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) Neil Gittings, M.A. (CMS) June 2004

Study Objectives 1.Describe rates of potentially preventable adverse events among hospitalized Medicare beneficiaries –Nationally –Within specific subgroups 2.Disaggregate selected complications –Explore internal validity –Targeting specific complications 3.Different ways of describing the relative importance of adverse events

Methods Medicare hospital claims data: Fee-for-service beneficiaries 2000 and 2001 Medicare hospital claims data: Fee-for-service beneficiaries 2000 and 2001 Adapt AHRQ Patient Safety Indicators for Medicare beneficiaries 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 Excess LOS, charges, mortality attributable to PSIs: Zhan et al –Adapt to Medicare: convert to relative ratios

National Rates of Patient Safety Events per 1,000 Discharges

Event Rates Vary with Age

Rates Vary with Race

Rates Vary with Dual Eligibility

Rates Vary with Reason for Medicare Eligibility

Disaggregating Postoperative Septicemia: Specific Diagnoses

Postoperative Septicemia: Specific Procedures

Postop Septicemia: Rates per 1,000 by DRG DRG

Postop Hemorrhage or Hematoma: Rates per 1,000 by DRG DRG

Absolute Numbers of Events

Relative Ratios for Excess LOS and Mortality Zhan et al. JAMA, 2003; 290:

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.) Exploration by disaggregation and by DRGs: – –Mixed support for internal validity – –DRGs may provide another way to target efforts

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.) 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