Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA.
Kaiser Permanente, Sacramento, CA, USA.
Health Serv Res. 2022 Jun;57(3):654-667. doi: 10.1111/1475-6773.13918. Epub 2022 Jan 9.
To reweight the Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator [PSI] 90) from weights based solely on the frequency of component PSIs to those that incorporate excess harm reflecting patients' preferences for outcome-related health states.
National administrative and claims data involving hospitalizations in nonfederal, nonrehabilitation, acute care hospitals.
We estimated the average excess aggregate harm associated with the occurrence of each component PSI using a cohort sample for each indicator based on denominator-eligible records. We used propensity scores to account for potential confounding in the risk models for each PSI and weighted observations to estimate the "average treatment effect in the treated" for those with the PSI event. We fit separate regression models for each harm outcome. Final PSI weights reflected both the disutilities and the frequencies of the harms.
DATA COLLECTION/EXTRACTION METHODS: We estimated PSI frequencies from the 2012 Healthcare Cost and Utilization Project State Inpatient Databases with present on admission data and excess harms using 2012-2013 Centers for Medicare & Medicaid Services Medicare Fee-for-Service data.
Including harms in the weighting scheme changed individual component weights from the original frequency-based weighting. In the reweighted composite, PSIs 11 ("Postoperative Respiratory Failure"), 13 ("Postoperative Sepsis"), and 12 ("Perioperative Pulmonary Embolism or Deep Vein Thrombosis") contributed the greatest harm, with weights of 29.7%, 21.1%, and 20.4%, respectively. Regarding reliability, the overall average hospital signal-to-noise ratio for the reweighted PSI 90 was 0.7015. Regarding discrimination, among hospitals with greater than median volume, 34% had significantly better PSI 90 performance, and 41% had significantly worse performance than benchmark rates (based on percentiles).
Reformulation of PSI 90 with harm-based weights is feasible and results in satisfactory reliability and discrimination, with a more clinically meaningful distribution of component weights.
将医疗保健研究和质量患者安全选择指标综合（患者安全指标 [PSI] 90）的机构权重从仅基于组件 PSI 频率的权重重新调整为纳入反映患者对与结果相关健康状态偏好的过度伤害的权重。
涉及非联邦、非康复、急性护理医院住院的国家行政和索赔数据。
我们根据每个指标的分母合格记录，使用队列样本为每个指标估计与每个组件 PSI 发生相关的平均过度总伤害。我们使用倾向评分来解释每个 PSI 风险模型中的潜在混杂，并对有 PSI 事件的个体进行观察加权，以估计“治疗中的平均处理效果”。我们为每个伤害结果拟合了单独的回归模型。最终 PSI 权重反映了伤害的不适和频率。
数据收集/提取方法：我们使用 2012 年医疗保健成本和利用项目州住院数据库中的入院时数据和超额伤害数据，以及 2012-2013 年医疗保险和医疗补助服务中心 Medicare 按服务收费数据，从 2012 年 Healthcare Cost and Utilization Project State Inpatient Databases 中估计 PSI 频率。
在加权方案中纳入伤害会改变原始基于频率的加权个别组件权重。在重新加权的组合中，PSI 11（“术后呼吸衰竭”）、PSI 13（“术后败血症”）和 PSI 12（“围手术期肺栓塞或深静脉血栓形成”）造成的伤害最大，权重分别为 29.7%、21.1%和 20.4%。关于可靠性，重新加权的 PSI 90 的总体平均医院信号-噪声比为 0.7015。关于区分度，在大于中位数的医院中，34%的医院 PSI 90 表现明显更好，41%的医院表现明显低于基准率（基于百分位数）。
用基于伤害的权重重新制定 PSI 90 是可行的，结果具有令人满意的可靠性和区分度，并且组件权重的分布更具临床意义。
