Impact of including readmissions for qualifying events in the patient safety indicators

Area of Science:

• Health Services Research
• Patient Safety
• Quality Improvement

Background:

• The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) are widely used to assess hospital quality.
• Current PSIs do not account for complications that arise after a patient is discharged, potentially underestimating hospital-acquired complications.

Purpose of the Study:

• To quantify the impact of including 7-day and 30-day readmissions for PSI-qualifying conditions on hospital PSI rates.
• To assess the bias introduced by omitting readmissions in PSI calculations.

Main Methods:

• Utilized California's Patient Discharge Data from 2000-2009.
• Analyzed changes in PSI rates by incorporating readmissions into the numerator.
• Examined hospital performance in extreme deciles and longitudinal trends.

Main Results:

• Including 7-day readmissions increased average hospital PSI rates by 0.3% to 8.9%.
• Hospital PSI rates showed high correlation with and without 30-day readmissions for point estimates and longitudinal changes.
• Most hospitals maintained their relative performance decile rankings.

Conclusions:

• Omitting readmissions from PSI calculations is unlikely to lead to significantly erroneous conclusions regarding hospital performance.
• Factors such as longer length of stay, public payer status, and discharge to skilled nursing facilities are associated with higher readmission risk for PSI-qualifying events.