Establishing standard performance measures for adult stroke patients: a nationwide inpatient sample database study

The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are used to evaluate the safety and quality of health care provided by health care systems and individual facilities. To understand better the incidence of PSIs and HACs in hospitalized patients with stroke, we determined the rates of these events among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database.

We queried the NIS for all hospitalizations involving ischemic stroke. We determined the incidence of various PSIs and HACs by searching the hospital records for International Classification of Diseases, 9th edition, codes indicating each PSI or HAC. Statistical analysis was performed with SAS statistical software package.

There were 903,647 hospitalizations involving stroke in the NIS database for years 2002-2010. Among these hospitalizations, 137,161 (15.2%) patients experienced ≥1 Agency for Healthcare Research and Quality PSIs. The most common PSIs included postoperative respiratory failure (9.44%), sepsis (4.43%), and pressure ulcer (2.19%). Of stroke patients, 28,323 (3.13%) experienced ≥1 HACs. The most common HACs included falls and trauma (2.51%) and stage III and IV pressure ulcers (0.43%). Increasing comorbidity score (P ≤ 0.001) was associated with increased likelihood of all PSIs and HACs. The presence of PSIs or HACs resulted in increased length of stay, increased hospital charges, and an increase in mortality rates (P < 0.0001).

Our results estimate baseline national incidence rates of PSIs and HACs in patients with stroke. These data may be used to determine individual institutional improvements or success by comparison.