Of note, the weight for PSI #7 was forced to be 0 by AHRQ so that hospitals would not be double counted for their rates of central venous catheter-related blood stream infection (National Quality Forum (NQF) 2015a).
Similar to the approach used by the CMS Hospital Compare website to profile hospitals (Centers for Medicare and Medicaid Services [CMS] 2016e), we computed a 9.5 percent confidence interval (CI) for each hospital's PSI composite score and then assigned hospitals to performance categories based on a comparison of each hospital's 95 percent CI with the national VA PSI composite score.
Due to the lack of longitudinal data in this study and the complexity of combining the PSI component with other measures in the outcome domain, we used a simplified approach that is conceptually similar to that used by CMS, but which considered only the achievement part of the performance score.
We found moderate agreement in the distribution of hospitals across quartiles (method used for the HAC Reduction Program) based on which PSI composite was used (i.e., kappa = 0.40 with 95 percent CI of [0.29, 0.52]); there was 55 percent agreement between measures on hospital quartile assignment.
To address these questions we calculated annual PSI rates from 9 years (1997-2005) of VA hospital discharge data.
We applied AHRQ's algorithms for finding adverse events and calculating PSI rates to all VA hospital discharge data for federal fiscal years 1997-2005 inclusive.
From the risk-adjusted PSI rates AHRQ's SAS programs also calculate smoothed rates with standard errors, using multivariate signal extraction (AHRQ 2003b, pp.
We applied the AHRQ programs to calculate, for each PSI and for each year, (a) the number of adverse events detected, (b) the number of patients at risk for them, (c) the risk-adjusted, smoothed PSI rate, and (d) the standard error for this rate.
A third limitation involves using AHRQ software to calculate PSIs and evaluate hospital patient safety performance.
CAH conversion was associated with significantly increased performance of risk-adjusted rates of iatrogenic pneumothorax, selected infections due to medical care, accidental puncture or laceration, and a composite score of four PSIs. No significant effect was found for observed rates of death in low-mortality DRGs, foreign body left during procedure, risk-adjusted rate of decubitus ulcer, or composite score of six PSIs.
Table S2: Median for Continuous PSIs, Frequency and Percentage for Binary PSIs.
Table S3: GEE Logit Models of the Performance of PSIs (1 = Poor Performance, 0 = Good Performance) in Iowa Rural Hospitals (Composite Scores Weighted by Denominators), 1997-2004.