Development process
Page contents: Introduction | Revision & adaptation | Mapping of codes | Programming
Introduction
AHRQ developed quality indicators with the aim of measuring health care quality by using readily available hospital inpatient administrative data . There are four modules in the quality indicator set.
Module three is a Patient Safety Indicator (PSI) module. The PSI module is a set of indicators providing information on potential in-hospital complications and adverse events following surgery, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses. The AHRQ PSIs comprises a set of 27 indicators.
The AHRQPSIs use an earlier version of ICD coding (ICD-9-CM) than is the standard in Australia. The standard for coding in Australia is ICD-10 AM. ICD-9-CM was last used in Australia prior to 1998 at which time all Australian states and territories converted to the use of ICD-10-AM.
As a result of the inconsistency of codes between the AHRQ PSIs and the available data in Australia, the PSIs required translation.
The aim of the translation was to provide a tool to enable:
- Identification of:
-
- Adverse event trends
- Areas of concern in the quality arena
- Tracking of quality improvement initiatives
- Benchmarking between health service and campuses
This translation was undertaken by the Department of Human Services in a partnership between the Statewide Quality Branch and Funding, Health & Information Policy Branch. The translation of the AHRQPSIs is now complete.
The translated AHRQPSIs can be applied to all Australian administrative datasets.
Revision & adaptation
Following review of the translation, many of the AHRQPSIs have been revised and adapted to provide a set of set of patient safety indicators that are more suitable for Victoria and Australia. These are the AusPSIs. The AusPSIs result from detailed consideration of the AHRQ indicator definitions, the limitations/strengths of ICD-10-AM data and of the Victorian clinical environment.
A comprehensive description of the indicator definitions is available here. This includes numerator, denominator, exclusions and rationale for change from the original AHRQ definitions. A complete listing of the tools you will need to use the AusPSIs is available here. This includes SAS programs, ICD-10-AM codes and indicator definitions.
Mapping of codes
The ICD-9-CM codes contained in the AHRQ PSIs were forward mapped to 4th edition ICD-10-AM/ACHI codes so that the indicators could be run against the most recent complete financial year data. This produced a 4th edition ICD-10-AM/ACHI list of numerator, denominator and exclusion codes for each PSI. As the mapping was based on a ‘one to on’ mapping process, these lists were then checked against the actual classification to determine whether codes had been missed, and whether the mapped code was consistent with the intention of the PSI. Where direct mapping was not available for ICD-9-CM codes on the original lists and where new codes had been created that did not have a match in the original list the decision to include or exclude them was made after consultation with the project team and the reference group. These 4th edition lists were then backward mapped, and checked, through all the editions of ICD-10-AM so that comparison data could be run. Finally the 4th edition lists were forward mapped to the 5th edition ICD-10-AM/ACHI codes and checked against the 5th edition classification to ensure accuracy for use in analysing the 2006-08 data.
Programming
SAS macros identify admitted episodes contributing to the numerator and denominator and output the rate per 1,000 episodes at risk. The programs use multi-dimensional arrays to identify admitted episodes contributing to the numerator and denominator by matching codes from the expert reviewed input files with diagnosis and procedure codes for the episode of care. The multi-dimensional array statements are generated by SAS based on parameters from the input files. This flexibility enables the programs to adapt to changes in the number of codes in the input files with changes in editions of ICD-10-AM coding.