International Journal for Quality in Health Care Advance Access originally published online on April 24, 2009
International Journal for Quality in Health Care 2009 21(4):272-278; doi:10.1093/intqhc/mzp018
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Application of patient safety indicators internationally: a pilot study among seven countries
1 Faculty of Industrial Engineering and Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld, Germany
2 Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
3 Health Division, Organization for Economic Co-operation and Development, Paris, France
4 Division of General Medicine, University of California Davis School of Medicine, 4150 V Street, PSSB Suite 2400, Sacramento, CA, USA
5 Center for Healthcare Policy and Research and Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
6 Institute of Health Information, Ministry of Health, Madrid, Spain
7 Health Care Safety and Quality Unit, Australian Institute of Health and Welfare, Canberra, Australia
8 National Patient Safety Agency, London, UK
9 Unit for Qualifications and Patient Safety, Swedish National Board of Health and Welfare, Stockholm, Sweden
10 Canadian Institute for Health Information, Toronto, Canada
11 Department of Community Health Sciences, University of Calgary, Calgary, Canada
12 Rand Corporation, Washington, DC, USA
13 World Health Association's Patient Safety Programme, Geneva, Switzerland
Objective. To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ).
Design. A retrospective cross-sectional study.
Setting. Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006.
Data sources. Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat.
Results. Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821–0.966). However, there was substantial systematic variation in rates across countries.
Conclusions. This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. ‘birth trauma’, ‘complications of anesthesia’) may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine databases.
Keywords: patient safety, quality indicators, International Classification of Diseases
Address reprint requests to: Saskia E. Drösler, Faculty of Industrial Engineering and Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld, Germany. Tel: +49 21518226643; Fax: +49 21518226660; E-mail: saskia.droesler{at}hsnr.de
Accepted for publication March 26, 2009.