A Method for Identifying Potentially Preventable Complications PPCs in Hospitalized Patients

1. A Method for Identifying Potentially Preventable Complications (PPCs) in Hospitalized Patients Presented by 3M Health Information Systems May, 2008

2. Overview PPC methodology Data used to produce reports Data quality Description of reports Objective: Provide an understanding of PPC methodology

3. A Method to Identify Potentially Preventable Complications (PPCs): Purpose To create a method for identifying in-hospital complications using computerized discharge abstract data To assess the risk of developing in-hospital complications according to Reason for admission Severity of Illness Examine observed vs. expected complication rates at the hospital level

4. Why Develop a Method to Identify Potentially Preventable Complications? Interest in comparing healthcare provider performance to enhance quality of care Previous emphasis on length of stay, cost and mortality Address only limited aspects of quality of care Death in hospital is a relatively rare event In-hospital complication rates will provide additional information on quality of care

5. A New Approach Current attempts, including public reports, to compare complications rates across hospitals using administrative data have had limited scope and/or uncertain validity Inability to determine if a potential complication occurred after admission Limited to obvious complication codes (e.g. foreign body left) or elective surgery Inadequate methods to adjust for patient risk and severity of illness

6. The Present on Admission Indicator Allows Better Evaluation of Potential Complications FL, NY, CA and MA now require that each diagnosis code contain an additional indicator of whether it was present at the time of admission Permits more accurate determination of possible complications (from diagnoses that arose after admission) Permits more accurate assessment of severity of illness at admission (using only diagnoses present on admission)

7. Assumptions Underlying the Comparison of Rates of PPCs Patients who have had a problem with the quality of in-hospital care will be more likely to incur a PPC A patient�s risk of a PPC is related to: The reason for admission & underlying medical conditions The severity of illness at the time of admission

8. Method Identify Potentially Preventable Complications (PPCs) from the secondary diagnoses not present at admission Determine whether the PPC was potentially preventable given the patient�s reason for admission & underlying medical conditions Determine a patient�s expected risk of PPCs based on the reason for admission and severity of illness at admission