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Table 3 Difference Between Rate of Changeb in IQIs and PSIs Before Announcement and After Implementation of Metric Area (Medicare patients only)

From: Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed

Outcome

Description

Focus/Non-Focusc

Raw Trend

Before Announcementd

Raw Trend

After Implementatione

Rate Difference (Confidence Interval)

Expected vs. Unexpected Change

Inpatient Quality Indicators (IQIs)a

IQI14

Hip Replacement Mortalityf

focus

-0.20

0.00

0.15 (− 0.17, 0.47)

Not significant

IQI15

Acute Myocardial Infarction (AMI) Mortality

focus

-5.10

0.60

5.66 (4.12, 7.21)

Unexpected

IQI16

Heart Failure (HF) Mortality

focus

-2.60

0.50

3.11 (2.48, 3.73)

Unexpected

IQI20

Pneumonia Mortality

focus

-5.50

1.40

6.95 (6.04, 7.68)

Unexpected

IQI32

AMI w/o transfers Mortality

focus

-5.90

0.40

6.26 (4.47, 8.05)

Unexpected

IQI12

Coronary Artery Bypass Graft Mortality

non-focus, similar

-2.20

0.20

2.39 (0.74, 3.98)

Unexpected

IQI30

Percutaneous Coronary Intervention Mortality

non-focus, similar

0.90

3.20

2.25 (1.21, 3.24)

Unexpected

IQI11

Abdominal Aortic Aneurysm Repair Mortality

non-focus, not similar

-4.70

-0.30

4.37 (0.45, 8.19)

Unclear

IQI13

Craniotomy Mortalityf

non-focus, not similar

-3.60

4.50

8.04 (4.48, 11.52)

Unclear

IQI17

Acute Stroke Mortality

non-focus, not similar

-6.00

-0.40

5.60 (4.14, 7.04)

Unclear

IQI18

Gastrointestinal Hemorrhage Mortality

non-focus, not similar

-1.10

0.00

1.16 (0.27, 1.94)

Unclear

IQI19

Hip Fracture Mortality

non-focus, not similar

-1.00

-0.70

0.25 (− 0.75, 1.28)

Not significant

Patient Safety Indicators (PSIs)a

PSI03

Pressure Ulcerg,h

focus

-0.02

0.05

0.06 (0.05, 0.07)

Unexpected

PSI06

Iatrogenic Pneumothoraxh

focus

-0.01

-0.04

− 0.02 (-0.03, -0.02)

Expected

PSI07

CLABSIh,i

focus

-0.11

-0.09

0.01 (0.00, 0.02)

Unexpected

PSI08

Inpatient Fall with Hip Fractureh

focus

0.00

0.00

0.001 (− 0.005, 0.007)

Not significant

PSI09

Perioperative Hemorrhage or Hematomaj

focus

-0.18

-0.59

-0.41 (-0.46, -0.35)

Expected

PSI10

Postop Acute Kidney Injury Requiring Dialysisk

focus

0.00

0.02

0.02 (-0.04, 0.07)

Not significant

PSI11

Postop Respiratory Failurek

focus

0.68

-1.61

-2.29 (-2.53, -2.03)

Expected

PSI12

Perioperative Pulmonary Embolismk

focus

-0.28

-0.12

0.16 (0.11, 0.21)

Unexpected

PSI13

Postop Sepsisk

focus

-0.53

-0.03

0.49 (0.33, 0.65)

Unexpected

PSI14

Postop Wound Dehiscencel

focus

-0.17

-0.40

-0.23 (-0.33, -0.14)

Expected

PSI15

Abdominopelvic Accidental Puncture or Lacerationl

focus

0.03

0.05

0.02 (-0.05, 0.09)

Not significant

PSI90

Patient safety compositem

focus

-0.12

-0.03

0.09 (0.02, 0.12)

Unexpected

PSI04

Death of surgical patients with serious treatable complicationsn

non-focus, similar

3.40

-7.16

-10.57 (-20.94, -1.19)

Expected

  1. aFor additional details on definitions of IQIs and PSIs, see https://www.qualityindicators.ahrq.gov/
  2. bMultiplied by 1,000 for ease of presentation
  3. cFocus = clinical areas targeted by Medicare’s P4P programs; Non-focus, similar = areas not targeted but clinically similar to focus areas
  4. dRate at announcement – Rate before announcement; eRate after implementation – Rate at implementation;
  5. fIQI13 and IQI14 have been retired. Reasons included limited evidence base, rare events, or practice change that affects validity
  6. gStage III or IV pressure ulcers; hPer 1,000 discharges; iCentral line associated blood stream infections; jPer 1,000 surgical discharges
  7. kPer 1,000 elective surgical discharges; lPer 1,000 abdominopelvic surgery discharges; mWeighted average of observed-to-expected ratios for component PSIs
  8. nPer 1,000 surgical discharges with serious treatable complications (deep vein thrombosis/ pulmonary embolism, pneumonia, sepsis, shock/cardiac arrest, or gastrointestinal hemorrhage/acute ulcer)
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BMC Health Services Research

ISSN: 1472-6963

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