International comparability of patient safety indicators in 15 OECD member countries: A methodological approach of adjustment by secondary diagnoses

Saskia E. Drösler, Patrick S Romano, Daniel J Tancredi, Niek S. Klazinga

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective. To improve the international comparability of patient safety indicators based on administrative hospital data, adjustment of country-specific rates by a proxy measure of diagnostic coding intensity was tested. Data Sources. Secondary data (numerator and denominator counts of patient safety indicators) based on adults discharged from acute care hospitals between 2006 and 2008 was used. Study Design. A retrospective cross-sectional study using hospital administrative data was performed. Data Collection. Belgium, Canada, Denmark, Germany, Italy, Ireland, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, the United Kingdom, and the United States provided data according to detailed instructions. Principal Findings. Age- and sex-standardized rates varied across countries. An ordinary least squares regression model was estimated for each Patient Safety Indicator (PSI) using the mean number of secondary diagnoses among denominator cases as the predictor (R 2=23 percent to 56 percent). Estimated country-specific residuals were linearly transformed into adjusted PSI rates. Variation among age-sex standardized PSI rates decreased substantially after this adjustment. Conclusions. International comparisons of health system performance based on unadjusted patient safety indicators are problematic due to suspected coding or ascertainment bias. The model could be an interim approach to provide comparable information on hospital quality, with a long-term goal of improving international consistency in diagnostic reporting in administrative data.

Original languageEnglish (US)
Pages (from-to)275-292
Number of pages18
JournalHealth Services Research
Volume47
Issue number1 PART 1
DOIs
StatePublished - Feb 2012

Fingerprint

Patient Safety
Portugal
Information Storage and Retrieval
Belgium
Singapore
Proxy
Denmark
Norway
Least-Squares Analysis
Switzerland
New Zealand
Ireland
Sweden
Spain
Italy
Canada
Germany
Organisation for Economic Co-Operation and Development
Research Design
Cross-Sectional Studies

Keywords

  • international classification of diseases
  • Patient safety
  • quality indicators

ASJC Scopus subject areas

  • Health Policy

Cite this

International comparability of patient safety indicators in 15 OECD member countries : A methodological approach of adjustment by secondary diagnoses. / Drösler, Saskia E.; Romano, Patrick S; Tancredi, Daniel J; Klazinga, Niek S.

In: Health Services Research, Vol. 47, No. 1 PART 1, 02.2012, p. 275-292.

Research output: Contribution to journalArticle

@article{1a28793be61542bab65a412c0a5c48e8,
title = "International comparability of patient safety indicators in 15 OECD member countries: A methodological approach of adjustment by secondary diagnoses",
abstract = "Objective. To improve the international comparability of patient safety indicators based on administrative hospital data, adjustment of country-specific rates by a proxy measure of diagnostic coding intensity was tested. Data Sources. Secondary data (numerator and denominator counts of patient safety indicators) based on adults discharged from acute care hospitals between 2006 and 2008 was used. Study Design. A retrospective cross-sectional study using hospital administrative data was performed. Data Collection. Belgium, Canada, Denmark, Germany, Italy, Ireland, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, the United Kingdom, and the United States provided data according to detailed instructions. Principal Findings. Age- and sex-standardized rates varied across countries. An ordinary least squares regression model was estimated for each Patient Safety Indicator (PSI) using the mean number of secondary diagnoses among denominator cases as the predictor (R 2=23 percent to 56 percent). Estimated country-specific residuals were linearly transformed into adjusted PSI rates. Variation among age-sex standardized PSI rates decreased substantially after this adjustment. Conclusions. International comparisons of health system performance based on unadjusted patient safety indicators are problematic due to suspected coding or ascertainment bias. The model could be an interim approach to provide comparable information on hospital quality, with a long-term goal of improving international consistency in diagnostic reporting in administrative data.",
keywords = "international classification of diseases, Patient safety, quality indicators",
author = "Dr{\"o}sler, {Saskia E.} and Romano, {Patrick S} and Tancredi, {Daniel J} and Klazinga, {Niek S.}",
year = "2012",
month = "2",
doi = "10.1111/j.1475-6773.2011.01290.x",
language = "English (US)",
volume = "47",
pages = "275--292",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "1 PART 1",

}

TY - JOUR

T1 - International comparability of patient safety indicators in 15 OECD member countries

T2 - A methodological approach of adjustment by secondary diagnoses

AU - Drösler, Saskia E.

AU - Romano, Patrick S

AU - Tancredi, Daniel J

AU - Klazinga, Niek S.

PY - 2012/2

Y1 - 2012/2

N2 - Objective. To improve the international comparability of patient safety indicators based on administrative hospital data, adjustment of country-specific rates by a proxy measure of diagnostic coding intensity was tested. Data Sources. Secondary data (numerator and denominator counts of patient safety indicators) based on adults discharged from acute care hospitals between 2006 and 2008 was used. Study Design. A retrospective cross-sectional study using hospital administrative data was performed. Data Collection. Belgium, Canada, Denmark, Germany, Italy, Ireland, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, the United Kingdom, and the United States provided data according to detailed instructions. Principal Findings. Age- and sex-standardized rates varied across countries. An ordinary least squares regression model was estimated for each Patient Safety Indicator (PSI) using the mean number of secondary diagnoses among denominator cases as the predictor (R 2=23 percent to 56 percent). Estimated country-specific residuals were linearly transformed into adjusted PSI rates. Variation among age-sex standardized PSI rates decreased substantially after this adjustment. Conclusions. International comparisons of health system performance based on unadjusted patient safety indicators are problematic due to suspected coding or ascertainment bias. The model could be an interim approach to provide comparable information on hospital quality, with a long-term goal of improving international consistency in diagnostic reporting in administrative data.

AB - Objective. To improve the international comparability of patient safety indicators based on administrative hospital data, adjustment of country-specific rates by a proxy measure of diagnostic coding intensity was tested. Data Sources. Secondary data (numerator and denominator counts of patient safety indicators) based on adults discharged from acute care hospitals between 2006 and 2008 was used. Study Design. A retrospective cross-sectional study using hospital administrative data was performed. Data Collection. Belgium, Canada, Denmark, Germany, Italy, Ireland, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, the United Kingdom, and the United States provided data according to detailed instructions. Principal Findings. Age- and sex-standardized rates varied across countries. An ordinary least squares regression model was estimated for each Patient Safety Indicator (PSI) using the mean number of secondary diagnoses among denominator cases as the predictor (R 2=23 percent to 56 percent). Estimated country-specific residuals were linearly transformed into adjusted PSI rates. Variation among age-sex standardized PSI rates decreased substantially after this adjustment. Conclusions. International comparisons of health system performance based on unadjusted patient safety indicators are problematic due to suspected coding or ascertainment bias. The model could be an interim approach to provide comparable information on hospital quality, with a long-term goal of improving international consistency in diagnostic reporting in administrative data.

KW - international classification of diseases

KW - Patient safety

KW - quality indicators

UR - http://www.scopus.com/inward/record.url?scp=84855829559&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84855829559&partnerID=8YFLogxK

U2 - 10.1111/j.1475-6773.2011.01290.x

DO - 10.1111/j.1475-6773.2011.01290.x

M3 - Article

C2 - 21762143

AN - SCOPUS:84855829559

VL - 47

SP - 275

EP - 292

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 1 PART 1

ER -