Hawaii Health Information Corporation - Hawaii's Source for Healthcare Data

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Focus on Patient Safety
By: Jill Miyamura, Ph.D.
3/9/2009

The patient safety indicators (PSIs) are a set of indicators providing information on potential in hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses. The indicators were developed by investigators at Stanford University and the University of California, under a contract with the Agency of Healthcare Quality and Research (AHRQ). The PSIs measure health care quality by using readily available hospital inpatient administrative data.

The meter summarizes how Hawaii compares to the U.S. The performance meter score is based on up to 19 measures of quality of care and is reported only if at least 10 measures are available. Hawaii receives a stronger performance meter score as the number of measures for which Hawaii is doing better than the U.S. increases. Hawaii receives a weaker performance meter score as the number of measures for which Hawaii is doing worse than the U.S. increases.

The meter is determined by the underlying measure comparisons summarized below:

Category	Measure	Hawaii to U.S. Comparison
Patient Safety Measures*	Complications of Anesthesia	n
	Decubitus Ulcer	p
	Failure to Rescue	q
	Iatrogenic Pneumothorax	q
	Selected Infections Due to Medical Care	n
	Postoperative Hip Fracture	n
	Postoperative Hemorrhage or Hematoma	n
	Postoperative Physiologic and Metabolic Derangement	p
	Postoperative Respiratory Failure	n
	Postoperative Pulmonary Embolism or Deep Vein Thrombosis	n
	Postoperative Sepsis	q
	Postoperative Wound Dehiscence	n
	Accidental Puncture or Laceration	n
	Birth Trauma-Injury to Neonate	p
	Obstetric Trauma-Vaginal Delivery with Instrument	n
	Obstetric Trauma-Vaginal Delivery without Instrument	q
“Never Events”*	Death in Low-Mortality DRGs	q
	Foreign Body Left During Procedure	n
	Transfusion Reaction	n
*Rates per 1,000 discharges

* These Patient Safety Indicators reflect quality of care inside hospitals. A higher number rate signals poorer quality of care.

State to U.S. Comparison of Disparity:
pindicates that the State/hospital is performing better than the U.S. (i.e., State/hospital rate is smaller than the U.S.); better is defined as statistically better than the U.S. comparison (p<0.05) for two of the three years represented in this study (CY 2005-CY2007).
nindicates that the State/hospital is performing similar to the U.S. (i.e., State/hospital rate is similar to the U.S.); this symbol reflects rates that are not statistically significant (compared to the US) for 2 of the past 3 years (CY 2005-CY2007).
qindicates that the State/hospital is performing worse than the U.S. (i.e., State/hospital is larger than in the U.S.); worse is defined as statistically worse than the U.S. comparison (p<0.05) for two of the three years represented in this study (CY 2005-CY2007).

Definitions for all indicators provided in AHRQ technical documentation: http://www.qualityindicators.ahrq.gov/downloads/psi/psi_technical_specs_v32.pdf and IQI Guide: http://qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf

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