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How valid is the AHRQ Patient Safety Indicator "postoperative physiologic and metabolic derangement"?

Ann M Borzecki1, Marisa Cevasco, Qi Chen

  • 1Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA, Boston, MA, USA. amb@bu.edu

Journal of the American College of Surgeons
|April 15, 2011
PubMed
Abstract

Insights

The Agency for Healthcare Research and Quality

Area of Science:

  • Healthcare quality and safety research.
  • Patient safety indicators and outcomes.
  • Nephrology and critical care medicine.

Background:

  • The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) postoperative physiologic and metabolic derangement (PMD) uses ICD-9-CM codes to identify acute kidney injury (AKI) and diabetes complications.
  • Limited data exist on the accuracy of the PMD indicator in identifying true patient events.
  • This study evaluated the positive predictive value (PPV) of the PMD indicator within the Veterans Health Administration (VA).

Purpose of the Study:

  • To assess the positive predictive value (PPV) of the AHRQ PMD indicator in the VA.
  • To determine the accuracy of the PMD indicator in identifying actual postoperative AKI and diabetes complications.
  • To analyze reasons for false positives and outcomes of true positives to inform indicator improvement.

Main Methods:

  • Medical records of 119 PSI software-flagged PMD cases were reviewed by trained abstractors.
  • Positive predictive values (PPVs) were calculated overall and for renal and diabetes complications separately.
  • Analysis included examination of false positives for reasons of incorrect identification and true positives for outcomes and risk factors.

Main Results:

  • The overall PPV for the PMD indicator was 63%.
  • The PPV for AKI was 70%, while the PPV for diabetes complications was only 13%.
  • False positives often related to nonelective admissions or complications present on admission; AKI cases frequently involved chronic kidney disease or perioperative hypoperfusion.

Conclusions:

  • The low PPV, particularly for diabetes complications, suggests removing these from the indicator.
  • Improving the PMD indicator's PPV could involve using present-on-admission and admission status codes.
  • Many identified cases were high-risk, but the preventability of these events requires further investigation.

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