Patient Safety Indicators Ripe for Improvement

Tinker Ready, January 5, 2017

Several research teams have raised issues about the limitations of claims data to measure PSIs. Now changes are in the works.

New data promises to add fuel to the ongoing discussion over the accuracy of billing data used to calculate patient safety indicators (PSI).

A group of Ohio State University researchers has found that hospital cases "flagged with a clinically validated PSIs" are linked to greater length of stay and higher rates of 30-day unplanned readmissions, and mortality.

The study, published in the American Journal of Medical Quality, "demonstrates a strong association between clinically validated PSIs and patient outcomes."

The Ohio State researchers note that by going beyond claims data to look at patients' medical records, they controlled for "the poor validity of the current PSI algorithm."

Several research teams have raised issues about the limitations of claims data to measure PSIs. And changes are in the works.

Some of the PSIs have been refined since the Ohio State study as part of an ongoing analysis of safety measures by the federal Agency of Healthcare Research and Quality. And, an upcoming report from the National Quality Forum, which works with AHRQ on refining measures, calls for a closer look at the use of claims, or administrative data, to measure PSIs.

Darrell Gray, an OSU gastroenterologist and lead author of the study, said his team saw a gap in the literature linking validated PSIs to other key outcomes, such as readmissions. Their recent research looked at outcome for 1,874 validated cases flagged for PSIs.

The researchers found that patients flagged with validated PSIs were more likely to be readmitted. For example, 22.2% of patient flagged for pressure ulcers were readmitted, compared to 19.8 of those not flagged.


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The team included OSU researcher Jennifer Hefner and built off her earlier research at Ohio State. Published in August under the title, "Navigating the Ocean with a Broken Compass," the findings involved a retrospective analysis of all flagged PSI for the year 2014.

Hundreds of medical charts were compared to the administrative data to measure the accuracy of the PSI designation. The August study concluded that improvements are needed in the quality of data and algorithms data being used to identify the PSIs.

Tinker Ready

Tinker Ready is a contributing writer at HealthLeaders Media.

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