Development of the Medicare Patient Safety Monitoring System Susan L. Abend, MD, FACP David R. Hunt,...
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Transcript of Development of the Medicare Patient Safety Monitoring System Susan L. Abend, MD, FACP David R. Hunt,...
Development of the Medicare Patient Safety Monitoring
System
Susan L. Abend, MD, FACP David R. Hunt, MD, FACSGaston Mbateng, Ph.D. Nancy Safer, RN, MSN
Janet P. Tate, MPHNancy R. Verzier, RN, MSN, CPHQ
Background and Development Team
• DHHS Patient Safety Task Force
• CMS– David R. Hunt, MD, FACS
• Qualidigm– Connecticut Quality Improvement Organization
• Active Collaborators– Federal Agency Work Group
• AHRQ, CDC, FDA, VA– Technical Expert Panel– Computer Science Corporation (Central Data Abstraction Center)
Goal
To determine the incidence of To determine the incidence of specific, clearly defined, specific, clearly defined,
hospital-acquired adverse hospital-acquired adverse events within the Medicare events within the Medicare
populationpopulation
Purpose
• Baseline data for CMS national quality improvement initiatives– Surgical Care Improvement Project
• Annual data to the National Healthcare Quality Report
• A method for repeated assessment of events (tracking and trending) for safety improvement activities within healthcare organizations
Design
• Retrospective Cohort Study
• 25,000- 40,000 randomly-selected discharges/year from the Hospital Payment Monitoring Program – Data obtained from medical charts and
Medicare Part A claims database
• HPMP cases– randomly selected cases from 50 states, D.C.,
Puerto Rico, U.S. Virgin Islands– sent to CDAC’s to check coding accuracy
MPSMS Definition of Adverse Event
“An unintended patient harm, injury, or loss more likely associated with an interaction with the health care delivery system than
from an attendant disease process.”
• Patient centered– Focuses on patient experience– Does not presume to assign severity
• Detects an untoward outcome• Requires defined healthcare exposure• Not dependent on cause
– Process malfunction (error, negligence)– Imperfect technology
Measure Development Process
• Event and exposure defined
• Boolean algorithm developed to detect exposure-related event
• Alpha test
• Beta test
• Clinical review
• Production
Measure Selection Measure Selection CriteriaCriteria
• Findable/FeasibleFindable/Feasible• Adverse event(s) very likely to be Adverse event(s) very likely to be
associated with exposureassociated with exposure• Common (burden on Medicare Common (burden on Medicare
population)population)• Responsible for serious morbidity Responsible for serious morbidity
and mortalityand mortality• PreventablePreventable
Adverse Event Rates’02 and ‘03 Medicare Inpatients
Post-Operative Pneumonia 2.5 + 0.3
Post-Operative Venous Thromboemboli 0.6 + 0.1
Post-Operative Urinary Tract Infection 3.7 + 0.3
Knee Replacement Adverse Events 7.2 + 1.3
Hip Replacement Adverse Events 11.4 + 1.8
Rate (%) + 95%CI
Adverse Event Rates’02 and ‘03 Medicare Inpatients
Ventilator Associated Pneumonia 11.9 + 1.8
Hospital-Acquired Bloodstream Infection 0.30 + 0.05
CVC-Associated Bloodstream Infection 1.4 + 0.3
CVC-Associated Insertion Site Infection 2.6 + 0.4
CVC-Associated Mechanical Adverse Events
2.3 + 0.3
Rate (%) + 95% CI
Average Length of Stay ’02, ‘03 Medicare Patients With Invasive
Surgical Procedures
Error bars indicate 95% CI
0
5
10
15
20
25
30
Post OpPneumonia
Post Op VTE Post Op UTI
DA
YS
with event
no event
Inpatient Mortality Rate’02, ‘03 Medicare Patients With Invasive
Surgical Procedures
Error bars indicate 95% CI
0
5
10
15
20
25
Post OpPneumonia
Post Op VTE Post Op UTI
%
with event
no event
Phase II MeasuresOne Year of Data Pending
• Postoperative Cardiac EventsPostoperative Cardiac Events
• Adverse Drug EventsAdverse Drug Events– Anticoagulant-related hemorrhagic eventsAnticoagulant-related hemorrhagic events– Insulin/oral hypoglycemic agent-related hypoglycemic Insulin/oral hypoglycemic agent-related hypoglycemic
eventsevents– Antibiotic-associated C. Difficile infectionAntibiotic-associated C. Difficile infection
• Pressure UlcersPressure Ulcers
Phase III Measures In Development
• In- Hospital Falls
• Angiography-Related Adverse Events– Contrast nephropathy– Adverse events related to femoral artery
puncture
• Urinary Tract Infections Associated with Bladder Catheterization
Reliability
Agreement Rate of Reported MPSMS Variables
0
10
20
30
40
50
60
70
80
90
100
>=95% >=90% and < 95% >=80% and < 90%
%t
dichotomous
categorical
Kappa Statistic for Reported MPSMS Variables
15%
30%55%
> 0.8
0.61 - 0.8
<= 0.6
Limitations
• Validation– No true gold standard yet defined for
determining sensitivity and specificity
• Data source issues– Retrospective– Depends on consistent documentation of
exposures and events in medical record
• Events are relatively infrequent• Limited capability for risk adjustment
Policy Implications
• Complements reporting efforts– Able to detect denominator– No reporting bias
• Complements indicators derived from administrative data alone– Potential for improved sensitivity– Richer database of variables
Policy Implications cont’d
• Standard definitions– trackable over time
• Allows hospitals to use common, standard benchmarks
• Potential for post-discharge surveillance of events
• Usable in paper or electronic health records– Potential for concurrent or prospective use in error
trapping or event avoidance.
Summary
• The MPSMS is a reliable tool for measuring adverse events in hospitalized patients
• Can measure the outcome of errors, suboptimal systems and/or technologies
• Uses standardized, patient-oriented definitions of adverse events
• Development is transparent and consensus-driven – strong collaboration between public and private stakeholders
Conclusion
The MPSMS is a valuable tool for hospitals and health care organizations
to use in making transformational changes to create a safe healthcare
environment.
This material was prepared by Qualidigm, the Medicare Quality Improvement Organization for Connecticut, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Pub. # QUALCT-PSMS-200501