Establishing standard performance measures for adult brain tumor patients: a Nationwide Inpatient Sample database study

Abstract

Background: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital acquired conditions (HACs) are used to evaluate the safety and quality of health care. We determined the incidence rates of PSIs and HACs among brain tumor patients in the Nationwide Inpatient Sample database (NIS).

Methods: We queried the NIS for all hospitalizations involving a brain tumor. We determined the incidence rates of various PSIs and HACs among these patients by searching the hospital records for codes in the International Classification of Diseases, 9th Revision indicating each PSI or HAC.

Results: Among the 501 908 hospitalizations involving a brain tumor in the NIS, there were 102 046 occurrences of an AHRQ PSI, with 16% of patients experiencing one or more AHRQ PSI. Among brain tumor patients treated without surgery, 17.2% experienced ≥ 1 PSI. Among brain tumor patients treated with surgery, 9.8% experienced ≥ 1 PSI. The most common PSIs were postoperative respiratory failure, deep vein thrombosis, and sepsis. The total number of HACs associated with brain tumor patients was 13 778, with 2.63% of patients experiencing ≥1 HAC. Among brain tumor patients treated without surgery, 3.0% experienced ≥ 1 HAC. Among brain tumor patients treated with surgery, 7.4% experienced ≥ 1 HAC. The most common HACs were falls and trauma and pressure ulcers. Increasing comorbidity score was associated with increased likelihood of almost all PSIs and HACs.

Conclusion: These data may be used to determine individual institutional improvements or success by comparison.

Keywords: brain tumor; hospital acquired condition; patient safety indicators; pay for performance.

Fig. 1.

Relationship of CVL infection risk and CM score.

Fig. 2.

Relationship of postoperative physiologic derangement risk and CM score.

Fig. 3.

Relationship of sepsis risk and CM score.

Fig. 4.

Relationship of pressure ulcer risk and CM score.

Fig. 5.

Relationship of falls and trauma risk and CM score.

Fig. 6.

Relationship of vascular catheter-associated infection risk and CM score.