq.gov/
PSI 1: Complications of Anesthesia PSI 2: Death in Low-mortality
PSI 3: Decubitus Ulcer PSI 4: Failure to Rescue
PSI 5: Foreign Body Left During Procedure PSI 6: Iatrogenic Pneumothorax
PSI 7: Selected Infections Due to Medical Care PSI 8: Postoperative Hip Fracture
PSI 9: Postoperative Haemorrhage or Haematoma PSI 10: Postoperative Physiologic and
Metabolic Derangement
PSI 11: Posterative Respiratory Failure PSI 12: Postoperative Pulmonary Embolism or
Deep Vein Thrombosis
PSI 13: Postoperative Sepsis PSI 14: Postoperative Wound Dehiscence
PSI 15: Accidental Puncture or Laceration PSI 16: Transfusion Reaction
PSI 17: Birth Trauma―Injury to Neonate PSI 18: Obstetric Trauma―Vaginal Delivery
with Instrument
PSI 19: Obstetric Trauma―Vaginal Delivery
without Instrument PSI 20: Obstetric Trauma―Cesarean Delivery
Complications of Anesthesia (PSI 1)
Numerator:ICD-9-CM diagnosis codes in any secondary diagnosis field:
E8763 ENDOTRACHEAL TUBE WRONGLY PLACE DURING ANESTHETIC
PROCEDURE
E9381 HALOTHANE
E9382 OTHER GASEOUS ANESTHETICS
E9383 INTRAVENOUS ANESTHETICS
E9384 OTHER AND UNSPECIFIED GENERAL ANESTHETICS
E9385 SURFACE AND INFILTRATION ANESTHETICS
E9386 PERIPHERAL NERVE AND PLEXUS BLOCKING ANESTHETICS
E9387 SPINAL ANESTHETICS
E9389 OTHER AND UNSPECIFIED LOCAL ANESTHETICS
9681 HALOTHANE
9682 OTHER GASEOUS ANESTHETICS
9683 INTRAVENOUS ANESTHETICS
9684 OTHER AND UNSPECIFIED GENERAL ANESTHETICS
9687 SPINAL ANESTHETICS
E8551 ACCIDENTAL POISONING, OTHER NERVOUS SYSTEM DEPRESSANTS
Complications of Anesthesia (PSI 1)
Denominator:
• All surgical discharges
• Age 18 years and older
• DRG - MDC 14 (pregnancy, childbirth, and puerperium)
• Operating room procedure.
Complications of Anesthesia (PSI 1)
Requirements:
1. Secondary Diagnosis Codes
2. DRG
3. Procedure Codes
4. Operating room procedure indicator.
PSI 1 Rate = Numerator/Denominator * 100%
Realities – Variations
• Country specific ICD versions
• Diagnosis related grouping (DRG)
• Primary/Most Responsible Diagnosis
• Procedure Classification
• Validity
Canadian SituationDisease Classification
ICD-9
ICD-9-CM
ICD-10-CA
Procedure ClassificationICD-9-CM
Canadian Classification of Procedure
Disease GroupingDiagnosis-Related Group (DRG)
Developed by 3M and classified about 500 groups
Case Mix Groups (CMG)
Developed by CIHI. Groups have to be statistically
homogeneous with respect to length of hospital stay.
Need to harmonize AHRQ PSI
administrative data definition
between ICD-9-CM and ICD-10
Process
• Step 1: Code Search
-- 2569 ICD-10 codes
• Step 2: Rating rating
-- 1775 codes consensus
-- 794 codes with disagreement
-- 2541 additional codes
• Step 3: Face to face meeting
Discussed and rated a total of 3335 codes
Advances in Patient Safety
Title: Adaptation of AHRQ Patient Safety Indicators for
Use in ICD-10 Administrative Data by an
International Consortium
Hude Quan, Saskia Drösler, Vijaya Sundararajan, Eugene Wen,
Bernard Burnand, Chantal Marie Couris, Patricia Halfon, Jean-Marie
Januel, Edward Kelley, Niek Klazinga, Jean-Christophe Luthi, Lori
Moskal, Eric Pradat, Patrick S. Romano, Jennie Shepheard,
Lawrence So, Lalitha Sundaresan, Linda Tournay-Lewis, Béatrice
Trombert-Paviot, Greg Webster, William A. Ghali, for the IMECCHI
Investigators
http://www.chaps.ucalgary.ca/sas.htm
ICD-10-WHO PSI Codes
Applications
A set of algorithms for the AHRQ PSIs using
ICD-10-WHO diagnoses has been
developed and structured in close relation
to the AHRQ PSI documentation.
This work supports international applications
in ICD-9-CM and ICD-10 data.
Australia, Canada, Germany, Spain, Sweden, UK, US
Conclusions
This pilot study reveals that AHRQ Patient Safety Indicators
can be applied to international hospital data. However, the
analyses suggest that certain indicators may be too
unreliable for international comparisons. Data quality varies
across countries; undercoding may be a systematic problem
in some countries. Efforts at international harmonization of
hospital discharge data sets as well as improved accuracy
of documentation should facilitate future comparative
analyses of routine databases.
PSI positive inpatient
records
Data
Chart Review
Validation EffortsIn Canada, US, France
Medical Care, 2009
How Valid is the ICD-9-CM Based AHRQ
Patient Safety Indicator for Postoperative
Venous Thromboembolism?
Positive predictive value:
56% anytime during hospitalization
47% after operation
Conclusion:
“Current PSI 12 criteria do not accurately identify
patients with acute postoperative lower extremity
DVT or PE. Modification of the ICD-9-CM codes and
implementation of "present on admission" flags
should improve the predictive value for clinically
important VTE events.”
Annuals of Surgery, 2009
Positive Predictive Value of the AHRQ
Accidental Puncture or Laceration
Patient Safety Indicator
Positive predictive value: 91%
Conclusion:
“ Although PSI 15 is highly predictive of APL from a coding
perspective, the indicator is less predictive of APL that
could be considered clinically important. A significant
proportion of cases represent relatively inconsequential
injuries or injuries for which the risk may have been
acceptable relative to the goals of the procedure.”
Administrative dataHospital discharge data
Dx1 Dxtype1, Dx1 Dxtype1,,, Dx16 Dxtype16
M
1
2
2 = Post-admit comorbidity - A diagnosis or
condition that arises post-admission and
satisfies the requirements for determining
comorbidity.
WHO
Family of
International Classifications
… building blocks of health information …
International Classification of
Patient Safety and Quality of Care