Incorporating harms into the weighting of the revised Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90).

Objective: To reweight the Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator [PSI] 90) from weights based solely on the frequency of component PSIs to those that incorporate excess harm reflecting patients' preferences for outcome-related health states.

Data Sources: National administrative and claims data involving hospitalizations in nonfederal, nonrehabilitation, acute care hospitals.

Study Design: We estimated the average excess aggregate harm associated with the occurrence of each component PSI using a cohort sample for each indicator based on denominator-eligible records.

The transfer instability index: a novel metric of emergency department transfer relationships.

Objectives: In this study, the objective was to characterize emergency department (ED) transfer relationships and study the factors that predict the stability of those relationships. A metric is derived for ED transfer relationships that may be useful in assessing emergency care regionalization and as a resource for future emergency medicine research.

Methods: Emergency department records at transferring hospitals were linked to ED and inpatient records at receiving hospitals in nine U.

Emergency department transfers and transfer relationships in United States hospitals.

Objectives: The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals.

Methods: Emergency department records were linked at transferring hospitals to ED and inpatient records at receiving hospitals in nine U.S.

How often are potential patient safety events present on admission?

Background: Data fields that capture whether diagnoses are present on admission (POA)--distinguishing comorbidities from potential in-hospital complications--became part of the Uniform Bill for hospital claims in 2007. The AHRQ Patient Safety Indicators (PSIs) were initially developed as measures of potential patient safety problems that use routine administrative data without POA information. The impact of adding POA information to PSIs was examined.

Modifying DRG-PPS to include only diagnoses present on admission: financial implications and challenges.

Objective: The inability to distinguish complications acquired in hospital from comorbid conditions that are present on admission (POA) has long hampered the use of claims data in quality and safety research. Now pay-for-performance initiatives and legislation requiring Medicare to reduce payment for acquired infections add imperative for POA coding. This study used data from 2 states currently coding POA to assess the financial impact if Medicare pays based on POA conditions only and to examine the challenges in implementing POA coding.