Rosen Amy K, Rivard Peter, Zhao Shibei, Loveland Susan, Tsilimingras Dennis, Christiansen Cindy L, Elixhauser Anne, Romano Patrick S
Center for Health Quality, Outcomes and Economic Research, Bedford VAMC (152), Bedford, Massachusetts 01730, USA.
Med Care. 2005 Sep;43(9):873-84. doi: 10.1097/01.mlr.0000173561.79742.fb.
The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen for potential in-hospital patient safety problems. Although the Veterans Health Administration (VA) is a national leader in patient safety, accurate information on the epidemiology of patient safety events in the VA is still unavailable.
Our objectives were to: (1) apply the AHRQ PSI software to VA administrative data to identify potential instances of compromised patient safety; (2) determine occurrence rates of PSI events in the VA; and (3) examine the construct validity of the PSIs.
We examined differences between observed and risk-adjusted PSI rates in the VA, compared VA and non-VA PSI rates, and investigated the construct validity of the PSIs by examining correlations of the PSIs with other outcomes of VA hospitalizations.
We identified 11,411 PSI events in the VA nationwide in FY'01. Observed PSI rates per 1000 discharges ranged from 0.007 for "transfusion reaction" to 155.5 for "failure to rescue." There were significant, although small, differences between VA and non-VA risk-adjusted PSI rates. Hospitalizations with PSI events had longer lengths of stay, higher mortality, and higher costs than those without PSI events.
Our results suggest that the PSIs may be useful as a patient safety screening tool in the VA. Our PSI rates were consistent with the national incidence of low rates; however, differences between VA and non-VA rates suggest that inadequate case-mix adjustment may be contributing to these findings.
患者安全指标（PSIs）是美国医疗保健研究与质量局开发的一种基于行政数据的工具，越来越多地用于筛查医院内潜在的患者安全问题。尽管退伍军人健康管理局（VA）在患者安全方面处于全国领先地位，但VA中患者安全事件流行病学的准确信息仍然无法获取。
我们的目的是：（1）将AHRQ PSI软件应用于VA行政数据，以识别患者安全受到损害的潜在情况；（2）确定VA中PSI事件的发生率；（3）检验PSIs的结构效度。
我们检查了VA中观察到的PSI率与风险调整后的PSI率之间的差异，比较了VA和非VA的PSI率，并通过检查PSIs与VA住院其他结果的相关性来调查PSIs的结构效度。
我们在2001财年在全国范围内的VA中识别出11411起PSI事件。每1000例出院患者中观察到的PSI率从“输血反应”的0.007到“未能挽救”的155.5不等。VA和非VA风险调整后的PSI率之间存在显著差异，尽管差异较小。发生PSI事件的住院患者比未发生PSI事件的患者住院时间更长、死亡率更高且费用更高。
我们的结果表明，PSIs可能作为VA中的患者安全筛查工具有用。我们的PSI率与全国低发生率一致；然而，VA和非VA率之间的差异表明，病例组合调整不足可能是导致这些结果的原因。
