Address correspondence to Michael D. Greenberg, J.D., Ph.D., RAND Health, 4570 Fifth Avenue, Pittsburgh, PA 15213, e-mail: email@example.com. Amelia M. Haviland, Ph.D., Hao Yu, Ph.D., and Donna O. Farley, Ph.D., are with RAND Health, Pittsburgh, PA.
Safety Outcomes in the United States: Trends and Challenges in Measurement
Article first published online: 29 DEC 2008
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 2p2, pages 739–755, April 2009
How to Cite
Greenberg, M. D., Haviland, A. M., Yu, H. and Farley, D. O. (2009), Safety Outcomes in the United States: Trends and Challenges in Measurement. Health Services Research, 44: 739–755. doi: 10.1111/j.1475-6773.2008.00926.x
- Issue published online: 12 MAR 2009
- Article first published online: 29 DEC 2008
- Patient safety;
- national trends;
Objective. To prepare Agency for Healthcare Research and Quality (AHRQ) for monitoring the impact of its own patient safety initiative, by exploring available outcomes data, assessing usability of measures, and estimating national trends in patient outcomes.
Data Sources. Annual summary data on incidence of Joint Commission Sentinel Events, MEDMARX medication error events, and MDS measures of falls and pressure ulcers in nursing home residents. HCUP National Inpatient Sample (NIS) administrative claims data.
Methods. Description and assessment of published summary data on selected safety measures. Analysis of selected Patient Safety Indicators (PSIs) and Utah–Missouri adverse event measures using HCUP NIS claims data (1994–2003).
Principal Findings. Interpretation of safety outcome trends requires close attention to the characteristics of underlying data sources and measures. Encounter-based measures have been affected by changes in definitions and ICD-9 coding, as well as by changes in the structure of administrative datasets like HCUP NIS. Historical trends are mixed for the safety outcome measures reviewed, with some measures showing improvement, others deterioration, and still others remaining fairly stable.
Conclusions. Constructing national trends of safety outcomes is difficult because of limitations in available data sources and measures. Tracking growth in the adoption of safe practices could offer an important strategy for complementing existing safety measurement capabilities.