Consideration of ICD-9 code-derived disease-specific safety indicators in CKD

Area of Science:

• Nephrology
• Patient Safety
• Health Services Research

Background:

• Existing patient safety indicators do not adequately capture adverse events specific to Chronic Kidney Disease (CKD).
• There is a need for specialized indicators to monitor safety in hospitalized CKD patients.
• This study evaluates candidate CKD-specific patient safety indicators.

Purpose of the Study:

• To identify and compare novel CKD-pertinent patient safety indicators with existing Agency for Healthcare and Research Quality (AHRQ) patient safety indicators.
• To assess the prevalence and distinctness of CKD patient safety indicators in hospitalized patients.

Main Methods:

• Retrospective analysis of 247,160 hospitalized veterans from the Veterans Health Administration (2005).
• Comparison of CKD patient safety indicators (acute kidney failure, heart failure, electrolyte disturbances, medication errors) against AHRQ indicators using ICD-9 codes.
• Patients with prehospital estimated GFR <60 ml/min/1.73 m² (CKD group) were compared to a non-CKD group.

Main Results:

• CKD patient safety indicators were generally more common than AHRQ indicators and occurred in different patient populations.
• CKD indicators were more prevalent in the CKD group compared to the non-CKD group, with exceptions for certain electrolyte disturbances.
• The adjusted composite CKD patient safety indicator rate was significantly higher in the CKD group (398.0) versus the non-CKD group (250.0).

Conclusions:

• Candidate CKD patient safety indicators are distinct from AHRQ indicators and more prevalent in CKD patients.
• These novel indicators show potential as tools to identify hospitalized CKD patients requiring closer monitoring for disease-specific safety events.
• Developing and implementing CKD-specific safety indicators is crucial for improving care quality and patient outcomes.