{
    "abstract": "The validity of the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) has been established in the USA and Canada. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied. We performed a medical record review using administrative and electronic medical record data from nine Swiss hospitals. Seven independent reviewers evaluated 1245 cases at various hospitals using retrospective data from the years 2014-18. True positives, false positives, positive predictive values (PPVs), and reasons for misclassification were compared across all investigated PSIs, and the documentation quality of the PSIs was examined. PSIs 6 (iatrogenic pneumothorax), 10 (postoperative acute kidney injury), 11 (postoperative respiratory failure), 13 (postoperative sepsis), 14 (wound dehiscence), 17 (birth trauma), and 18 and 19 (obstetric trauma with or without instrument) showed high PPVs (range: 90-99%) and were not strongly influenced by missing POA information. In contrast, PSIs 3 (pressure ulcer), 5 (retained surgical item), 7 (central venous catheter-related bloodstream infection), 8 (fall with hip fracture), and 15 (accidental puncture/laceration) showed low PPVs (range: 18-49%). In the case of PSIs 3, 8, and 12 (perioperative embolism/thrombosis), the low PPVs were largely due to the lack of POA information. Additionally, it was found that the documentation of PSI 3 in discharge letters could be improved. We found large differences in validity across the 16 PSIs in Switzerland. These results can guide policymakers in Switzerland and comparable health-care systems in selecting and prioritizing suitable\u00a0PSIs for quality initiatives. Furthermore, the national introduction of a POA flag would allow for the inclusion of additional PSIs in quality monitoring.",
    "authors": [
        {
            "affiliation": "Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, Lucerne 6002, Switzerland.",
            "firstname": "Michael M",
            "initials": "MM",
            "lastname": "Havranek"
        },
        {
            "affiliation": "University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.",
            "firstname": "Florian",
            "initials": "F",
            "lastname": "R\u00fcter"
        },
        {
            "affiliation": "University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.",
            "firstname": "Selina",
            "initials": "S",
            "lastname": "Bilger"
        },
        {
            "affiliation": "University Hospital Zurich, R\u00e4mistrasse 100, Zurich 8006, Switzerland.",
            "firstname": "Yuliya",
            "initials": "Y",
            "lastname": "Dahlem"
        },
        {
            "affiliation": "University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.",
            "firstname": "Leonel",
            "initials": "L",
            "lastname": "Oliveira"
        },
        {
            "affiliation": "Zug Cantonal Hospital, Landhausstrasse 11, Zug 6340, Switzerland.",
            "firstname": "Daniela",
            "initials": "D",
            "lastname": "Ehbrecht"
        },
        {
            "affiliation": "Cantonal Hospital Winterthur, Brauerstrasse 15, Winterthur 8400, Switzerland.",
            "firstname": "Rudolf M",
            "initials": "RM",
            "lastname": "Moos"
        },
        {
            "affiliation": "Hirslanden Private Hospital Group, Boulevard Lilienthal 2, Zurich 8152, Switzerland.",
            "firstname": "Christian",
            "initials": "C",
            "lastname": "Westerhoff"
        },
        {
            "affiliation": "University Hospital Berne (Inselspital), Freiburgstrasse, Berne 3010, Switzerland.",
            "firstname": "Thomas",
            "initials": "T",
            "lastname": "Beck"
        },
        {
            "affiliation": "Department of Epidemiology and Health Systems, Unisant\u00e9 (University Center for Primary Care and Public Health), University of Lausanne, Route de la Corniche 10, Lausanne 1010, Switzerland.",
            "firstname": "Marie-Annick",
            "initials": "MA",
            "lastname": "Le Pogam"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care.",
    "doi": "10.1093/intqhc/mzad092\n10.1097/PTS.0000000000000615\n10.1016/j.amjsurg.2009.08.008\n10.1097/JHQ.0000000000000088\n10.1093/intqhc/mzp018\n10.1111/j.1475-6773.2011.01290.x\n10.1093/intqhc/mzl019\n10.1093/intqhc/mzl030\n10.1136/bmjopen-2013-003716\n10.1111/j.1475-6773.2008.00905.x\n10.1097/01.AOG.0000179552.36108.6d\n10.1016/j.jamcollsurg.2010.12.053\n10.1097/MLR.0000000000000550\n10.1093/intqhc/mzv045\n10.1093/intqhc/mzw053\n10.1136/bmj.310.6973.170",
    "journal": "International journal for quality in health care : journal of the International Society for Quality in Health Care",
    "keywords": [
        "chart review",
        "documentation",
        "patient safety",
        "present on admission",
        "quality indicators",
        "validity"
    ],
    "methods": null,
    "publication_date": "2023-11-11",
    "pubmed_id": "37949115\n16148964\n32217926\n19874937\n28658091\n19395469\n21762143\n16954509\n16954511\n24114372\n18823449\n16199627\n21620288\n27116111\n26133382\n27272404\n38315675\n7833759",
    "results": null,
    "title": "Validity of\u00a016 AHRQ Patient Safety Indicators to identify in-hospital complications: a medical record review across nine Swiss hospitals.",
    "xml": "<Element 'PubmedArticle' at 0x78850458d030>"
}