Using Estimated True Safety Event Rates versus Flagged Safety Event Rates: Does It Change Hospital Profiling and Payment?

Objective

To assess whether use of the Patient Safety Indicator () composite measure versus modified composite measures leads to changes in hospital profiles and payments.

Data Sources/Study Setting

Retrospective analysis of 2010 Veterans Health Administration discharge data.

Study Design

We used the software (v4.2) to obtain ‐flagged events and composite scores for all 151 hospitals in the database ( = 517,814 hospitalizations). We compared the composite to two modified composites that estimated “true safety events” from previous chart abstraction findings: one with modified numerators based on the positive predictive value () of each , and one with similarly modified numerators but whose denominators were based on the expected fraction of ‐eligible cases that remained after removing those s that were present‐on‐admission ().

Principal Findings

Although a small percentage (5–6 percent) of hospitals changed outlier status based on modified composites, some of these changes were substantial; 30 and 19 percent of hospitals changed ≥20 ranks after adjustment for s and flags, respectively. We estimate that 33 percent of hospitals would see a change of at least 10 percent in performance payments.

Conclusions

Changes in hospital profiles and payments would be substantial for some hospitals if the composite score used weights reflecting the relative prevalence of true versus flagged events.