viernes, 21 de octubre de 2016

AHRQ National Scorecard on Rates of Hospital-Acquired Conditions | Agency for Healthcare Research & Quality

AHRQ National Scorecard on Rates of Hospital-Acquired Conditions | Agency for Healthcare Research & Quality


  

Pharmacists Association Recognizes Federal Effort To Reduce Adverse Drug Events

 AHRQ’s and DHHS’ Quality Improvement Commitment recognized by American Pharmacists Association



The Department of Health and Human Services has been awarded the American Pharmacists Association (APhA) Foundation’s 2016 Pinnacle Award for its commitment to quality improvement initiatives, including AHRQ’s work on the National Scorecard on Hospital-Acquired Conditions. The National Scorecard has shown that adverse drug events were reduced by 40 percent between 2010 and 2014, and instances of patient harm overall fell by 17 percent during that time. The APhA Foundation specifically mentioned AHRQ’s efforts, and those of other HHS agencies, in creating tools and resources and working with frontline pharmacists, physicians, nurses and other caregivers to generate and measure these substantial reductions in adverse drug events. Access a video highlighting AHRQ’s work, and get more information on how the National Scorecard can help your organization.

AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care



AHRQ National Scorecard on Rates of Hospital-Acquired Conditions

The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services, and other public and private groups are part of the Partnership for Patients, an initiative working to improve the quality, safety, and affordability of health care for all Americans, including resources, measures, and reports on reducing the rate of hospital-acquired conditions (HACs). 
HACs are costly and dangerous events that occur while patients are receiving care for another condition during a hospital stay. HACs may include bloodstream and urinary tract infections, pressure ulcers, and adverse drug events.  New data that are part of AHRQ's National Scorecard show that, between 2010 and 2014, the rate of HACs declined by 17 percent around the country, saving about 87,000 lives and nearly $20 billion in health costs. The final report concludes that hospital patients experienced 2.1 million fewer HACs over the 4-year period than would have occurred had the rates remained at the 2010 level.
Saving Lives and Saving Money: Hospital-Acquired Conditions Update: Interim Data From National Efforts To Make Care Safer, 2010-2014
Final Report on 2013 Hospital-Acquired Condition Rate
Interim Update on 2013 Hospital-Acquired Condition Rate
Methods To Estimate the Baseline 2010 and 2011-12 PFP National Hospital-Acquired Condition Rates

Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate

Prepared by Noel Eldridge.
This document describes the methods AHRQ used to estimate the national rate of hospital-acquired conditions (HACs) for the Partnership for Patients (PFP) program. The estimate includes a wide variety of adverse events, including the nine HACs selected for special focus as part of the PFP, as well as several other HACs. Collectively, 28 specific measures are used: 14 measures to generate rates for the 9 specific PFP HACs and 14 measures to generate a summary rate for "all other" HACs. Of the 28 measures, 21 are from the AHRQ/CMS Medicare Patient Safety Monitoring System (MPSMS), 6 are from the AHRQ Patient Safety Indicators (PSIs), and 1 is based on National Healthcare Safety Network (NHSN) data from CDC. The measures are shown in Table 1 below.

Table 1. Measures Used To Estimate the National Hospital-Acquired Condition Rate

Partnership for Patients Hospital-Acquired ConditionsSourceMeasure
Adverse Drug Event (ADE)MPSMSADE Associated With Digoxin
MPSMSADE Associated With Hypoglycemic Agents
MPSMSADE Associated With IV Heparin
MPSMSADE Associated With Low Molecular Weight Heparin and Factor Xa Inhibitor
MPSMSADE Associated With Warfarin
CAUTIMPSMSCatheter-Associated Urinary Tract Infections (physician diagnosed)
CLABSIMPSMSBlood Stream Infections Associated With Central Venous Catheters
FallsMPSMSIn-Hospital Patient Falls
Obstetric Adverse EventsPSIOB Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19)
Pressure UlcersMPSMSHospital-Acquired Pressure Ulcers
Surgical Site InfectionsNHSNSSIs combined for 17 procedures based on CDC NHSN data
VAPMPSMSVentilator-Associated Pneumonia
VTEMPSMSPostoperative Venous Thromboembolic Events
"All Other" HACs (not identified for national focus as specific PFP HACs)MPSMSFemoral Artery Puncture for Catheter Angiographic Procedures
MPSMSAdverse Events Associated With Hip Joint Replacements
MPSMSAdverse Events Associated With Knee Joint Replacements
MPSMSContrast Nephropathy Associated With Catheter Angiography
MPSMSHospital-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA)
MPSMSHospital-Acquired Vancomycin-Resistant Enterococcus(VRE)
MPSMSHospital-Acquired Antibiotic-Associated Clostridium difficile
MPSMSMechanical Complications Associated With Central Venous Catheters
MPSMSPostoperative Cardiac Events for Cardiac and Noncardiac Surgeries
MPSMSPostoperative Pneumonia
PSIIatrogenic Pneumothorax (PSI 6)
PSIPost-Op Hemorrhage or Hematoma (PSI 9)
PSIPost-Op Respiratory Failure (PSI 11)
PSIAccidental Puncture or Laceration (PSI 15)
Acronyms: Central Line-Associated Blood Stream Infection (CLABSI), Medicare Patient Safety Monitoring System (MPSMS), Patient Safety Indicators (PSIs), National Healthcare Safety Network (NHSN).
Data from these 28 measures are combined to generate a summary national HAC rate that can be calculated annually, and that uses data from the AHRQ Healthcare Cost and Utilization Project (HCUP) on the annual number of hospital inpatient discharges as the denominator for the rate calculation. The details of how the national HAC rate is calculated for PFP are summarized below.
  1. The national rate of PFP HACs is calculated using the following variables:
    1. The rate of 21 MPSMS adverse events in the MPSMS sample provided by the CMS Inpatient Quality Reporting (IQR) sample of charts. The IQR sample for 2010 (the baseline year for the PFP national HAC rate) included approximately 34,000 charts from four patient groups: those included in the Surgical Care Improvement Project (SCIP) (major surgery) sample, and those with a principal diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia. The IQR sample is limited to patients 18 years old and over. The rates of the 21 MPSMS adverse events are expressed as a rate for the whole sample population, rather than as a rate for the subpopulation that has the opportunity to experience the adverse event. For example, the CLABSI rate, like all the rates, uses all patients in the denominator, not just the patients who had a central line inserted during their hospital stay. To ensure that the estimated rate will not be affected by variation across years in the proportion of patients from each of the four groups (that is, SCIP, AMI, CHF, and pneumonia), for each of the 21 MPSMS HACs the estimate is a weighted average of the HAC rate for each group, where each group is given a 25% weight.
    2. The national number of adverse events captured by PSIs 18 and 19 on obstetric injury, and the national number of four other PSIs (numbers 6, 9, 11, and 15) included among the "all other" HACs.
    3. The national number of selected surgical site infections computed in a special calculation for the PFP by CDC. This calculation is based on NHSN data for 17 specific operations: the 12 "SCIP" operations and 5 others.
    4. The data described above for MPSMS are unlike the NHSN and PSI data in two ways. First, they originate as a rate, and second, they are an estimate for four specific subpopulations of hospital patients rather than all inpatients. In order to estimate MPSMS rates for all patients, rather than simply those with one of the four diagnoses included in the 2010-2012 IQR sample, we use data from the 2005-2006 MPSMS sample. Using the 2005-2006 MPSMS data, we estimate, for each of the 21 HACs included in the MPSMS analysis, the ratio of the rate of HACs for all patients in the sample to the rate of HACs for patients with the four diagnoses. As shown in Table 2, these ratios vary from .28 to 1.08, with 14 of 21 ratios being between .4 and .8 and the arithmetic mean of the ratios being .64. The fact that the ratios are, with one exception, all below 1.0 makes intuitive sense: it is credible that the rate of harm is greater for patients who have had major surgery, AMI, CHF, or pneumonia than it is for other patients.
    5. In order to estimate the rate of adverse events for each of the 21 HACs for all patients for which the MPSMS data are used, we multiply the adverse event rate for each of the 21 HACs for patients with one of the four conditions included in the 2010-2012 MPSMS sample as estimated in (a) above by the ratio of adverse events for all patients to adverse events for patients with one of the four diagnoses. Then, in order to estimate the number of adverse events for each of these 21 HACs, we multiply the estimated rate for all patients by the estimated total number of hospital discharges, where the estimate for the total number of hospital discharges comes from HCUP.
  2. The estimated total count of annual HACs in the PFP national HAC rate is calculated as the sum of the total number of HACs for the 21 MPSMS HACs in (e) above, plus the estimated number of PSI HACs in (b), plus the number of NHSN-estimated HACs in (c).
  3. The PFP national HAC rate is the total HAC count in (2) above divided by the number of annual hospital inpatient discharges of patients at least 18 years old, as provided by HCUP. Table 3 provides a summary of the data that shows how the 28 rates from all the measures are combined into the PFP national HAC rate.
  4. As of April 2014, this method has been repeated for 2011, and for 2012 using preliminary data for the number of annual hospital discharges. To be able to compare the estimated total number of HACs in 2011 and 2012 to 2010 without having that comparison be affected by changes in the total number of discharges, for 2011 and 2012, the data were normalized to generate national counts based on 32,750,000 discharges, which was the total number of discharges in 2010 for inpatients 18 years old and over. This method will be used again to finalize estimates for 2012, 2013, and 2014 as the data become available.

Table 2. Summary of Ratio Calculations

PFP HAC CategoryMPSMS MeasureRate per 1,000 Discharges in FFS Medicare Patients >64 Years: All Diagnoses (CY 2005-2006 Combined)Rate per 1,000 Discharges in FFS Medicare Patients >64 Years: Four Principal Diagnoses Only: AMI, HF, Pneumonia, & SCIP (CY 2005-2006 Combined)Ratio (Calculated as All Diagnoses Rate/Four Principal Diagnoses Rate)
ADEADE Associated With Digoxin0.190.171.08
ADEADE Associated With Hypoglycemic Agents34.0644.280.77
ADEADE Associated With IV Heparin10.2220.590.50
ADEADE Associated With Low Molecular Weight Heparin and Factor Xa Inhibitor13.9025.240.55
ADEADE Associated With Warfarin10.8517.400.62
CLABSIBlood Stream Infections Associated With Central Venous Catheters1.442.240.64
CAUTICatheter-Associated Urinary Tract Infections18.8025.580.73
FallsIn-Hospital Patient Falls12.2514.560.84
Pressure UlcersHospital-Acquired Pressure Ulcers53.0362.450.85
VAPVentilator-Associated Pneumonia1.302.670.49
VTEPostoperative Venous Thromboembolic Events1.844.390.42
All Other HACsContrast Nephropathy Associated With Catheter Angiography8.4618.350.46
All Other HACsFemoral Artery Puncture for Catheter Angiographic Procedures3.023.620.83
All Other HACsHospital-Acquired Antibiotic-Associated C. difficile4.215.170.81
All Other HACsHospital-Acquired MRSA1.231.550.79
All Other HACsHospital-Acquired VRE0.370.520.72
All Other HACsAdverse Events Associated With Hip Joint Replacements1.023.700.28
All Other HACsAdverse Events Associated With Knee Joint Replacements1.023.620.28
All Other HACsMechanical Complications Associated With Central Venous Catheters4.005.250.76
All Other HACsPostoperative Cardiac Events for Cardiac and Noncardiac Surgeries4.008.700.46
All Other HACsPostoperative Pneumonia4.399.730.45

Table 3. 2010 Estimated Final HAC Data (Finalized May 2012)

PFP Hospital-Acquired ConditionsInformation on 2010 Measured HACs Baseline
Partnership for Patients Hospital-Acquired ConditionSourceMeasure2010 PFP HACs (Not Rounded)2010 (18+ y.o.) Discharges (HCUP)2010 PFP Measured HACs per 1,000 Discharges
ADEMPSMSADE Associated With Digoxin11,65032,750,0000.356
MPSMSADE Associated With Hypoglycemic Agents930,86332,750,00028.423
MPSMSADE Associated With IV Heparin170,97332,750,0005.221
MPSMSADE Associated With Low Molecular Weight Heparin and Factor Xa Inhibitor335,82632,750,00010.254
MPSMSADE Associated With Warfarin171,60932,750,0005.240
MPSMSTotal ADE (sum of above 5 measures)1,620,92132,750,00049.496
CAUTIMPSMSCatheter-Associated Urinary Tract Infections401,13932,750,00012.249
CLABSIMPSMSBlood Stream Infections Associated With Central Venous Catheters18,09132,750,0000.552
FallsMPSMSIn-Hospital Patient Falls262,31732,750,0008.010
Obstetric Adverse EventsPSIOB Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19)82,30032,750,0002.513
Pressure UlcerMPSMSHospital-Acquired Pressure Ulcers1,317,21132,750,00040.220
Surgical Site InfectionNHSNSSIs for 17 procedures in 2010 with CDC data96,46732,750,0002.946
VAPMPSMSVentilator-Associated Pneumonia37,60432,750,0001.148
VTE (updated June 2014)MPSMSPostoperative Venous Thromboembolic Events27,56432,750,0000.842
All Other Hospital- Acquired ConditionsMPSMSFemoral Artery Puncture for Catheter Angiographic Procedures75,80432,750,0002.315
MPSMSAdverse Events Associated With Hip Joint Replacements30,41332,750,0000.929
MPSMSAdverse Events Associated With Knee Joint Replacements28,85532,750,0000.881
MPSMSContrast Nephropathy Associated With Catheter Angiography227,41932,750,0006.944
MPSMSHospital-Acquired MRSA14,82832,750,0000.453
MPSMSHospital-Acquired VRE13,18632,750,0000.403
MPSMSHospital-Acquired Antibiotic-Associated C. difficile86,91632,750,0002.654
MPSMSMechanical Complications Associated With Central Venous Catheters114,68932,750,0003.502
MPSMSPostoperative Cardiac Events for Cardiac and Noncardiac Surgeries43,12032,750,0001.317
MPSMSPostoperative Pneumonia96,89632,750,0002.959
PSIIatrogenic Pneumothorax (PSI 6)13,49032,750,0000.412
PSIPost-Op Hemorrhage or Hematoma (PSI 9)20,69132,750,0000.632
PSIPost-Op Respiratory Failure (PSI 11)50,05832,750,0001.528
PSIAccidental Puncture or Laceration (PSI 15)77,19432,750,0002.357
MPSMS & PSITotal All Other HACs (sum of above 14 measures)893,55932,750,00027.284
Total PFP HACs, and HACs per 1,000 discharges (updated June 2014)4,757,173 145.26
Total PFP HACs, and HACs per 1,000 discharges (rounded)  (updated June 2014)4,757,000 145
Ideally, we would have estimated the adverse event rates for the 21 MPSMS HACs using data from patients with all diagnoses, rather than being restricted to the four diagnoses that were included in the 2010 IQR sample. Because the 2010 IQR sample did not include patients with all diagnoses, we used the 2005 and 2006 MPSMS data, as described above, to estimate the ratio of adverse events for all diagnoses to adverse events for the four diagnoses. However, the 2005 and 2006 sample was restricted to Medicare patients age 65 and over, and it is possible that the ratios we estimated with those data are not correct for all patients. It makes sense to think, for example, that because many of the adverse events we measure are less common among obstetric patients than among other patients, the ratio for all patients would be lower than the ratio for Medicare patients 65 years old and over. It is also possible that the ratio has changed from 2005-2006 to the present.

New MPSMS data are now available based on an expanded 2012-2013 IQR sample that includes charts from patients with diagnoses other than those in the four diagnosis groups present in the 2010-2011 IQR sample. Use of these data may enable the development of a new method that could provide an improved estimate of the PFP national HAC rate. Information from these 2012 and 2013 charts is currently being analyzed to ensure the reliability of the MPSMS rates and other data present in charts from these additional IQR samples. Preliminary data and calculations based on data that include the new IQR samples suggest that a method that includes data from these additional charts would produce somewhat lower national HAC rates than have been computed to date, but not necessarily change the annual trends in the HAC rates.
Page last reviewed October 2016
Internet Citation: AHRQ National Scorecard on Rates of Hospital-Acquired Conditions. Content last reviewed October 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html