Patient Safety and Public Health Informatics

Iona Thraen, ACSWPatient Safety Director

Agenda

DATA Past - designed specifically for patient safety purposes and can

be easily changed Present - designed for other’s purposes but patient safety can

use – not easily changed Future - not currently designed for patient safety purposes but

could be created, redesigned and/or repurposed

The Message Integrating a patient safety paradigm into public health

surveillance strategies and perspectives provides: multiple opportunities

to identify the scope to improve the system to assure patient safety

The Past Data designed for patient safety reporting

Voluntary - Self Report of Sentinel Events

The 2000 IOM report methodology (retrospective chart review) estimates at the lower end a death rate due to adverse events of 1.3/1000 admissions

Utah had 268,652 hospital discharges in 2005

An estimated 350 deaths (most conservative) would be due to adverse events

Average # SE reported since 2001 has been between 30-40/year – a tenfold under-reporting

New rule revisions by users group expanded 8 general categories to 32 specific categories to be consistent with NQF, CMS, and JCAHO

Sentinel Events Hospitals/Ambulatory Surgical

CentersSentinel Events 10/15/2001-12/31/2006

7

3748

39 4636

0

10

20

30

40

50

60

2001 2002 2003 2004 2005 2006

Total number reported by year

Utah Wrong Site Surgery InitiativeC³

Utah Wrong Site Surgeries 2002-Q2/2007

0

1

2

3

4

5

6

Q4-20

01

Q2-20

02

Q4-20

02

Q2-20

03

Q4-20

03

Q2-20

04

Q4-20

04

Q2-20

05

Q4-20

05

Q2-20

06

Q4-20

06

Q2-20

07

Time Periods

Nu

mb

er

of

Oc

cu

ran

ce

s

Baseline

INTV

The Present Data designed for other’s purposes that patient

safety can use Hospital Discharge Data – Administrative claims data

Misadventures Adverse Events Adverse Drug Events AHRQ-Patient Safety Indicators

Medical Examiners prescription based overdoses Perinatal clinical chart reviews Vital Records (Death and Birth certificates – ICD 10) Other UDOH registries currently in place

MisadventuresRate of Misadventures per 100 Inpatient Discharges in Utah Acute Care Hospitals, 1999-2004

Data NotesAdverse event ICD-9-CM codes can be in any of up to 9 reported diagnosis codes including ecode(s).ICD-9-CM codes: E870-E876, 998.2, 998.4, 998.7. Utah Adverse Event Classes, 2001 Version.Data Sources

Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health; 

Adverse Events – Inpatient Hospitalizations

Adverse Drug Events – Inpatient Hospitalizations

AHRQ - PSIs

AHRQ-PSIs

Adverse Drug Events Prescription Drug Overdoses

0

50

100

150

200

250

300

1991

1993

1995

1997

1999

2001

2003

2005

illicit_onlynot_illicitboth

Prescription medication overdose deaths* by implicated medication

Utah 1997-2005

0

20

40

60

80

100

120

140

1997 1998 1999 2000 2001 2002 2003 2004 2005

MethadoneHydrocodoneOxycodoneFentanyl

The FutureData systems in need of creation, redesign or

repurposing

Health Associated Infections (CLA-BSI, Influenza vaccination rates) ME/DOPL controlled substance DB – prescriptive patterns Peri-natal mortality chart review (extended to morbidity, use of IHI triggers,

etc.) Clinical informatics (pharmacy, episodes of care, labs, etc.) BRFSS – Behavior Risk Factor Surveillance System Other UDOH registries – AHRQ Registries for Evaluating Patient Outcomes

(Ch 9 – Detecting AEs) Traumatic Brain Injury EMS pre hospital data base MDS/OASIS Vital records – death certificates (ICD-10)

Health Associated Infections (CLA-BSI, Influenza vaccination rates)

User group formation CDC definitions – ICU Voluntary WEB reporting Terminology reconciliation (JCAHO/CDC) Immunization (hospitals/nursing homes)

ME/DOPL controlled substance DB – prescriptive patterns

Repurposing from a criminal justice approach to a public health intervention

Definition of alerts Algorithm development Pattern recognition

Peri-natal mortality chart review (extended to morbidity, use of IHI triggers, etc.)

Chart review database Mortality and Morbidity traditional review

process IHI triggers and chart review data Intervention development

Clinical Informatics - RHIOs

Pharmacy data Selected medications Number of prescriptions Mixture of prescriptions Dosages Other

Laboratory data Outliers Ranges Timing

BRFSS – Behavior Risk Factor Surveillance System

Construction of controlled substance use questions - process

Question examples Testing of questions Process of implementation Data capture – establishing a baseline

Adverse Event Detection, Processing and Reporting using Registries

Establish a process with an oversight group

Define scope of detectionsDevice relatedMedication relatedProcess relatedProcedure relatedOther

Adverse Event Detection, Processing and Reporting using Registries

Formalized and systematized definitions and applicability to source of data Clinical chart information and clinical expert opinion Existing codified tools (ICD 9, ICD 10)

Predictive values

Triggers Others

Validation and verification

Adverse Event Detection, Processing and Reporting using Registries

Specification of protections Use of information

Public disclosureTrend analysis InterventionOther