Abstract
In 2008, we conducted a retrospective cross-sectional study to determine the test characteristics of the Agency for Healthcare Research and Quality patient safety indicator (PSI) for hospital-acquired pressure ulcer (PU). We sampled 1,995 inpatient records that met PSI 3 criteria and 4,007 records assigned to 14 DRGs with the highest empirical rates of PSI 3, which did not meet PSI 3 criteria, from 32 U.S. academic hospitals. We estimated the positive predictive value (PPV), sensitivity, and specificity of PSI 3 using both the software version contemporary to the hospitalizations (v3.1) and an approximation of the current version (v4.4). Of records that met PSI 3 version 3.1 criteria, 572 (PPV 28.3%; 95% CI 23.6-32.9%) were true positive. PU that was present on admission (POA) accounted for 76% of the false-positive records. Estimated sensitivity was 48.2% (95% CI 41.0-55.3%) and specificity 71.4% (95% CI 68.3-74.5%). Reclassifying records based on reported POA information and PU stage to approximate version 4.4 of PSI 3 improved sensitivity (78.6%; 95% CI 62.7-94.5%) and specificity (98.0; 95% CI 97.1-98.9%). In conclusion, accounting for POA information and PU staging to approximate newer versions of the PSI software (v4.3) moderately improves validity.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 287-297 |
| Number of pages | 11 |
| Journal | Journal for healthcare quality : official publication of the National Association for Healthcare Quality |
| Volume | 37 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 1 2015 |
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Keywords
- Academic medical center/teaching hospital
- AHRQ
- Hospital-acquired condition
- Nursing
- Patient safety
- Pressure ulcer
- Quality measures
- Sentinel/serious/never events
ASJC Scopus subject areas
- Health Policy
- Public Health, Environmental and Occupational Health
Cite this
How accurate is the AHRQ patient safety indicator for hospital-acquired pressure ulcer in a national sample of records? / Zrelak, Patricia A.; Utter, Garth H; Tancredi, Daniel J; Mayer, Lindsay Grogean; Cerese, Julie; Cuny, Joanne; Romano, Patrick S.
In: Journal for healthcare quality : official publication of the National Association for Healthcare Quality, Vol. 37, No. 5, 01.09.2015, p. 287-297.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - How accurate is the AHRQ patient safety indicator for hospital-acquired pressure ulcer in a national sample of records?
AU - Zrelak, Patricia A.
AU - Utter, Garth H
AU - Tancredi, Daniel J
AU - Mayer, Lindsay Grogean
AU - Cerese, Julie
AU - Cuny, Joanne
AU - Romano, Patrick S
PY - 2015/9/1
Y1 - 2015/9/1
N2 - In 2008, we conducted a retrospective cross-sectional study to determine the test characteristics of the Agency for Healthcare Research and Quality patient safety indicator (PSI) for hospital-acquired pressure ulcer (PU). We sampled 1,995 inpatient records that met PSI 3 criteria and 4,007 records assigned to 14 DRGs with the highest empirical rates of PSI 3, which did not meet PSI 3 criteria, from 32 U.S. academic hospitals. We estimated the positive predictive value (PPV), sensitivity, and specificity of PSI 3 using both the software version contemporary to the hospitalizations (v3.1) and an approximation of the current version (v4.4). Of records that met PSI 3 version 3.1 criteria, 572 (PPV 28.3%; 95% CI 23.6-32.9%) were true positive. PU that was present on admission (POA) accounted for 76% of the false-positive records. Estimated sensitivity was 48.2% (95% CI 41.0-55.3%) and specificity 71.4% (95% CI 68.3-74.5%). Reclassifying records based on reported POA information and PU stage to approximate version 4.4 of PSI 3 improved sensitivity (78.6%; 95% CI 62.7-94.5%) and specificity (98.0; 95% CI 97.1-98.9%). In conclusion, accounting for POA information and PU staging to approximate newer versions of the PSI software (v4.3) moderately improves validity.
AB - In 2008, we conducted a retrospective cross-sectional study to determine the test characteristics of the Agency for Healthcare Research and Quality patient safety indicator (PSI) for hospital-acquired pressure ulcer (PU). We sampled 1,995 inpatient records that met PSI 3 criteria and 4,007 records assigned to 14 DRGs with the highest empirical rates of PSI 3, which did not meet PSI 3 criteria, from 32 U.S. academic hospitals. We estimated the positive predictive value (PPV), sensitivity, and specificity of PSI 3 using both the software version contemporary to the hospitalizations (v3.1) and an approximation of the current version (v4.4). Of records that met PSI 3 version 3.1 criteria, 572 (PPV 28.3%; 95% CI 23.6-32.9%) were true positive. PU that was present on admission (POA) accounted for 76% of the false-positive records. Estimated sensitivity was 48.2% (95% CI 41.0-55.3%) and specificity 71.4% (95% CI 68.3-74.5%). Reclassifying records based on reported POA information and PU stage to approximate version 4.4 of PSI 3 improved sensitivity (78.6%; 95% CI 62.7-94.5%) and specificity (98.0; 95% CI 97.1-98.9%). In conclusion, accounting for POA information and PU staging to approximate newer versions of the PSI software (v4.3) moderately improves validity.
KW - Academic medical center/teaching hospital
KW - AHRQ
KW - Hospital-acquired condition
KW - Nursing
KW - Patient safety
KW - Pressure ulcer
KW - Quality measures
KW - Sentinel/serious/never events
UR - http://www.scopus.com/inward/record.url?scp=84942742957&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942742957&partnerID=8YFLogxK
U2 - 10.1111/jhq.12052
DO - 10.1111/jhq.12052
M3 - Article
C2 - 24118246
AN - SCOPUS:84942742957
VL - 37
SP - 287
EP - 297
JO - Journal for healthcare quality : official publication of the National Association for Healthcare Quality
JF - Journal for healthcare quality : official publication of the National Association for Healthcare Quality
SN - 1062-2551
IS - 5
ER -