This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Full Title: Measures of Patient Safety Based on Hospital Administrative Data—The Patient Safety Indicators
View or download Summary/Report
Objectives: Concerns have mounted about the complexities of the health care system
potentially causing significant unintended adverse effects. With a major national interest
in addressing patient safety issues, a wide spectrum of individuals and organizations are
working toward developing methods and systems to detect, characterize, and report
potentially preventable adverse events. One approach is to develop screening measures
based on routinely collected administrative data, such as the patient safety indicators
(PSIs) reported here. The purpose of the PSI project is to report:
- Literature-based evidence on potential PSIs.
- Clinician panel review results of potential indicators.
- Empirical analyses on a subset of indicators.
- Recommendations regarding potential PSIs.
Methods: A four-pronged strategy to collect validation data and descriptive information was used:
- Background literature review.
- Structured clinical panel reviews of candidate PSIs.
- Expert review of ICD-9-CM codes in candidate PSIs.
- Empirical analyses of the potential candidate PSIs.
Evidence from these four sources was used to
modify and select the most promising indicators for use as a screening tool to provide an
accessible and low-cost approach to identifying potential problems in the quality of care
related to patient safety.
Main Results: A review of previously reported measures in the literature, and of medical
coding manuals, resulted in identification of over 200 ICD-9-CM codes representing
potential patient safety problems. Most of these codes were grouped into clinically
meaningful indicators either based on previous indicator definitions or on clinical and
coding expertise. Based on literature review of the published evidence related to their
validity, several potential PSIs were eliminated. Because of the limited validation
literature available on PSIs and complications indicators from which many PSIs were
derived, the research team conducted a clinical panel review process to assess the face
validity and to guide refinements to the initial definitions of the 34 most promising PSIs.
Response to a questionnaire by clinicians (i.e., physicians from a number of specialties,
nurses, and pharmacists) for each indicator, augmented by coding review and initial
empirical testing, provided the basis for selecting the indicators expected to be most
useful for screening for potentially preventable adverse events. Twenty hospital level
PSIs are recommended for implementation as the initial AHRQ PSI set (designated
Conclusions and Future Research: Future validation work should focus on:
- The sensitivity and specificity of these indicators in detecting the occurrence of a complication.
- The extent to which failures in processes of care at the system or individual level are detected
- using these indicators.
- The relationship of these indicators with other measures of quality, such as mortality.
- Further explorations of bias and risk adjustment.
administrative data are worth exploring in the context of further validation studies that
utilize data from other sources. The current development and evaluation effort will best
be augmented by a continuous communication loop between users of these measures,
researchers interested in improving these measures, and policymakers with influence
over the resources aimed at data collection and patient safety measurement.
Measures of Patient Safety Based on Hospital Administrative Data—The Patient Safety Indicators
Evidence-based Practice Center: University of California, San Francisco and Stanford University (UCSF-Stanford)
Topic Nominator: Agency for Healthcare Research and Quality
Current as of August 2002