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. 2021 Jun 1;17(4):e327-e334.
doi: 10.1097/PTS.0000000000000615.

Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013

Dario Tedesco, Nuriel Moghavem  1 , Yingjie Weng  2 , Maria Pia Fantini  3 , Tina Hernandez-Boussard
Affiliations

Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013

Dario Tedesco et al. J Patient Saf. .

Abstract

Objectives: Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms.

Methods: This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ's PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013.

Results: Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (-3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives.

Conclusions: National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.

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Conflict of interest statement

The authors disclose no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Patient safety indicator trends per 1000 discharges for PSIs regulated by RHQDAPU/IQR policy reform, between 2000 and 2013.
FIGURE 2.
FIGURE 2.
Patient safety indicator trends per 1000 discharges for PSIs regulated by RHQDAPU/IQR and HAC policy reform, between 2000 and 2013.
FIGURE 3.
FIGURE 3.
Patient safety indicator trends per 1000 discharges for PSIs not regulated by major policy reform, between 2000 and 2013.
See this image and copyright information in PMC

References

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