PubMed · 14839332
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P R HAWLEY. 1951. The hospital standardisation program.. https://pubmed.ncbi.nlm.nih.gov/14839332/
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OBJECTIVE: . To investigate the reliability of self-reported standardized performance indicators introduced by the Joint Commission on Accreditation of Healthcare Organizations in July 2002 and implemented in approximately 3400 accredited US hospitals. The study sought to identify the most common data quality problems and determine causes and possible strategies for resolution. DESIGN: Data were independently reabstracted from a random sample of 30 hospitals. Reabstracted data were compared with data originally abstracted, and discrepancies were adjudicated with hospital staff. Structured interviews were used to probe possible reasons for abstraction discrepancies. RESULTS: The mean data element agreement rate for the 61 data elements evaluated was 91.9%, and the mean kappa statistic for binary data elements was 0.68. The rate of agreement for individual data elements ranged from 100 to 62.4%. The mean difference between calculated indicator rates was 4.88% (absolute value) and the range of differences was 0.0-13.3%. Symmetry of disagreement among original abstractors and reabstractors identified eight indicators whose differences in calculated rates were statistically unlikely to have occurred through random chance (P < 0.05). CONCLUSION: Although improvement in the accuracy and completeness of the self-reported data is possible and desirable, the baseline level of data reliability appears to be acceptable for indicators used to assess and improve hospital performance on selected clinical topics.
OBJECTIVE: Iatrogenic pneumothorax (IP) is an inherent risk to patients who undergo procedures that involve the intentional puncturing of the lung. IP also could occur accidentally to patients who do not undergo such procedures; such accidental IP (AIP) is suggestive of lapses in safe care. This study assessed the risk for AIP in patients hospitalized with specific diagnoses who underwent specific procedures. RESEARCH DESIGN: We analyzed 7.5 million discharge abstracts from 994 short-term acute care hospitals across 28 states in 2000 in the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project Nationwide Inpatient Sample. AHRQ Patient Safety Indicators (PSIs) were used to identify AIP. AIP incidences and associated diagnoses and procedures were explored. RESULTS: Patients who were admitted for pleurisy, cancer of the kidney and renal pelvis, or conduction disorders and complications of cardiac devices had the highest rates of developing AIP during hospitalization, with AIP rates at 2.24%, 1.14%, and 0.83% respectively. The procedure-specific rates for AIP varied from 2.68% for patients who underwent thoracentesis to 1.30% for those who underwent nephrectomy, to 0.06% for those who underwent gastrostomy. Thoracentesis appeared to be a high-risk procedure for patients who were admitted for secondary malignancies, pleurisy, or pneumonia, with AIP rates at 3.76%, 3.13%, and 2.28%, respectively. CONCLUSIONS: Although AIP is most common after thoracentesis, it is a substantial threat to patients undergoing a wide range of procedures.
BACKGROUND/OBJECTIVES: This study examined the statistical relationship between hospital ownership and teaching status and hospital rates for potentially preventable adverse events measured using patient safety indicators recently developed by the Agency for Healthcare Research and Quality. RESEARCH DESIGN/MEASURES: A nationally representative sample of hospitals grouped into mutually exclusive combinations of control/ownership, teaching status, and rurality was defined using the Nationwide Inpatient Sample data set for the year 2000. Hospital rates for 5 categories of preventable adverse events were measured in 3 forms: unadjusted, risk-adjusted, and risk-adjusted ratios with smoothing. Multivariable regression analysis was used to measure the statistical significance of the relationship between hospital type and rates for potentially preventable adverse events, with adjustments for differences in hospital bed size and region. RESULTS: This analysis found an inconsistent relationship between categories of hospital type and quality care measured by alternative indicators of potentially preventable conditions. CONCLUSIONS: Hospital ownership and teaching status is not a consistent predictor of differences in rates of potentially preventable adverse events, and these characteristics explain little of the observed variation in the rates of these events across hospitals.