Postoperative respiratory failure: An update on the validity of the Agency for Healthcare Research and Quality Patient Safety Indicator 11 in an era of clinical documentation improvement programs

Jacqueline C Stocking; Garth H Utter; Christiana Drake; J Matthew Aldrich; Michael K Ong; Alpesh Amin; Rebecca A Marmor; Laura Godat; Maxime Cannesson; Michael A Gropper; Patrick S Romano

doi:10.1016/j.amjsurg.2019.11.019

Postoperative respiratory failure: An update on the validity of the Agency for Healthcare Research and Quality Patient Safety Indicator 11 in an era of clinical documentation improvement programs

Am J Surg. 2020 Jul;220(1):222-228. doi: 10.1016/j.amjsurg.2019.11.019. Epub 2019 Nov 14.

Authors

Affiliations

¹ Department of Internal Medicine, University of California Davis, Sacramento, CA, USA. Electronic address: jcstocking@ucdavis.edu.
² Department of Surgery, Outcomes Research Group, University of California Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA.
³ Department of Statistics, University of California Davis, Davis, CA, USA.
⁴ Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
⁵ Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁶ Department of Hospital Medicine, University of California Irvine, Irvine, CA, USA.
⁷ Department of Surgery, University of California San Diego, San Diego, CA, USA.
⁸ Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁹ Department of Internal Medicine, University of California Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA.

Abstract

Background: Administrative data can be used to identify cases of postoperative respiratory failure (PRF). We aimed to determine if recent changes to the Agency for Healthcare Research and Quality Patient Safety Indicator 11 (PSI 11) and adoption of clinical documentation improvement programs have improved the validity of PSI 11. We also analyzed reasons why PSI 11 was falsely triggered.

Study design: Cross-sectional study of all eligible discharges using health record data from five academic medical centers between October 1, 2012 and September 30, 2015.

Results: Of 437 flagged records, 434 (99.3%) were accurately coded and 414 (94.7%) represented true clinical PRF. None of the false positive records involved respiratory failure present on admission. Most (78.3%) false positive records required airway protection but did not have respiratory failure.

Conclusion: The validity of PSI 11 has improved with recent changes to the code criterion and adoption of clinical documentation improvement programs.

Keywords: Agency for Healthcare Research and Quality (AHRQ); Patient Safety Indicator 11 (PSI 11); positive predictive value; postoperative respiratory failure; validity.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Health Services Research / methods*
Humans
Medical Records Systems, Computerized / standards*
Morbidity / trends
Patient Safety*
Postoperative Complications / epidemiology*
Quality Indicators, Health Care*
Reproducibility of Results
Respiratory Insufficiency / epidemiology*
Retrospective Studies
United States / epidemiology
United States Agency for Healthcare Research and Quality / statistics & numerical data*

Abstract

Publication types

MeSH terms

Grants and funding