VA Boston Healthcare System, Boston, MA, USA.
J Am Coll Surg. 2011 Jun;212(6):962-7. doi: 10.1016/j.jamcollsurg.2011.01.053. Epub 2011 Apr 13.
The Agency for Healthcare Research and Quality patient safety indicator (PSI) 14, or "postoperative wound dehiscence," is 1 of 4 PSIs recently adopted by the Centers for Medicare & Medicaid Services to compare quality and safety across hospitals. We determined how well it identifies true cases of postoperative wound dehiscence by examining its positive predictive value (PPV).
A retrospective cross-sectional study of hospitalization records that met PSI 14 criteria was conducted within the Veterans Health Administration hospitals from fiscal years 2003 to 2007. Trained abstractors used standardized abstraction instruments to review electronic medical records. We determined the PPV of the indicator and performed descriptive analyses of cases.
Of the 112 reviewed cases, 97 were true events of postoperative wound dehiscence, yielding a PPV of 87% (95% CI 79% to 92%). Sixty-one percent (n = 59) of true positive cases had at least 1 risk factor, such as low albumin level, COPD, or superficial wound infection. False positives were due to coding errors, such as cases in which the patient's abdomen was intentionally left open during the index procedure.
PSI 14 has relatively good predictive ability to identify true cases of postoperative wound dehiscence. It has the highest PPV among all PSIs evaluated within the Veterans Health Administration system. Inaccurate coding was the reason for false positives. Providing additional training to medical coders could potentially improve the PPV of this indicator. At present, this PSI is a promising measure for both quality improvement and performance measurement; however, its use in pay-for-performance efforts seems premature.
医疗保健研究与质量局（Agency for Healthcare Research and Quality）的患者安全指标（PSI）14，即“术后伤口裂开”，是医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）最近采用的 4 个 PSI 之一，用于比较医院之间的质量和安全性。我们通过检查其阳性预测值（PPV）来确定其识别真正术后伤口裂开病例的能力。
对 2003 年至 2007 年退伍军人事务部（Veterans Health Administration）医院内符合 PSI 14 标准的住院记录进行回顾性横断面研究。经过培训的摘要员使用标准化的摘要工具审查电子病历。我们确定了该指标的阳性预测值，并对病例进行了描述性分析。
在 112 例审查病例中，有 97 例是真正的术后伤口裂开事件，阳性预测值为 87%（95%置信区间为 79%至 92%）。61%（n=59）的真正阳性病例至少有 1 个风险因素，如低白蛋白水平、COPD 或浅表伤口感染。假阳性是由于编码错误，例如在索引过程中患者的腹部被故意留下敞开的情况。
PSI 14 具有较好的预测能力，能够识别真正的术后伤口裂开病例。它在退伍军人事务部系统内评估的所有 PSI 中具有最高的阳性预测值。不准确的编码是假阳性的原因。为医疗编码员提供额外的培训可能会提高该指标的阳性预测值。目前，该 PSI 是质量改进和绩效衡量的一个有前途的指标；然而，在绩效付费方面的应用似乎还不成熟。
