Patient Safety Reporting and ICD-11 AHRQ's Common Formats

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Slide 1

Patient Safety Reporting and ICD-11 AHRQ's Common Formats

William B Munier, MD, MBA, Director
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality

AHRQ Annual Conference
10 September 2012

Slide 2

Agenda

• Introduction.
• Common Formats.
• Relationship to ICD-11 and the Patient Safety Technical Advisory Group.
• The Future.

Slide 3

The Reporting Issue

• There are no universally-accepted definitions for reporting of patient safety events, either as:
  • A theoretical taxonomy, or
  • An operational patient safety reporting system.
• ICD-11 can serve as a guiding taxonomy.
• It will need to have functional value for reporting systems if it is to be used, just as ICD diagnosis codes have functional value for classifying discharge diagnoses in the U.S.; they are used for payment & other purposes.

Slide 4

Partnership for Patients (PfP)

• Nationwide campaign in US to reduce harm to patients over three years: 2011-2013.
• Goals are to reduce:
  • Preventable hospital-acquired conditions by 40%.
  • Hospital readmissions by 20%.
• Measurement challenge that faced PfP:
  • No way to know precisely how many patient safety events have occurred or are occurring in the U.S.
  • No way to measure actual performance nationally.

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PfP Measurement Challenge

• Without measurement, there is no way to know if progress is being made.
• Existing systems & research studies were used to:
  • Estimate incidence & determine goals.
  • Develop a plan to track performance based on measurement of representative populations & extrapolation to the entire U.S.
• While that approach allows PfP to track progress, what is needed is a universally-accepted way to measure patient safety events—defined clinically & electronically.
• ICD-11 & AHRQ Common Formats could both be part of the solution in the future.

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Nov 2010 and Jan 2012 Office of the Inspector General (OIG) Reports on Adverse Events

• OIG reported that 13.5% of hospitalized Medicare beneficiaries experienced serious adverse events; an additional 13.5% experienced temporary harm events.
• Hospital staff did not report 86% of events to the hospital's internal incident reporting systems.
• Medicare "hospital acquired conditions" & AHRQ "PSIs" rarely occurred.
• In those states that require hospitals to report certain types of adverse events, serious underreporting occurs: only 1 in 12 events (found by OIG) were reported.

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Problems Identified by OIG

• Inconsistent identification of adverse events:
  • Variation within hospitals.
  • Variation across hospitals.
  • Variation among states that have external reporting requirements.
• Confusion among front line staff regarding what events they need to report to the hospital.
• OIG identified the Common Formats as providing a systematic method for collection of all types of adverse events and recommended that AHRQ and CMS promote more widespread use of the Formats.

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AHRQ Common Formats

• Only patient safety reporting scheme designed to meet three goals:
  • Provide information on harms from all causes.
  • Support local quality/safety improvement.
  • Allow the end user—to collect information once & supply it to whoever needs it (harmonization).
• Developed through consensus among government health experts/agencies; feedback from the private sector; & vetting through a National Quality Forum (NQF) expert panel.

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Modular Focus Hospital Version 1.2

• Blood & Blood Products.
• Device & Medical or Surgical Supply, Including HIT.
• Fall.
• Healthcare-Associated Infection.
• Medication & Other Substances.
• Perinatal.
• Pressure Ulcer.
• Surgery & Anesthesia.
• Venous thromboembolism.
• All others via generic forms .

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Harmonization Issues

• Current Medicare HACs & PSIs—administrative data.
• Partnership for Patients HACs.
• CDC's NHSN.
• FDA's MedSun.
• NQF Serious Reportable Events (SREs).
• State reporting system requirements.
• Event reporting vs. surveillance.
• EHRs & ONC's meaningful use.

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Event Reporting vs. Surveillance

• The Common Formats are currently designed as a concurrent event-reporting system:
  • Contain information in the EHR & more.
  • Do not include denominators.
• The Formats are being adapted to be used as a retrospective surveillance system—Safer Care:
  • Will include denominators; will generate rates.
  • Will not address near misses & unsafe conditions.

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ICD–11 and the Common Formats

• The objective of both efforts is to define patient safety events to guide patient safety reporting:
  • WHO's ICD–11 is part of the long-standing, universally-accepted classification of diagnoses; it is a natural home for a conceptually sound taxonomy for patient safety events.
  • AHRQ's Common Formats are designed for use at the local level with operational definitions that are specific enough to support software systems.
• There should be a direct relationship between ICD-11 & the Common Formats; supporting that link, AHRQ serves on the WHO Patient Safety Technical Advisory Group.

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The Future

• Definition of patient safety events (ICD-11 & Common Formats) ultimately needs to support operational systems at three levels:
  1. Adverse event reporting (not part of medical record).
  2. Surveillance (derived from medical records).
  3. Use of electronic health records (recording of data directly into EHRs).
• Clinical & electronic definitions must be consistent throughout all levels, & be interoperable where appropriate.

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Common Formats on the Web

To view sample reports, event descriptions, user guide, and programming instructions for electronic implementation visit:
https://www.psoppc.org/web/patientsafety