Agency for Healthcare Research and Quality Patient Safety Indicators

Agency for Healthcare Research and Quality Patient Safety Indicators
Name	Agency for Healthcare Research and Quality Patient Safety Indicators
Established	2003
Jurisdiction	United States
Parent agency	Agency for Healthcare Research and Quality

Contents

Agency for Healthcare Research and Quality Patient Safety Indicators are standardized metrics developed to identify potentially preventable adverse events and complications during hospital stays. Originally published by the Agency for Healthcare Research and Quality in collaboration with stakeholders from Centers for Medicare & Medicaid Services, National Quality Forum, and academic centers such as Johns Hopkins Hospital and Mayo Clinic, the Indicators have been used for national reporting, research, and payment policy discussions. They translate administrative data into signals for quality improvement activities pursued by entities including Centers for Disease Control and Prevention, Institute for Healthcare Improvement, World Health Organization, and state health departments.

Overview

The Patient Safety Indicators (PSIs) are a suite of claims-based algorithms that use diagnosis and procedure codes from the International Classification of Diseases, the Healthcare Cost and Utilization Project, and other administrative sources to flag events like iatrogenic pneumothorax, postoperative sepsis, and retained foreign bodies. Designed within the context of initiatives from Patient Safety Movement Foundation, Joint Commission, and National Patient Safety Agency (UK), PSIs complement clinical registries such as Society of Thoracic Surgeons databases and disease-specific datasets from American College of Surgeons and Centers for Medicare & Medicaid Services quality programs. Users include academic researchers at Harvard Medical School, University of California, San Francisco, and University of Michigan conducting health services research and policymakers in Department of Health and Human Services and state agencies.

Initial development drew on methods applied in projects led by AHRQ Healthcare Cost and Utilization Project, with coding schemas informed by versions of ICD-9-CM and later ICD-10-CM and ICD-10-PCS. Technical work involved contributors from RAND Corporation, Kaiser Permanente, Agency for Healthcare Research and Quality contractors, and clinical experts from American Medical Association panels. Methodological choices — inclusion/exclusion criteria, present-on-admission indicators, and risk adjustment using comorbidity indices such as Charlson Comorbidity Index and case-mix approaches from Diagnosis-Related Group systems — were debated in forums including meetings of the National Quality Forum and scholarly journals like The New England Journal of Medicine and Health Affairs. Updates incorporated feedback from stakeholders including American Hospital Association, state hospital associations, and patient advocacy organizations like Consumers Union.

The PSIs enumerate specific event categories similar to lists found in clinical surveillance programs from Centers for Disease Control and Prevention and World Health Organization. Major PSIs include indicators for:

- PSI 03: Pressure ulcer rates analogous to surveillance by National Pressure Ulcer Advisory Panel and studies in Annals of Internal Medicine. - PSI 06: Iatrogenic pneumothorax similar to case series reported by American Thoracic Society. - PSI 07: Central line–associated bloodstream infection identification paralleling Centers for Disease Control and Prevention definitions. - PSI 08: Postoperative hemorrhage or hematoma used alongside American College of Surgeons National Surgical Quality Improvement Program measures. - PSI 09: Postoperative physiological and metabolic derangements referenced in work at Mayo Clinic. - PSI 12: Transfusion reaction surveillance coherent with Food and Drug Administration reporting systems. - PSI 13: Postoperative sepsis tied to research from Infectious Diseases Society of America.

Additional PSIs cover obstetric complications, accidental puncture or laceration, and readmissions, aligning with initiatives by Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and National Institute for Health and Care Excellence standards.

Hospitals use PSIs for internal quality improvement, benchmarking against datasets from Healthcare Cost and Utilization Project and public reporting platforms operated by Centers for Medicare & Medicaid Services. Payers including Medicare and state Medicaid programs have used PSI-derived signals to inform payment reforms and value-based purchasing programs influenced by reports from Institute of Medicine and policy proposals by Congressional Budget Office. Health systems such as Kaiser Permanente and academic medical centers employ PSIs alongside electronic health record surveillance developed by vendors like Epic Systems and Cerner Corporation.

Multiple validation studies from investigators at Johns Hopkins University School of Medicine, Yale School of Medicine, and Stanford University School of Medicine have raised concerns about sensitivity, specificity, and coding variability. Critics including researchers publishing in JAMA and BMJ emphasize that PSIs were originally designed for screening rather than definitive case ascertainment, and their accuracy depends on documentation practices influenced by billing guidelines from Centers for Medicare & Medicaid Services and coding audits by Office of Inspector General (United States Department of Health and Human Services). Limitations also mirror debates in reports by National Academies of Sciences, Engineering, and Medicine about reliance on administrative data versus clinical registries, and highlight potential unintended consequences described in analyses by The Commonwealth Fund.

Adoption has influenced hospital accreditation activities by The Joint Commission and informed quality incentives in programs such as Hospital Readmissions Reduction Program and Hospital-Acquired Condition Reduction Program. State-level initiatives in New York (state), California, and Massachusetts integrated PSIs into public dashboards alongside measures from Agency for Healthcare Research and Quality and state health data organizations. Research demonstrating associations between PSI signals and mortality or length-of-stay informed policy dialogues at Department of Health and Human Services and congressional hearings involving stakeholders including American Hospital Association and Association of American Medical Colleges.

Although developed in the United States, PSIs have influenced international surveillance and comparative studies published by institutions such as University of Toronto, Imperial College London, and Australian Commission on Safety and Quality in Health Care. Comparative work uses crosswalks between ICD-9-CM/ICD-10 coding schemes and aligns with measurement frameworks from Organisation for Economic Co-operation and Development and World Health Organization patient safety programs. Adaptations for national contexts appear in research from Health Quality Ontario, NHS England, and agencies in New Zealand and Sweden assessing how administrative-sourced safety indicators perform against clinical audit data.

Category:Patient safety