An investigation of biases in Patient Safety Indicator score distribution among hospital cohorts

Denman Research Forum- 2nd Place, Health Professions-ClinicalThe Centers for Medicare and Medicaid Services (CMS) have implemented a hospital reimbursement system that incentivizes payment proportional to the quality of care delivered and performance on certain metrics. One such metric is the Agency for Healthcare Research and Quality’s Patient Safety Indicator 90 (PSI-90). It is composed of eight individual indicators designed to flag adverse patient events that are potentially preventable, such as post-operative wound dehiscence and accidental lacerations. CMS publicly reports four of these individual PSI scores (6, 12, 14 and 15) in addition to the composite PSI-90. Previous studies question the PSIs’ validity beyond screening purposes and furthermore question the underlying administrative data’s ability to accurately and reliably flag such events. This study looks to analyze biases in PSI score distribution for hospitals depending on teaching status, differences in patient demographics and lastly, interactions between teaching status and patient demographic factors and their ability to account for differences in PSI rates. Significant differences were found between teaching and non-teaching hospitals for PSIs 6, 12, 15 and 90 (p<0.01). Inpatient volume and patient severity (p<0.01) were found to be significantly different between teaching status cohorts. Lastly, significant differences in PSI scores were found between patient severity quartiles for PSI 6, 15 and 90 (p<0.05) and between socio-economic quartiles for PSI 6, 12, 15 and 90 (p<0.05); but interaction between patient severity and teaching status was only significant for PSI 90 (p<0.05) and between socioeconomic and teaching statuses for PSI 6 (p<0.05). These results indicate current PSI score distributions may be biased against teaching hospitals for 4 out of 5 PSI measures. Further studies will involve assessing the adequacy of risk-adjustment methodology for PSI metrics. Until then, use of PSI metrics to determine federal reimbursement can lead to bias against teaching hospitals.A three-year embargo was granted for this item.Academic Major: Health Information Management and System

Perioperative use of blood products is associated with risk of morbidity and mortality after surgery

Background: Administration of blood products may be associated with increased morbidity and perioperative mortality in surgical patients. Methods: Patients aged 18 + who underwent gastrointestinal surgery at the Ohio State University Wexner Medical Center 9/10/2015-5/9/2018 were identified. Multivariable logistic regression models were used to evaluate impact of blood product use on survival and complications, as well as to identify factors associated with receipt of transfusions. Results: Among 10,756 patients, 35,517 units of blood products were transfused. Preoperative nadir hemoglobin was associated with receipt of blood product transfusion (OR 0.55, 95% CI 0.53, 0.68). After adjusting for patient and procedural characteristics, patients undergoing transfusion of blood products had an increased risk of perioperative mortality (OR 7.80, 95% CI 6.02, 10.10). Conclusions: The use of blood products was associated with increased risk of complication and death. Patient blood management programs should be implemented to provide rational criteria and guidance for the transfusion of blood products