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Do pre-existing complications affect the failure to rescue quality measures?
J P Moriarty1, D M Finnie, M G Johnson
1Division of Health Care Policy & Research, Department of Health Sciences Research Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. moriarty.james@mayo.edu
Quality & Safety in Health Care
|February 23, 2010
Summary
Failure to rescue (FTR) measures are biased by including pre-existing complications. Differentiating between pre-existing and acquired complications improves FTR accuracy for internal quality control.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety Metrics
- Hospital Performance Measurement
Background:
- Failure to rescue (FTR) quality indicator definitions by the Agency for Healthcare Research and Quality (AHRQ) show inaccuracy and institutional variability.
- A significant proportion (29.5%) of complications identified by FTR were pre-existing upon hospital admission.
Purpose of the Study:
- To investigate potential bias in FTR measures due to the inclusion of pre-existing complications.
- To differentiate FTR rates for pre-existing versus acquired complications.
Main Methods:
- Retrospective analysis of hospital discharges from January 1996 to September 2007.
- Calculation of FTR rates using AHRQ and National Quality Forum (NQF) definitions.
- Recalculation of FTR rates using present on admission coding to distinguish pre-existing from acquired complications.
Main Results:
- Overall AHRQ FTR rate was 11.60%. FTR rates were 8.85% for pre-existing and 18.46% for acquired complications (p<0.001).
- Overall NQF FTR rate was 9.93%. Rates were 9.42% for pre-existing and 12.77% for acquired complications (p<0.001).
Conclusions:
- Current FTR measures are biased by including pre-existing complications and excluding some relevant patient cases.
- Accounting for the timing of complications can make FTR measures useful for internal quality control.
- Institutional coding practices significantly impact the comparability of FTR measures between hospitals; chart review validation may be necessary.
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