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Comment & Response
June 23/30, 2015

Flaws in Patient Safety Measures—Reply

Author Affiliations
  • 1Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
  • 2Division of Quality, Northwestern Memorial HealthCare, Chicago, Illinois

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;313(24):2495. doi:10.1001/jama.2015.5751

In Reply In addition to the several methodological concerns we described regarding the AHRQ’s PSI-90 composite measure, Dr Glaser and colleagues note that the PSI-90 and other administratively derived measures can also be influenced by nuances in coding. In the example they described, their hospital’s performance on the PSI-90 was worsened because their coding software precluded the entering of exclusion criteria for iatrogenic pneumothorax (PSI-6).

The broader question raised by these issues is how well do current coding and measure criteria, and the health information systems that capture and report them, identify preventable patient harm using administrative data. Vague measurement criteria may result in false-negative results, coding errors, and underreporting of adverse events and imprecision may lead to false-positive results and overreporting.1,2

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