Safety Outcomes in the United States

Trends and Challenges in Measurement

Published In: HSR, Health Services Research, v. 44, no. 2, pt. 2, Apr. 2009, p. 739-755

Posted on RAND.org on March 31, 2009

by Michael D. Greenberg, Amelia Haviland, Hao Yu, Donna O. Farley

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OBJECTIVE: To prepare Agency for Healthcare Research and Quality (AHRQ) for monitoring the impact of its own patient safety initiative, by exploring available outcomes data, assessing usability of measures, and estimating national trends in patient outcomes. DATA SOURCES: Annual summary data on incidence of Joint Commission Sentinel Events, MEDMARX medication error events, and MDS measures of falls and pressure ulcers in nursing home residents. HCUP National Inpatient Sample (NIS) administrative claims data. METHODS: Description and assessment of published summary data on selected safety measures. Analysis of selected Patient Safety Indicators (PSIs) and Utah-Missouri adverse event measures using HCUP NIS claims data (1994-2003). PRINCIPAL FINDINGS: Interpretation of safety outcome trends requires close attention to the characteristics of underlying data sources and measures. Encounter-based measures have been affected by changes in definitions and ICD-9 coding, as well as by changes in the structure of administrative datasets like HCUP NIS. Historical trends are mixed for the safety outcome measures reviewed, with some measures showing improvement, others deterioration, and still others remaining fairly stable. CONCLUSIONS: Constructing national trends of safety outcomes is difficult because of limitations in available data sources and measures. Tracking growth in the adoption of safe practices could offer an important strategy for complementing existing safety measurement capabilities.

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