Patient Safety Indicators
The measurement of clinical performance, the development of clinical indicators and the interpretation of quality of care are prominent in the agendas of health departments, health care providers and key professional bodies both nationally, and internationally1,2. It has been recognised that no single indicator of quality exists3, so the review of outcomes and identification of adverse events relies on initiatives that are targeted or involve voluntary reporting4. This effort involves clinical audits, patient questionnaires, prevalence surveys and peer review. These activities capture information and provide results in relation to set groups of patients in specific areas of care provision. This specificity means that issues with the care of the broader patient population might not be identified.
An opportunity exists to benchmark hospital mortality, survival and complication rates in Victoria and Australia using administrative data. Administrative data is a resource with the potential for asking and answering questions of quality in the broader patient population.
Patient Safety Indicators (PSI) are measures of health care safety that make use of readily available hospital inpatient administrative data. There is significant variance in opinion on the value of using administrative data for this purpose5,6 and it should be acknowledged that PSIs are indicators not definitive measures of adverse events7.
To date this large source of data coded according to nationally and internationally agreed standards has been, to date, relatively untapped yet it offers the opportunity to identify areas of concern in quality of health care and subsequently track quality improvement initiatives in the broader patient population. One of the reasons that administrative data has remained relatively untapped has been the absence of the ability to apply a tested indicator set to the data.
The Department of Human Services has developed a set of indicators to meet this need. These are the AusPSIs and they are based on the PSI developed in the United States of America by the Agency for Healthcare Research and Quality (AHRQ). A detailed description of the translation process is available.
The AusPSIs are a set of 18 core indicators and 7 sub-indicators that are applicable to ICD-10-AM datasets that support the condition onset flag. The Victorian Admitted Episodes Dataset (VAED) is one of these datasets.
The website will provide you with the rationale for using PSIs when monitoring quality of care and the tools necessary for using the AusPSIs.
Footnotes:
1. Rivard P.E., Elwy A.R., Loveland S., Zhao S., Tsilimingras D., Elixhauser A., Romano P.S., Rosen A.K. Applying Patient Safety Indicators (PSIs) Across Health Care Systems: Achieving Data Comparability
2. Veena S., Raleigh J.C., Bremner S,A., Scobie S. Patient safety indicators for England from hospital administrative data: case-control analysis and comparison with US data. 2008. BMJ 2008;337;a1702
3. Schwartz J. Indicator Development and the McHenry County (IL) CEHA. (accessed 23.03.2009)
4. Zhan C., Miller M.R. Administrative data based patient safety research: a critical review. 2003, Qual. Saf. Health Care;12;ii58-ii63.
5. Use of Hospital Discharge Data to Monitor Uterine Rupture—Massachusetts, 1990–1997. 2000. Morbidity and Mortality Weekly Report (MMWR); 49:245-248.
6. Miller M.R., Elixhauser A., Zhan C., and Meyer G.S. Patient Safety Indicators: Using Administrative Data to Identify Potential Patient Safety Concerns. 2000.Health Serv Res. December; 36(6 Pt 2): 110–132.
7. Rosen A.K., Rivard P., Zhao S., Susan Loveland., Tsilimingras D., Christiansen C.L., Elixhauser A., and Romano P.S. Evaluating the Patient Safety Indicators: How Well Do They Perform on Veterans Health Administration Data? 2005. Med Care;43: 873–884