Jennifer A. Meddings, MD, MSc; Heidi Reichert, MA; Tim Hofer, MD, MSc; Laurence F. McMahon Jr., MD, MPH
Presented in part at the Society of General Internal Medicine 35th Annual Meeting, Orlando, Florida, 9–12 May 2012, and by poster presentation at the AcademyHealth 2012 Annual Research Meeting, Orlando, Florida, 24–26 June 2012.
Note: The pressure ulcer surveillance data reported on the CalHospitalCompare Web site were obtained by application, permission, and data use agreement from the executive committee of CHART.
Acknowledgment: The authors thank Andrew Hickner, MSI, for providing assistance with references and manuscript editing; Gwendolyn Blackford, BS, RHIA, for providing insight about processes used and regulations followed by hospital coders while assigning diagnosis codes; Susan Barbour, RN, MS, FNP, CWON, for providing insight into the California hospital pressure ulcer surveillance data collection process; and Nancy Stotts, RN, EdD, FAAN, for responding to several inquiries and providing references about the CALNOC data collection process for HAPUs.
Financial Support: By grant 1K08-HS019767-01 from the Agency for Healthcare Research and Quality to Dr. Meddings. The authors were also supported by award 1R01-0HS018344-01A1 to Dr. McMahon. Dr. Meddings is a recipient of the National Institutes of Health Clinical Loan Repayment Program for 2009 to 2013.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0482.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Meddings (e-mail, email@example.com). Data set: The data from the State Inpatient Databases used for this study are available by application, purchase, and data use agreement from the Healthcare Cost and Utilization Project (www.hcup-us.ahrq.gov/databases.jsp).
Corresponding Author: Jennifer A. Meddings, MD, MSc, Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Meddings: Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 427W, Ann Arbor, MI 48109-2800.
Ms. Reichert: Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, 2800 Huron Parkway, NCRC Room 474C, Ann Arbor, MI 48109-2800.
Dr. Hofer: HSR&D Field Program, Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI 48113.
Dr. McMahon: University of Michigan Medical Center, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Author Contributions: Conception and design: J.A. Meddings, T. Hofer, L.F. McMahon.
Analysis and interpretation of the data: J.A. Meddings, H. Reichert, T. Hofer, L.F. McMahon.
Drafting of the article: J.A. Meddings, H. Reichert, T. Hofer.
Critical revision of the article for important intellectual content: J.A. Meddings, T. Hofer, L.F. McMahon.
Final approval of the article: J.A. Meddings, T. Hofer, L.F. McMahon.
Statistical expertise: H. Reichert, T. Hofer.
Obtaining of funding: J.A. Meddings, T. Hofer, L.F. McMahon.
Administrative, technical, or logistic support: J.A. Meddings, L.F. McMahon.
Collection and assembly of data: J.A. Meddings, H. Reichert.
Value-based purchasing programs use administrative data to compare hospitals by rates of hospital-acquired pressure ulcers (HAPUs) for public reporting and financial penalties. However, validation of these data is lacking.
To assess the validity of the administrative data used to generate HAPU rates by comparing the rates generated from these data with those generated from surveillance data.
Retrospective analysis of 2 million all-payer administrative records from 448 California hospitals and quarterly hospitalwide surveillance data from 213 hospitals from the Collaborative Alliance for Nursing Outcomes (as publicly reported on the CalHospitalCompare Web site).
196 acute care hospitals with at least 6 months of available administrative and surveillance data.
Nonobstetric adults discharged in 2009.
Hospital-specific HAPU rates were computed as the percentage of discharged adults (from administrative data) or examined adults (from surveillance data) with at least 1 stage II or greater HAPU (HAPU2+). Categorization of hospital performance based on administrative data was compared with the grade assigned when surveillance data were used.
When administrative data were used, the mean hospital-specific HAPU2+ rate was 0.15% (95% CI, 0.13% to 0.17%); when surveillance data were used, the rate was 2.0% (CI, 1.8% to 2.2%). Among the 49 hospitals with HAPU2+ rates in the highest (worst) quartile from administrative data, use of the surveillance data set resulted in performance grades of “superior” for 3 of these hospitals, “above average” for 14, “average” for 15, and “below average” for 17.
Data are from 1 state and 1 year.
Hospital performance scores generated from HAPU2+ rates varied considerably according to whether administrative or surveillance data were used, suggesting that administrative data may not be appropriate for comparing hospitals.
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Meddings JA, Reichert H, Hofer T, McMahon LF. Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good Are the Grades?. Ann Intern Med. 2013;159: 505–513. doi: 10.7326/0003-4819-159-8-201310150-00003
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Published: Ann Intern Med. 2013;159(8): 505-513.
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