Data Comparability in Patient Safety Indicators

Transcription

1 Data Comparability in Patient Safety Indicators Yael Applbaum MD Shulamit Gordon Ziona Haklai

2 Background In Israel diagnosis is only at discharge without an additional admission diagnosis upon entrance to the hospital. A patient developing signs of complications after surgery might be transferred to a medical ward or an intensive care unit.

3 The order of diagnoses (primary vs. secondary) might subsequently change because of the above Coding is done by physicians and/or by professional medical coders. Local policies vary. Training programs for coding are lacking

4 Length of stay in Israel is very short. We assumed that certain post-op complications such as DVT might occur and be discovered only after discharge.

5 Aims of the project: To explore alternative models of reporting post-operative complications based on administrative databases and to investigate whether adopting such models can increase international comparability when data systems are not identical. To identify areas where indicator specifications may be changed to improve comparability.

6 OECD definition for post-surgical DVT/PE Knee or hip replacement DVT/PE in any secondary field

7 Modifications TIMELINE MODEL : anyone who had, in addition to surgery, a diagnosis of DVT, PE or Vena cava interruption, as long as it happened after the joint replacement.(regardless to whether it is a primary or secondary diagnosis) Repeat hospitalizations within 30 days of discharge, in which there was a diagnosis of DVT, under the premise that the thromboembolic event was a result of the surgery.

8 Post Surgical DVT/PE timeline model Model Numerator Denominator Rate: per According to OECD instructions , Timeline: DVT/PE after operation , Vena cava interruption after operation 17 38, DVT/PE and vena cava interruption 10 38, DVT/PE or vena cava interruption after ortho oper ,

9 Post surgical DVT/PE Repeat hospitalizations within 30 days Year Joint replacements DVT during initial hospitalization DVT during initial hospitalization or in recurrent hospitalization within 30 days Rates per 1000 operations during initial hospitalization Rates per 1000 operations , , , , , , , , , , , , ,

10 WOUND DEHISCENCE OECD definition: abd. surgery + procedure code for reclosure of postoperative disruption of abdominal wall Modified definition: abd. surgery + either reclosure of post-operative disruption or a diagnosis of dehiscence of wound.

11 Either or model Year All abd. surgery OECD numerator: reclosure procedures Numerator: diag. of dehiscence Numerator: either recolsure procedure or diag. of dehiscence Numerator: reclosure procedure and diag. of dehiscence OECD model: rates per 1000 Diag. only model: rates per 1000 Either /or model: rates per 1000 Reclosure and diag. model: rates per

12 Post Surgical Hemorrhage OECD definitions: those with surgery, a code of hemorrhage (diagnosis) and a code of drainage (procedure) Modification: surgery and either hemorrhage or drainage

13 Post Surgical Hemorrhage Year Time model Surgery + hemorrhage and drainage Surgery+ hemorrhage Surgery + drainage Surgery+ hemorrhage or drainage OECD definition Numerator ,018 1,616 2,393 Denominator , , , , ,851 Rate per

14 Post surgical sepsis Difficulty in interpretation of OECD definition because of lack of diagnosis upon admission Coders understanding of primary and secondary diagnosis often subjective

15 Post surgical sepsis timeline model" OECD definition: code of sepsis in any secondary field Modification: any case of sepsis, whether a primary or secondary diagnosis, as long as it occurred after the surgery.

16 Our model Post surgical sepsis denominator: all abdominal operations with exclusion criteria: 1) any case of sepsis or infection in ED or in any department (1 0 or 2 0 ) preceding the surgery. 2) sepsis or infection as primary diagnosis in the surgical dept. (although subjective)

17 Post surgical sepsis numerator: Secondary diagnosis of sepsis in surgical dept. Or Primary or secondary diagnosis of sepsis in any later dept.

18 Post surgical sepsis timeline model" Sepsis diagnosis after operation Values Year Timeline model Numerator Denominator ,211 Rate per

19 Future plans -1 Validate our data comparing with other clinical studies and with the National Quality Measures project (open files)

20 Future plans - 2 Collaboration with countries that have similar databases and similar quality issues: Do these models effect the PSI similarly in other countries Explore variance between physicians vs. professional coders Explore various auditing systems on coding quality Examine and compare training programs

21 Thank you!