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MQMS: Patient Safety Among Medicare Beneficiaries. Arnold Chen, M.D., M.Sc. (MPR) David Hunt, M.D. (CMS) Sheila Roman, M.D., M.P.H. (CMS) Lein Han, Ph.D. (CMS) Neil Gittings, M.A. (CMS) June 2004. Study Objectives.

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Mqms patient safety among medicare beneficiaries

MQMS: Patient Safety Among Medicare Beneficiaries

Arnold Chen, M.D., M.Sc. (MPR)

David Hunt, M.D. (CMS)

Sheila Roman, M.D., M.P.H. (CMS)

Lein Han, Ph.D. (CMS)

Neil Gittings,M.A. (CMS)

June 2004


Study objectives
Study Objectives

  • Describe rates of potentially preventable adverse events among hospitalized Medicare beneficiaries

    • Nationally

    • Within specific subgroups

  • Disaggregate selected complications

    • Explore internal validity

    • Targeting specific complications

  • Different ways of describing the relative importance of adverse events


Methods
Methods

  • Medicare hospital claims data: Fee-for-service beneficiaries 2000 and 2001

  • Adapt AHRQ Patient Safety Indicators for Medicare beneficiaries

    • Review of PSIs by CMS Workgroup: Select 12 measures

    • Specify measures for disaggregation

  • Excess LOS, charges, mortality attributable to PSIs: Zhan et al. 2003

    • Adapt to Medicare: convert to relative ratios








Postoperative septicemia specific procedures
Postoperative Septicemia: Specific Procedures


Postop septicemia rates per 1 000 by drg
Postop Septicemia: Rates per 1,000 by DRG

DRG


Postop hemorrhage or hematoma rates per 1 000 by drg
Postop Hemorrhage or Hematoma: Rates per 1,000 by DRG

DRG



Relative ratios for excess los and mortality
Relative Ratios for Excess LOS and Mortality

Zhan et al. JAMA, 2003; 290: 1868-1874


Conclusions
Conclusions

  • Decubitus ulcers, postoperative septicemia, postoperative respiratory failure

    • Occur commonly

    • Affect large numbers of people

  • Disparities in rates of patient safety events by age, dual eligibility, black ethnicity, and ESRD


Conclusions cont
Conclusions (cont.)

  • Exploration by disaggregation and by DRGs:

    • Mixed support for internal validity

    • DRGs may provide another way to target efforts


Policy implications
Policy Implications

  • MQMS PSIs: inexpensive, powerful means of tracking safety for Medicare beneficiaries in FFS program

  • Results suggest focusing attention on:

    • Decubitus ulcers, postoperative septicemia, and postoperative respiratory failure

    • Elderly, dually eligible, black, and ESRD beneficiaries


Policy implications cont
Policy Implications (cont.)

  • Potential considerations for targeting interventions

    • Rates

    • Absolute numbers

    • Impacts on LOS, (charges), mortality

  • Importance of surgical infections--Postoperative Sepsis, and Selected Infections

    • CMS-QIO Surgical Infection Project