Understanding the Data behind the National Landscape of Safety:

Have We Really Improved?

Consumers Advancing Patient Safety

Safety Across the Board Signature Learning Series

July 2015 Webinar

Welcome

Guest Speaker: Noel Eldridge, MSCenter for Quality Improvement and Patient Safety Agency for Healthcare Research and Qualitynoel.eldridge@ahrq.hhs.gov

Moderator: Marty Hatlie, J.D.Project Patient Caremhatlie@p4ps.net

Estimating and Measuring

Patient Safety at the National Level: Interim Update on 2013 Annual Hospital-Acquired

Condition Rate and Estimates of Cost Savings and

Deaths Averted From 2010 to 2013

Presentation for Consumers Advancing Patient Safety (CAPS) Webinar,

Understanding the Data Behind the National Landscape of Safety:

Have We Really Improved?

Noel Eldridge, MS

Center for Quality Improvement and Patient Safety

Agency for Healthcare Research and Quality

July 30, 2015

noel.eldridge@ahrq.hhs.gov 3

Outline

• Background

• Pre-launch Partnership for Patients (PfP) Hospital-Acquired Condition (HAC) projections based on reviewing the literature► HAC incidence, preventability, PfP goal, cost, & lethality

• Measuring the 9 PfP HACs and “All-Other” HACs (rates or counts on 28 HACs) through Interim 2013 data► Estimating results based on measured HACs and pre-launch

projections of preventability, cost, & mortality

The PfP Report through Interim 2013 data is online at: http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html,

The Washington Post Fact Checker article: http://www.washingtonpost.com/blogs/fact-checker/wp/2015/05/12/the-

most-popular-fact-checks-of-april-2/

4

AHRQ Data Analysis Earns

Geppetto Checkmark

• President Obama uses

AHRQ analysis in remarks

on 5th anniversary of ACA

► “Fact Checker” awards Geppetto

Checkmark

► One of three Geppettos awarded*

► Most popular “Fact Check” for April

2015

• AHRQ analysis published

in December 2014 on the

impact of the Partnership for

Patients

Significant omissions and/or

exaggerations

Fact Checker, by Glenn Kessler

One Pinocchio

Some shading of facts

The Geppetto Checkmark

“the truth, the whole truth, and nothing but

the truth”

Two Pinocchios

Significant omissions

Three Pinocchios

Significant factual errors

*97 “Fact Checker” articles published

January 2015 through April 15, 2015

5

Why is the 2013 Data Still

“Interim?”

• The Federal Government does not yet have national

data on how many patients were discharged from

hospitals in 2013 (We do have Medicare fee-for-service

data, because that’s what we pay for directly)

• The best all-payer data comes from the Healthcare Cost

and Utilization Project (HCUP), which is voluntary (47

States and DC participate) and combines State data

► Without these data we can’t compute the Patient

Safety Indicators or surgical site infections, which are

approximately 5% and 2% of the PfP HAC total,

respectively

• We expect to release the final 2013 PfP HAC data in

September 20156

Goals for the

Partnership for Patients

• In August 2010, AHRQ and other HHS agencies were

assigned the task of developing a national patient safety

initiative. Direction came from the Office of Health

Reform and CMS

• As announced by HHS Secretary Sebelius in April 2011,

the Partnership for Patients had two main goals:

1) To reduce preventable HACs by 40%

2) To reduce 30-day hospital readmissions by 20%

• The new CMS Center for Medicare & Medicaid

Innovation (CMMI) was assigned to lead the program. In

December 2011, CMS selected and funded 26 Hospital

Engagement Networks to work with hospitals nationwide7

Context for the PfP

HAC Goals (1 of 2)

• Prior to and at launch we used estimates for

HACs (not measurements)

1. HAC estimates and preventabilities were based on:

Peer-reviewed and other publications

Internal data from AHRQ, CDC, and CMS (MPSMS,

PSIs, NHSN, and “non-payment HACs”)

HHS OIG reports

Consensus review of the various estimates collected

8

Context for the PfP

HAC Goals (2 of 2)

• Prior to and at launch we used estimates for

HACs (not measurements)

2. The percent reduction goal for each HAC was

based on data from large and successful projects

undertaken for each HAC

Cost per HAC and mortality per HAC estimates were

also developed

9

Pre-launch HACs and Estimates

• The nine types of HAC’s selected for the focus of the program were:1. Adverse Drug Event

2. Urinary Tract Infection

3. Central Line-Associate Bloodstream

4. Injury From Fall

5. Obstetrical Adverse Event

6. Pressure Ulcer

7. Surgical Site Infection

8. Ventilator-Associated Pneumonia

9. Venous Thromboembolism

► All Other HACs

10

Pre-launch HACs and

Estimates (cont’d)

• Exactly how we would measure these HACs was

not planned prior to launch, and “measurability”

was not a major factor in the selection of types

of HACs

• The main considerations in selection were:

► The harm that the HACs cause (considering incidence

and average harm per HAC) and

► Whether there was sufficient information on how to

implement a prevention program for each type of HAC

11

Partnership for Patients "Pre-launch"

Estimates of Cases and Preventability and

Goals for Prevention

PFP Hospital Acquired

Condition (HAC)

PFP Total

Cases

Estimate

PFP

Preventability

Estimate

PFP

Preventable

HACs

Estimate

PFP Reduction

Goal (of

Preventable

HACs)

PFP HAC

Reduction

Goal

PFP HACs

Remaining

if Goal Met

Adverse Drug Event1,900,000 50% 950,000 50% 475,000 1,425,000

Catheter-Associated Urinary

Tract Infection530,000 40% 212,000 50% 106,000 424,000

Central Line-Associated

Bloodstream Infection40,000 50% 20,000 50% 10,000 30,000

Injury from Fall200,000 25% 50,000 50% 25,000 175,000

Obstetrical Adverse Event380,000 30% 114,000 50% 57,000 323,000

Pressure Ulcer250,000 50% 125,000 50% 62,500 187,500

Surgical Site Infection110,000 35% 38,500 20% 7,700 102,300

Ventilator-Associated

Pneumonia40,000 50% 20,000 50% 10,000 30,000

Venous Thromboembolism

(post-surgery)100,000 40% 40,000 50% 20,000 80,000

All Other HACs2,430,000 44% 1,069,200 25% 267,300 2,162,700

Totals 5,980,000 44.1% 2,638,700 39.4% 1,040,500 4,939,500

17.4% 12

Partnership for Patients "Pre-launch"

Estimates of Cost and Death per HAC

PFP Hospital Acquired

Condition (HAC)

PFP HAC

Reduction

Goal

Additional

Inpatient

Cost per

HAC

Savings in Year

Goal is Met

(not rounded)

Deaths per

HAC

Deaths Prevented

in Year Goal is Met

(not rounded)

Adverse Drug Event 475,000 $5,000 $2,375,000,000 0.0204 9,675

Catheter-Associated Urinary

Tract Infection106,000 $1,000 $106,000,000 0.0233 2,470

Central Line-Associated

Bloodstream Infection10,000 $17,000 $170,000,000 0.1850 1,850

Injury from Fall

(originally $30,000)25,000 $7,234 $180,850,000 0.0550 1,375

Obstetrical Adverse Event 57,000 $3,000 $171,000,000 0.0015 84

Pressure Ulcer

(originally $43,000)62,500 $17,286 $1,080,375,000 0.0723 4,519

Surgical Site Infection 7,700 $21,000 $161,700,000 0.0282 217

Venous Thromboembolism

(post-surgery)20,000 $8,000 $160,000,000 0.1438 2,876

Ventilator-Associated

Pneumonia10,000 $21,000 $210,000,000 0.1040 1,040

All Other HACs 267,300 $17,000 $4,544,100,000 0.0454 12,133

Totals 1,040,500 $9,159,025,000 36,239

Total for a 3-year PFP

(@25%, 50%, 100%)1,820,875 $16,028,293,750 63,419

Total for a 4-year PFP

(@25%, 50%, 75%, 100%)2,601,250 $22,897,562,500 90,598

13

14

Establishing the Measured

2010 HAC Baseline and

HAC Data through CY 2013 (Interim)

15

Measuring the Nine HACs

1. Adverse Drug Events (ADE)(from Medicare Patient Safety Monitoring System - MPSMS)

2. Catheter-Associated Urinary Tract Infections (CAUTI)(from MPSMS)

3. Central Line-Associated Bloodstream Infections (CLABSI)(from

MPSMS)

4. Injuries from Falls and Immobility (from MPSMS)

5. Obstetric Adverse Events (from Patient Safety Indicators - PSIs)

6. Pressure Ulcers (from MPSMS)

7. Surgical Site Infections (SSI)(from CDC’s National Healthcare Safety

Network [NHSN] – special calculation)

8. Venous Thromboembolism (VTE)(from MPSMS)

9. Ventilator-Associated Pneumonia (VAP)(from MPSMS)

• “All Other HACs” (10 from MPSMS and 4 from PSIs)

The nine HACs total about 80 percent of measured 2010 HACs

(as opposed to about 60 percent of the pre-launch estimated HACs)16

17

Good Measures but not Perfect

• We have good measures for the 9 HACs, but they are not perfect; for example:► VTE measure is post-op only

► ADE measures miss many ADEs – e.g., those due to opioids or allergies, etc.

► CAUTIs or CLABSIs caused by inpatient processes but manifesting post-discharge cannot be counted

► SSI measure covers only 17 selected procedures

► OB measures count injuries to mother only

• The measures for the 9 HACs and All Others do not represent every case of ADE, VTE, SSI, OB event, etc., but they do capture a consistent set of events every year and can be used to track the overall national trend in occurrence of HACs

18

2010 Baseline and 2011, 2012, and

2013 (Interim) HAC Data & Goal

PFP Hospital-Acquired Condition2010

Baseline 2011 2012 Interim 2013 PFP Goal

Percent change

from 2010 to date

(2013 MPSMS, 2012

NHSN& PSI)

Adverse Drug Events (ADE) 49.5 48.7 41.9 40.3 40.8 -19%

Catheter-Associated Urinary Tract

Infections (CAUTI)12.2 11.3 10.6 8.8 10.1 -28%

Central Line-Associated

Bloodstream Infections (CLABSI)0.55 0.52 0.51 0.28 0.45 -49%

Falls 7.9 7.8 7.2 7.2 6.5 -9%

Obstetric Adverse Events 2.5 2.5 2.4 2.4 2.1 -6%

Pressure Ulcers 40.3 40.4 39.4 32.5 33.2 -19%

Surgical Site Infections (SSI) 2.9 2.5 2.5 2.4 2.4 -24%

Ventilator-Associated Pneumonias

(VAP)1.2 1.1 1.0 1.1 1.0 -4%

Venous Thromboembolisms (VTE)

(Corrected May 2014)0.85 0.72 0.99 0.71 0.70 -17%

All Other HACs 27.3 26.7 25.7 25.1 22.5 -8%

Totals 145 142 132 121 120 -17%

19

Putting the Numbers in Context

• Where does 145/1000 discharges (for 2010) come from?

► 4,757,000 HACs (in 2010)

► 32,750,000 discharges (patients >17 years old)

► Equals 145.25 HACs per 1000 discharges

► 121 HACs (in 2013) is based on 3,957,200 HACs for 32,750,000

discharges

• Is 145 HACs per 1000 discharges the same as 14.5% of

patients having HACs?

► No. Some patients have more than one HAC, so it might be 11

or 12% of patients having 1 or more HAC

20

HACs and Hospital Discharges

• Our 2010 baseline data estimates are:► 4,757,000 HACs

► Approximately 2,100,000 preventable HACs (44%)

• Among:► 32,750,000 discharges (>17 y.o.)

• This means:► 145 HACs per 1,000 discharges

► 64 Preventable HACs per 1,000 discharges (44% of 145)

► 40% Goal for 2014 is to prevent about 25 of these 64 HACs

21

Interim* 2013 AHRQ National Scorecard

on HACs Compared to 2010 Baseline

• 17% Preliminary reduction in 2013 HACs

► from 4,757,000 to 3,960,000

► from 145 per 1,000 discharges to 121 per 1,000

discharges

► Very close to PFP Goal of 120 (goal for 2014)

• $8B in estimated associated cost savings for 2013

► $12B for 2013, 2012, and 2011 combined

• Estimated associated reductions in deaths due to HACs

► ~35,000 for 2013

► ~50,000 for 2013, 2012, and 2011 combined

*Based on final MPSMS-based 2013 HACs, preliminary 2013 NHSN-based

HAC, and temporary re-use of 2012 data for 2013 PSI-based HACs 22

Details of HAC Changes for 2010 and 2013

and Estimates of Associated Results

PfP Hospital-Acquired

Condition

2010

Measured

Baseline for

HACs

(rounded)

2013

Measured

HACs

(rounded)

Measured

Reduction in

HACs (2010

vs. 2013)

Percent

Reduction in

Measured HACs

(From 2010 to

2013)

Projected Cost Savings

in 2013: Based on

Measured Reductions

of HACs in 2013 vs.

2010

Projected Reductions

in Deaths in 2013:

Based on Measured

Reductions of HACs

in 2013 vs. 2010

Adverse Drug Events 1,621,000 1,320,000 301,000 19% $1,505,000,000 6,020

Catheter-Associated

Urinary Tract Infections

400,000 290,000 110,000 28% $110,000,000 2,563

Central Line-Associated

Bloodstream Infections

18,000 9,200 8,800 49% $149,600,000 1,628

Falls 260,000 240,000 20,000 8% $144,680,000 1,100

Obstetric Adverse

Events (2012 data used

in lieu of 2013)

82,000 77,000 5,000 6% $15,000,000 7

Pressure Ulcers 1,320,000 1,060,000 260,000 20% $4,420,000,000 18,824

Surgical Site Infections 96,000 78,000 18,000 19% $378,000,000 508

Ventilator-Associated

Pneumonias

38,000 37,000 1,000 3% $21,000,000 144

(Post-op) Venous

Thromboembolisms

28,000 23,000 5,000 18% $40,000,000 520

All Other HACs (2013

MPSMS data and 2012

PSI data)

894,000 823,000 71,000 8% $1,207,000,000 3,216

Totals 4,757,000 3,957,200 799,800 17% $7,990,280,000 34,530

23

24

Thanks for Your Patience

Any Questions?

25

Backup Slides

26

Background and Key Concepts

1. HHS had no pre-existing standardized way to track and trend the overall patient safety

status or rate of adverse events/hospital-acquired conditions at U.S. hospitals starting in

2010, which is what was needed for PfP

2. For PfP we couldn’t develop new measures, because we needed data for HACs going

back to before the PfP was announced, so we could establish a pre-launch “baseline”

3. What we developed for PfP to measure HACs might be considered a “market basket”-

type rate

► It is based on 28 different measures of types of adverse events or HACs; it’s not an

“all-cause harm” rate

4. We needed an all-payer rate, so we developed methods to produce incidence rates of

HACs to represent all discharges from short-stay acute care hospitals for patients 18 y.o.

and over

5. For 2011 and 2012, we’ve “normalized” the HAC rates and counts to make them all “as if”

the same number of 18+ y.o. patients were discharged in 2011 and 2012 as was the case

in 2010 (32,750,000: estimated from HCUP)

► Rates and counts won’t go up or down because of changes in discharges 2010-2014

6. In addition to use in the PfP, the bottom-line rate of HACs per 1,000 discharges that

we’ve developed is included in the “Annual Progress Report to Congress: National

Strategy for Quality Improvement in Health Care” as the “Incidence of measurable

hospital-acquired conditions”

27

Estimated HAC-Associated Cumulative Reductions in Costs

and Deaths: 2011, 2012, and Interim 2013 Data

24%

2%

2%3%

0.3%

40%

8%

1%

0.3%

20%

Estimated Cost Savings, by Hospital-Acquired Condition

(HAC), 2010 to 2013

23%

9%

4%

5%

0.03%

40%

3%

2%

1%

13%

Estimated Deaths Averted, by Hospital-Acquired Condition (HAC), 2010 to 2013

Adverse Drug Events

Catheter-Associated UrinaryTract Infections

Central Line-AssociatedBloodstream Infections

Falls

Obstetric Adverse Events

Pressure Ulcers

Surgical Site Infections

Ventilator-AssociatedPneumonias

(Post-op) VenousThromboembolisms

All Other HACs

28

Key Corrections to the Raw Data

• Weighting (to properly “balance” HAC rates across 4 admitting diagnosis-groups or “conditions”)

• “Conversion” (from rates within “4-conditions”*, to rates representing “all-conditions”)

*Note: The “4-conditions” are those available in the CMS IQR sample starting in 2009 that are used for MPSMS: CHF, AMI, PNEU, and SCIP

29

Calculating the AHRQ

National Scorecard (“Incidence of Measurable Hospital-Acquired Conditions”)

1. MPSMS weighted rate based on 4 conditions Yellow

2. “Factors” or “Ratios” for MPSMS rates (including use

of MPSMS 2005-2006 and 2009-2010 data) Orange

3. HCUP 2012 discharges Green

4. CDC NHSN’s special PfP calculation of SSIs (for 17

operations) Blue

5. Patient Safety Indicators (for OB Adverse Events and

as part of “All-Other HACs” calculation) Pink

6. Normalize to 2010 discharges Purple

7. Calculate 2012 HAC Rates Gray

8. Round 2012 numbers (HAC counts and rate)

30

Table With Color-Coded Inputs

PFP Hospital-

Acquired

Condition Source Measure

2012 (full CY)

Weighted HAC

Rate per 1,000

Discharges

(MPSMS only)

MPSMS Factor

to Convert 4-

Conditions Data

to All-

ConditionsData

2012 (18+ y.o.)

Discharges

2012 PFP HACs

(Unrounded and

not Normalized)

2012 PFP HACs

Normalized with

2010 Discharges

(Unrounded

HACs Rate)

2012

Normalized

PFP HAC

Rate

2012 PFP HACs

Normalized with

2010 Discharges

(Rounded HACs)

MPSMS ADE Associated with Digoxin 0.30 1.08 30,636,000 9,922 10,606 0.32 11,000

MPSMS ADE Associated with Hypoglycemic Agents 30.17 0.77 30,636,000 711,114 760,184 23.21 760,000

MPSMS ADE Associated with IV Heparin 8.71 0.50 30,636,000 132,511 141,655 4.33 140,000

MPSMS ADE Associated with LMWH and Factor Xa Inhibitor 17.29 0.55 30,636,000 291,551 311,669 9.52 310,000

MPSMS ADE Associated with Warfarin 7.26 0.62 30,636,000 138,731 148,304 4.53 150,000

MPSMS Total ADE (sum of 5 above) 30,636,000 1,283,829 1,372,418 41.91 1,372,000

CAUTI MPSMS Catheter Associated Urinary Tract Infections 14.40 0.73 30,636,000 324,224 346,596 10.58 350,000

CLABSI MPSMS Blood Stream Infections Associated with Central Venous Catheters 0.79 0.64 30,636,000 15,538 16,610 0.51 17,000

Falls MPSMS In-hospital Patient Falls 8.51 0.84 30,636,000 219,408 234,548 7.16 230,000

Obstetric

Adverse EventsPSI

OB Trauma in Vaginal Delivery with (PSI 18) and without Instrument

(PSI 19)NA NA 30,636,000 72,385 77,380 2.36 77,000

Pressure Ulcer MPSMS Hospital Acquired Pressure Ulcers 46.44 0.85 30,636,000 1,207,864 1,291,211 39.43 1,300,000

Surgical Site

InfectionNHSN SSIs for 17 procedures in 2010 w/CDC data NA NA 30,636,000 76,882 82,187 2.51 82,000

VAP MPSMS Ventilator Associated Pneumonia 2.10 0.49 30,636,000 31,355 33,519 1.02 34,000

VTE MPSMS Postoperative Venous Thromboembolic Events 2.37 0.42 30,636,000 30,375 32,471 0.99 32,000

MPSMS Femoral Artery Puncture for Catheter Angiographic Procedures 2.36 0.83 30,636,000 60,378 64,545 1.97 65,000

MPSMS AE associated with Hip Joint Replacements 3.38 0.28 30,636,000 28,541 30,510 0.93 31,000

MPSMS AE associated with Knee Joint Replacements 2.86 0.28 30,636,000 24,776 26,486 0.81 26,000

MPSMS Contrast Nephropathy Associated with Catheter Angiography 11.39 0.46 30,636,000 160,801 171,897 5.25 170,000

MPSMS Hospital Acquired MRSA 0.36 0.79 30,636,000 8,752 9,356 0.29 9,400

MPSMS Hospital Acquired Vancomycin Resistant Enterococcus (VRE) 0.14 0.72 30,636,000 3,159 3,377 0.10 3,400

MPSMS Hospital Acquired Antibiotic Associated C diff 4.06 0.81 30,636,000 101,165 108,146 3.30 110,000

MPSMS Mechanical Complications Associated with Central Venous Catheters 4.92 0.76 30,636,000 114,641 122,552 3.74 120,000

MPSMS Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries 3.88 0.46 30,636,000 54,592 58,360 1.78 58,000

MPSMS Postoperative Pneumonia 6.82 0.45 30,636,000 94,277 100,782 3.08 100,000

PSI Iatrogenic Pneumothorax (PSI 6) NA NA 30,636,000 11,251 12,027 0.37 12,000

PSI Post-op Hemorrhage or Hematoma (PSI 9) NA NA 30,636,000 18,339 19,604 0.60 20,000

PSI Post-op Respiratory Failure (PSI 11) NA NA 30,636,000 46,750 49,976 1.53 50,000

PSI Accidental Puncture or Laceration (PSI 15) NA NA 30,636,000 61,305 65,535 2.00 66,000

MPSMS &

PSITotal All Other HACs (sum of 14 above) 30,636,000 788,728 843,153 25.75 843,000

Total HACs 4,050,588 4,330,094 4,337,000

PFP Measured HACs per 1,000 discharges 132.22 132.22 132

Adverse Drug

Event

All Other

Hospital-

Acquired

Conditions

PFP Measured Hospital Acquired Conditions/Measures Information on 2012 Measured and Normalized HACS

31

List of MPSMS Factors

MPSMS Measure Factor

Cases in MPSMS

Sample per Case

Among All 18+ Pts

ADE Associated with Digoxin 1.08 0.93

Hospital-Acquired Pressure Ulcers 0.85 1.18

In-hospital Patient Falls 0.84 1.19

Femoral Artery Puncture for Catheter Angiographic Procedures 0.83 1.20

ADE Hospital-Acquired Antibiotic Associated C diff 0.81 1.23

Hospital-Acquired MRSA 0.79 1.26

ADE Associated with Hypoglycemic Agents 0.77 1.30

Mechanical Complications Associated with Central Venous Catheters 0.76 1.31

Catheter-Associated Urinary Tract Infections 0.73 1.36

Hospital-Acquired Vancomycin-Resistant Enterococcus 0.72 1.39

Blood Stream Infections Associated with Central Venous Catheters 0.64 1.55

ADE Associated with Warfarin 0.62 1.60

ADE Associated with LMWH and Factor Xa Inhibitor 0.55 1.82

ADE Associated with IV Heparin 0.50 2.01

Ventilator-Associated Pneumonia 0.49 2.05

Contrast Nephropathy Associated with Catheter Angiography 0.46 2.17

Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries 0.46 2.18

Postoperative Pneumonia 0.45 2.22

Postoperative Venous Thromboembolic Events 0.42 2.39

Knee Joint Replacements 0.28 3.54

Hip Joint Replacements 0.28 3.62

Unweighted Average 0.64 1.57

32

Details on Measurement of “All-Other” HACs (2010)

33

All

Other

HACs

Type of HAC Source Events

Femoral Artery Puncture for Catheter Angiographic Procedures MPSMS 76,000

AE associated with Hip Joint Replacements MPSMS 30,000

AE associated with Knee Joint Replacements MPSMS 29,000

Contrast Nephropathy Associated with Catheter Angiography MPSMS 230,000

Hospital Acquired MRSA MPSMS 15,000

Hospital Acquired Vancomycin Resistant Enterococcus (VRE) MPSMS 13,000

Hospital Acquired Antibiotic Associated C difficile MPSMS 87,000

Mechanical Complications Associated with Central Venous Catheters MPSMS 110,000

Postoperative Cardiac Events for Cardiac and Non-cardiac Surgeries MPSMS 43,000

Postoperative Pneumonia MPSMS 97,000

Iatrogenic Pneumothorax (PSI 6) PSI 13,000

Post-op Hemorrhage or Hematoma (PSI 9) PSI 21,000

Post-op Respiratory Failure (PSI 11) PSI 50,000

Accidental Puncture or Laceration (PSI 15) PSI 77,000

Total All Other HACs (sum of 14 above) MPSMS

& PSI

894,000

Summary of How the 2010 PFP HAC Rate

Was Calculated, Noel Eldridge, AHRQ, 5/16/12 DRAFT #1

1. The rate 2010 of PFP HACs is calculated based on the following variables:

a. The rate of 21 MPSMS adverse events in the 4-patient-group MPSMS (IQR) sample, expressed as a rate per the whole sample population, rather than as a rate per 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 received a central line in the hospital. MPSMS data are used for 7 of the 9 targeted HACs, and for 10 of the 14 all-other HACs. In addition, this rate is weighted to include 25% of each of the four patient groups in the sample, i.e., there is a 25% contribution from each set of patients in the sample (HF, AMI, Pneumonia, and SCIP patients). This weighting will be repeated with the data from 2011 to 2013 too, in order to increase the validity of comparing the data from 2010 to the other years. [M]

b. The number of events captured by PSI 18 and 19 on obstetric injury, and the number of 4 other PSIs (numbers 6, 9, 11, and 15) included among the “all other” HACs. [P]

c. The number of surgical site infections computed by CDC based on NHSN data for 17 selected operations: the 12 “SCIP” procedures and 5 others. [N]

d. The number of annual hospital discharges in patients 18 years and older, as measured by HCUP. [D]

e. Factors calculated to compensate for the fact that the rates of adverse events in the MPSMS sample are likely to be different than in the all-diagnosis 18 years and older hospital population. This factor is based on the measured ratio between the MPSMS adverse event rate in the all-diagnosis inpatient population and MPSMS adverse event rate in the 4-patient-group population in 2005 and 2006, which is the most recent year for which we have all-diagnosis MPSMS data. (The sample used for MPSMS from 2002-2006 was a Medicare FFS population, since 2009 it has been the 4-patient-group population.) The factor was calculated for each MPSMS measure and varied from .28 to 1.08, with 14 of 21 factors being between .4 and .8 and the arithmetic mean of the factors being .64. [f]

2. Thus, the count of measured HACs in 2010= (M*f*D) + P +N, with (M*f*D) computed 21 times for the 21 different measures, 6 different P counts for the 6 PSIs, and N computed once by CDC staff based on their NHSN data on SSIs, the numbers of the 17 operations, and HCUP data.

3. And the rate of measured HACs = ((M*f*D) + P +N)/D

A more thorough (June 2014) version of this information (and more) is on-line at: http://www.ahrq.gov/professionals/quality-patient-safety/pfp/index.html

34

Comparison of PfP Projections, PfP Measured Data, & Jha et al‘s WHO Study Estimates

for 2009 in BMJ Quality and Safety (18 September 2013)

See: http://qualitysafety.bmj.com/content/22/10/809.short

35

PfP Final Data for 2010

(calculated in 2012)

Data (2013 for 2009) from WHO-funded

study published in BMJ Quality and Safety -

Analysis/Summary by Noel Eldridge 9/24/13

Pre-launch

Estimate of

2010

National

HACs

2010 Final

Measured

Data

(Rounded)

Pre-

launch

Estimate

as a

Percent

2010

Final

Data as

a

Percent

WHO-based

estimate (Jha,

et al, in BMJ

2013)

Jha's 95%

Confidence

Interval

Estimate for

USA (based

rates and

32,750,000

discharges)

Adverse

Drug Events

1,900,000 1,621,000 5.8% 4.9% 5% 2.7 to 7.2% 1,637,500

CAUTI 530,000 400,000 1.6% 1.2% 1.10% .8 to 1.5% 360,250

CLABSI 40,000 18,000 0.12% 0.05% 0.40% .2 to .6% 131,000

Falls 200,000 260,000 0.6% 0.8% 1.10% .3 to 2.0% 360,250

Obstetric

Adverse Events380,000 82,000 1.2% 0.3% No data No data

Pressure

Ulcers

250,000 1,320,000 0.8% 4.0% 2.40% .8 to 4.7% 786,000

Surgical Site

Infections

110,000 96,000 0.3% 0.3% No data No data

VAP 40,000 38,000 0.12% 0.12% 0.80% .7 to 1.1% 262,000

VTE 100,000 16,000 0.31% 0.05% 3.30% 1.9 to 4.8% 1,080,750

All Other

HACs

2,430,000 894,000 7.4% 2.7% No data No data

Totals 5,980,000 4,745,000 4,617,750Rate (for

32,750,000

discharges)

182.6 144.9 141.0

Potential Next Steps to Consider at a

Hospital, Hospital-System, or HEN level(excerpted from a May 2014 presentation on potential disparities in patient safety data)

1. Review local medication safety measures associated with hypoglycemic events (use of insulin and related drugs)o Are non-white patients exposed to these events at a higher rate?

o Are non-white patients experiencing these events at a higher rate?

2. Review local pressure ulcer measureso Are there disparities in the measured rates of low-stage (I and II) and higher

stage (III, IV and “unstageable”) events that may be partially due to skin color?

3. Review local obstetric adverse event rateso Do rates differ for different racial/ethnic groups?

4. Review HAI rates, especially CAUTIo Are rates higher in groups of patients who often have English as a second

language?

5. Is the “Do Not Resuscitate” (DNR) status being documented equally well for all groups? If so, do the decisions patients make vary by group?

Two new (October 2014) publications to consider on HAIs, see:http://journals.cambridge.org/action/displayIssue?jid=ICE&volumeId=35&seriesId=0&issueId=S3 36

Discussion

Dr. Knitasha Washington

CAPS

Knitasha.washington@gmail.com

Noel Eldridge, MS

AHRQ

noel.eldridge@ahrq.hhs.gov

Marty Hatlie, J.D.

PPC

mhatlie@p4ps.net

Thank you for joining us today!

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