1. 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

2. 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

3. 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. 2003 Excess LOS, charges, mortality attributable to PSIs: Zhan et al. 2003 –Adapt to Medicare: convert to relative ratios

4. National Rates of Patient Safety Events per 1,000 Discharges

5. Event Rates Vary with Age

6. Rates Vary with Race

7. Rates Vary with Dual Eligibility

8. Rates Vary with Reason for Medicare Eligibility

9. Disaggregating Postoperative Septicemia: Specific Diagnoses

10. Postoperative Septicemia: Specific Procedures

11. Postop Septicemia: Rates per 1,000 by DRG DRG

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

13. Absolute Numbers of Events

14. Relative Ratios for Excess LOS and Mortality Zhan et al. JAMA, 2003; 290: 1868-1874

15. 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

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

17. 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

18. 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