Patient Safety and Public Health Informatics Iona Thraen, ACSW Patient Safety Director

Agenda DATA  Past - designed specifically for patient safety purposes and can be easily changed  Present - designed for other’s purposes but patient safety can use – not easily changed  Future - not currently designed for patient safety purposes but could be created, redesigned and/or repurposed The Message  Integrating a patient safety paradigm into public health surveillance strategies and perspectives provides: multiple opportunities  to identify the scope  to improve the system  to assure patient safety

The Past Data designed for patient safety reporting Voluntary - Self Report of Sentinel Events The 2000 IOM report methodology (retrospective chart review) estimates at the lower end a death rate due to adverse events of 1.3/1000 admissions Utah had 268,652 hospital discharges in 2005 An estimated 350 deaths (most conservative) would be due to adverse events Average # SE reported since 2001 has been between 30-40/year – a tenfold under-reporting New rule revisions by users group expanded 8 general categories to 32 specific categories to be consistent with NQF, CMS, and JCAHO

Sentinel Events Hospitals/Ambulatory Surgical Centers

Utah Wrong Site Surgery Initiative C³

The Present Data designed for other’s purposes that patient safety can use Hospital Discharge Data – Administrative claims data  Misadventures  Adverse Events  Adverse Drug Events  AHRQ-Patient Safety Indicators Medical Examiners prescription based overdoses Perinatal clinical chart reviews Vital Records (Death and Birth certificates – ICD 10) Other UDOH registries currently in place

Misadventures Rate of Misadventures per 100 Inpatient Discharges in Utah Acute Care Hospitals, Data Notes Adverse event ICD-9-CM codes can be in any of up to 9 reported diagnosis codes including ecode(s).ICD-9-CM codes: E870-E876, 998.2, 998.4, Utah Adverse Event Classes, 2001 Version. Data Sources Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health;

Adverse Events – Inpatient Hospitalizations

Adverse Drug Events – Inpatient Hospitalizations

AHRQ - PSIs

Adverse Drug Events Prescription Drug Overdoses

Prescription medication overdose deaths* by implicated medication Utah

The Future Data systems in need of creation, redesign or repurposing Health Associated Infections (CLA-BSI, Influenza vaccination rates) ME/DOPL controlled substance DB – prescriptive patterns Peri-natal mortality chart review (extended to morbidity, use of IHI triggers, etc.) Clinical informatics (pharmacy, episodes of care, labs, etc.) BRFSS – Behavior Risk Factor Surveillance System Other UDOH registries – AHRQ Registries for Evaluating Patient Outcomes (Ch 9 – Detecting AEs)  Traumatic Brain Injury  EMS pre hospital data base  MDS/OASIS  Vital records – death certificates (ICD-10)

Health Associated Infections (CLA-BSI, Influenza vaccination rates) User group formation CDC definitions – ICU Voluntary WEB reporting Terminology reconciliation (JCAHO/CDC) Immunization (hospitals/nursing homes)

ME/DOPL controlled substance DB – prescriptive patterns Repurposing from a criminal justice approach to a public health intervention Definition of alerts Algorithm development Pattern recognition

Peri-natal mortality chart review (extended to morbidity, use of IHI triggers, etc.) Chart review database Mortality and Morbidity traditional review process IHI triggers and chart review data Intervention development

Clinical Informatics - RHIOs Pharmacy data  Selected medications  Number of prescriptions  Mixture of prescriptions  Dosages  Other Laboratory data  Outliers  Ranges  Timing

BRFSS – Behavior Risk Factor Surveillance System Construction of controlled substance use questions - process Question examples Testing of questions Process of implementation Data capture – establishing a baseline

Adverse Event Detection, Processing and Reporting using Registries Establish a process with an oversight group Define scope of detections  Device related  Medication related  Process related  Procedure related  Other

Adverse Event Detection, Processing and Reporting using Registries Formalized and systematized definitions and applicability to source of data  Clinical chart information and clinical expert opinion  Existing codified tools (ICD 9, ICD 10) Predictive values  Triggers  Others Validation and verification

Adverse Event Detection, Processing and Reporting using Registries Specification of protections Use of information  Public disclosure  Trend analysis  Intervention  Other