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Am J Surg. 2018 Nov;216(5):974-979. doi: 10.1016/j.amjsurg.2018.06.023. Epub 2018 Jul 4.

The Patient Safety Indicator Perioperative Pulmonary Embolism or Deep Vein Thrombosis: Is there associated surveillance bias in the Veterans Health Administration?

Author information

1
Center for Healthcare Organization and Implementation Research, Bedford VAMC, Bedford, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA. Electronic address: amb@bu.edu.
2
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
3
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Boston University, Questrom School of Business, Boston, MA, USA.
4
Department of Surgery, Harvard Medical School, Boston, MA, USA.
5
VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
6
Boston University School of Medicine, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.

Abstract

BACKGROUND:

Studies disagree whether surveillance bias is associated with perioperative venous thromboembolism (VTE) performance measures. A prior VA study used a chart-based outcome; no studies have used the fully specified administrative data-based AHRQ Patient Safety Indicator, PSI-12, as their primary outcome. If surveillance bias were present, we hypothesized that inpatient surveillance rates would be associated with higher PSI-12 rates, but with lower post-discharge VTE rates.

METHODS:

Using VA data, we examined Pearson correlations between hospital-level VTE imaging rates and risk-adjusted PSI-12 rates and post-discharge VTE rates. To determine the robustness of findings, we conducted several sensitivity analyses.

RESULTS:

Hospital imaging rates were positively correlated with both PSI-12 (r = 0.24, p = 0.01) and post-discharge VTE rates (r = 0.16, p = 0.09). Sensitivity analyses yielded similar findings.

CONCLUSIONS:

Like the prior VA study, we found no evidence of PSI-12-related surveillance bias. Given the use of PSI-12 in nationwide measurement, these findings warrant replication using similar methods in the non-VA setting.

KEYWORDS:

Patient safety; Perioperative venous thromboembolism; Quality indicators; Surveillance bias

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