To examine the criterion validity of Agency for Health Care Research and Quality (AHRQ) Patient Safety Indicators (PSIs) using clinical data from Veterans Administration (VA) National Surgical Improvement Program (NSQIP).Fifty five thousand seven hundred fifty two matched hospitalizations 2001 VA inpatient surgical discharge NSQIP chart-abstracted data.We examined sensitivities, specificities, positive predictive values (PPVs), likelihood ratios PSIs that corresponded to adverse events. We...

Although lack of access to nonemergency medical transportation (NEMT) is a barrier health care, national and care surveys have not comprehensively addressed that link. Nationally representative studies investigated the magnitude problem or characteristics population experiences problems. The current study, relying primarily on studies, seeks address both those shortcomings. Results indicate about 3.6 million Americans do obtain because in given year. On average, they are disproportionately...

The aim of this study is to understand the relative contribution preoperative patient factors, operative characteristics, and postoperative hospital course on 30-day readmissions.Determining risk readmission after surgery difficult. Understanding most important contributing factors improving prediction reducing risk.National Veterans Affairs Surgical Quality Improvement Program data inpatient general, vascular, orthopedic from 2008 2014 were merged with laboratory, vital signs, prior...

Although lack of access to nonemergency medical transportation (NEMT) is a barrier health care, national and care surveys have not comprehensively addressed that link. Nationally representative studies investigated the magnitude problem or characteristics population experiences problems. The current study, relying primarily on studies, seeks address both those shortcomings. Results indicate about 3.6 million Americans do obtain because in given year. On average, they are disproportionately...

Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors surgical among homeless relative housed Veteran patients.Inpatient general, vascular, and orthopedic surgeries occurring in Health Administration from 2008 2014 were identified. Administrative International Classification Diseases, Ninth Revision, Clinical Modification codes clinic stops used identify...

Background: Readmissions are an attractive quality measure because they offer a broad view of beyond the index hospitalization. However, extent to which medical or surgical readmissions reflect care is largely unknown, complexity factors related readmission. Identifying those that clinically hospitalization important first step in closing this knowledge gap. Objectives: The aims study were examine unplanned Veterans Health Administration, identify versus unrelated readmissions, and compare...

Proteinuria indicates renal dysfunction and is a risk factor for morbidity among medical patients, but less understood surgical populations. There paucity of studies investigating how preoperative proteinuria associated with outcomes, including postoperative acute kidney injury (AKI) readmission.To assess urine protein levels as biomarker adverse outcomes.A retrospective, population-based study was conducted in cohort patients without known undergoing elective inpatient surgery performed at...

The trigger tool methodology uses clinical algorithms applied electronically to 'flag' medical records where adverse events (AEs) have most likely occurred. authors sought create surgical triggers detect AEs in the ambulatory care setting.Four consecutive steps were used develop surgery triggers. First, conducted a comprehensive literature review for Second, series of multidisciplinary focus groups (physicians, nurses, pharmacists and information technology specialists) provided user input...

Background: The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure the 3M Health Information System Division Potentially Preventable Readmissions (PPR) are both used public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing low-performing hospitals. Objectives: To examine consistently CMS PPR performance outliers, explore preventability component impacts hospital rates, reporting on CMS' Hospital Compare...

Postoperative readmission data are used to measure hospital performance, yet the extent which these readmissions reflect surgical quality is unknown.To establish expert consensus on whether reasons for postoperative associated with of surgery in index admission.In a modified Delphi process, panel 14 experts medical and comprising physicians nonphysicians from Veterans Affairs (VA) private-sector institutions reviewed 30-day fiscal years 2008 through 2014 inpatient procedures performed at VA...

<h3>Importance</h3> The existing readmission quality metric does not meaningfully distinguish readmissions associated with surgical from those that are and thus may reflect the of care. <h3>Objective</h3> To compare a classifies any unplanned in population. <h3>Design, Setting, Participants</h3> Cohort study using US nationwide administrative data collected on 4 high-volume procedures performed at 103 Veterans Affairs hospitals October 1, 2007, through September 30, 2014. Data analysis was...

Abstract Objective: To measure the association between receipt of specific infection prevention interventions and procedure-related cardiac implantable electronic device (CIED) infections. Design: Retrospective cohort with manually reviewed status. Setting: National, multicenter Veterans Health Administration (VA) cohort. Participants: Sampling procedures entered into VA Clinical Assessment Reporting Tracking-Electrophysiology (CART-EP) database from fiscal years 2008 through 2015. Methods:...

Health care-associated infections (HAIs) are preventable, harmful, and costly; however, few resources dedicated to infection surveillance of nonsurgical procedures, particularly cardiovascular implantable electronic device (CIED) procedures.To develop a method that includes text mining clinical notes reliably efficiently measure HAIs for CIED procedures.In this multicenter, national cohort study using medical record data patients undergoing procedures in Veterans Administration (VA)...

Objective: The objective of this study is to evaluate the performance 5 triggers detect adverse events (AEs) associated with outpatient surgery. Triggers use surveillance algorithms derived from clinical logic flag cases where AEs have most likely occurred. Current efforts focused primarily on inpatient setting, despite increase in surgery all health care settings. Methods: Using trigger logic, we retrospectively evaluated data 3 large systems' electronic medical records. Patients were...

The Centers for Medicare and Medicaid Services (CMS) use public reporting payment penalties as incentives hospitals to reduce readmission rates. In contrast the current condition-specific measures, CMS recently developed an all-condition, 30-day all-cause hospital-wide measure (HWR) provide a more comprehensive view of hospital performance.We examined whether assessment performance depends on used.We used inpatient data examine readmissions patients discharged from VA acute-care Fiscal Years...

Objective To determine the effects of including diagnostic and utilization data from a secondary payer on readmission rates hospital profiles. Data Sources/Study Setting Veterans Health Administration ( VA ) Medicare inpatient outpatient administrative for veterans discharged 153 hospitals during FY 2008–2010 with principal diagnosis acute myocardial infarction, heart failure, or pneumonia. Study Design We estimated hospital‐level risk‐standardized derived using only. then used both to...

Objectives: Adverse drug event (ADE) detection is an important priority of patient safety research. Trigger tools have been developed to help identify ADEs. As part a larger study, we complex and specific trigger algorithms intended for concurrent use with clinical care detect outpatient This article assesses the modified Delphi process obtain expert consensus on value these triggers. Methods: We selected panel distinguished research experts participate in process. created set ADE triggers...

Numerous health-care systems in the United States, including Veterans Health Administration (VA), use National Surgical Quality Improvement Program (NSQIP) to detect surgical adverse events (AEs). VASQIP sampling methodology excludes many routine ambulatory surgeries from review. Triggers, algorithms derived clinical logic flag cases where AEs have most likely occurred, could complement by detecting a higher yield of with true AE.We developed and tested set AE trigger using sample fiscal...

Abstract Background The rate of cardiovascular implantable electronic device (CIED) infection is increasing coincident with an increase in the number procedures. Preprocedural antimicrobial prophylaxis reduces CIED infections; however, there no evidence that prolonged postprocedural antimicrobials additionally reduce risk. Thus, we sought to quantify harms associated this approach. Objective To measure association between Clostridium difficile (CDI), acute kidney injury (AKI) and receipt...

Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation these evidence-based guidelines outpatient surgery is unknown. Thus, we sought to measure complexity, including ambulatory center (ASC) status availability ancillary services, impact adherence for timely surgery. A secondary aim was association between guideline compliance. multi-center,...

Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital multiple some being better targets for intervention than others. To understand risk factors surgical their incremental contribution current Veterans Health Administration (VA) quality assessment, study, Improving Surgical Quality: Readmission (ISQ-R), is conducted develop a prediction tool, explore predisposing enabling factors, identify rank...