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Facilitating Cross-National Comparisons of Indicators for Patient Safety at the Health-System Level in the Oecd Countries

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DELSA/ELSA/WD/HTP(2008)1 FACILITATING CROSS-NATIONAL COMPARISONS OF INDICATORS FOR PATIENT SAFETY AT THE HEALTH-SYSTEM LEVEL IN THE OECD COUNTRIES Saskia Drösler 19 OECD HEALTH TECHNICAL PAPERS Unclassified DELSA/ELSA/WD/HTP(2008)1 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 07-Apr-2008 ___________________________________________________________________________________________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS COMMITTEE Unclassified DELSA/ELSA/WD/HTP(2008)1 OECD HEALTH TECHNICAL PAPERS NO. 19 FACILITATING CROSS NATIONAL COMPARISONS OF INDICATORS FOR PATIENT SAFETY AT THE HEALTH SYSTEM LEVEL IN THE OECD COUNTRIES Saskia Drösler English text only English JT03243700 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/ELSA/WD/HTP(2008)1 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS OECD HEALTH TECHNICAL PAPERS This series is designed to make available to a wider readership methodological studies and statistical analysis presenting and interpreting new data sources, and empirical results and developments in methodology on measuring and assessing health care and health expenditure. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD Applications for permission to reproduce or translate all or part of this material should be made to: Head of Publications Service OECD 2, rue André-Pascal 75775 Paris, CEDEX 16 France Copyright OECD 2008 Health Technical Papers are available at: www.oecd.org/els/health/technicalpapers. 2 DELSA/ELSA/WD/HTP(2008)1 ACKNOWLEDGEMENTS The OECD Secretariat is grateful to Saskia Drösler for preparing this manual. The author1 would like to thank Edward Kelley (Agency for Healthcare Research and Quality), Soeren Mattke (RAND Corporation), Jürgen Stausberg (University of Duisburg-Essen), members of the International Methodology Consortium for Coded Health Information (IMECCHI) and Greg Webster, Eugene Wen, Lori Moskal and Linda Tournay-Lewis (Canadian Institute for Health Information) for their expert advice in preparing this document. The practical comments provided by Bernard Burnand (Switzerland), Chantal Couris (France), William Ghali (Canada), Patricia Halfon (Switzerland), Jean- Marie Januel (France), Jean-Christophe Luthi (Switzerland), Hude Quan (Canada), Patrick Romano (USA) and Vijaya Sundararajan (Australia) during the initial pilot data collection are greatly appreciated. The author would also like to thank Niek Klazinga, Sandra Garcia-Armesto and Lihan Wei (OECD Health Care Quality Indicators Team) for review and comments. This manual is a planned output of the OECD Health Care Quality Indicators (HCQI) Project which received financial support from a grant provided by the European Commission (DG SANCO) during 2007. Please direct enquiries regarding this publication to Dr Niek Klazinga, Coordinator, Health Care Quality Indicator Project – e-mail: [email protected], tel: +33 1 45 24 76 11 or the Project Contacts specified on the website: http://www.oecd.org/health/hcqi. 1. Saskia Drösler of the Niederrhein University of Applied Sciences. 3 DELSA/ELSA/WD/HTP(2008)1 SUMMARY This publication was prepared to support the overall work of the OECD Health Care Quality Indicators Project in developing a set of indicators that can be used to raise questions for investigation concerning the quality of care across countries. It provides a manual to facilitate cross national comparisons of indicators for patient safety through the provision of detailed practical advice on calculating each indicator in a selected set of Patient Safety Indicators (PSI) utilising national hospital administrative databases. The selected indicators are: Area Indicator name Infection due to medical care Hospital-acquired infections Decubitus ulcer Complications of anaesthesia Postoperative hip fracture Postoperative pulmonary embolism (PE) or deep vein thrombosis Operative and post-operative (DVT) complications Postoperative sepsis Technical difficulty with procedure Postoperative respiratory failure Iatrogenic pneumothorax Transfusion reaction Sentinel events Foreign body left in during procedure Birth trauma - injury to neonate Obstetric trauma – vaginal delivery with instrument Obstetrics Obstetric trauma – vaginal delivery without instrument Obstetric trauma - caesarean section For each of these indicators, the manual provides: • Generic coding and calculation instructions related to national hospital administrative databases, • Cross walk from ICD 9 to ICD 10 codes for each indicator, • Detailed definitions for calculation of indicators, and • Flow charts for visualising the calculation process. The manual was originally designed to support the calculation of patient safety indicators in a group of countries volunteering to participate in the validation of the methodology. However it is anticipated that the material presented will also be of interest to a wider audience, including researchers and experts interested in the technical background and construction of the Patient Safety Indicators and other countries looking to develop internationally comparable health care quality indicators. 4 DELSA/ELSA/WD/HTP(2008)1 RÉSUMÉ Cette publication a été préparée pour accompagner les travaux réalisés dans le cadre du Projet de l’OCDE sur les indicateurs de la qualité des soins visant à développer un ensemble d’indicateurs auxquels on puisse se référer pour s’interroger sur la qualité des soins et services de santé dans les différents pays. Cette publication contient un manuel destiné à faciliter les comparaisons entre pays au regard d’indicateurs de la sécurité des patients. On y trouve des indications concrètes précises sur la façon de calculer chacun des indicateurs d’un ensemble d’indicateurs de la sécurité des patients (Patient Safety Indicators ou PSI) établis à partir de bases de données hospitalières nationales. Les indicateurs considérés sont les suivants : Champ Nom de l’indicateur Infections liées aux soins médicaux Infections nosocomiales Escarres de décubitus Complications d’anesthésie Fracture de hanche postopératoire Embolie pulmonaire (EP) ou thrombose veineuse profonde (TVP) Complications opératoires et postopératoire postopératoires Septicémie postopératoire Difficulté technique pendant l’intervention Détresse respiratoire postopératoire Pneumothorax iatrogène Réaction à une transfusion Événements sentinelles Corps étranger laissé au cours d’une intervention Traumatisme à la naissance – traumatisme au nouveau-né Traumatisme obstétrical au cours d’un accouchement par voie basse avec instrument Obstétrique Traumatisme obstétrical au cours d’un accouchement par voie basse sans instrument Traumatisme obstétrical au cours d’une césarienne Pour chacun de ces indicateurs, le manuel fournit : • Les instructions de codification et de calcul à partir des bases de données hospitalières nationales, • Les correspondances entre la CIM--9 et la CIM--10 pour chaque indicateur, • Des définitions détaillées pour le calcul des indicateurs, et • Des graphiques pour visualiser le processus de calcul. Le manuel a initialement été conçu pour étayer le calcul des indicateurs de la sécurité des patients dans un groupe de pays volontaires pour participer à la validation de la méthodologie. Cependant, on s’attend que les éléments présentés intéressent aussi un plus large public, à savoir notamment des chercheurs et des experts intéressés par l’arrière-plan technique et la construction d’indicateurs de la sécurité des patients, ainsi que d’autres pays désireux de développer des indicateurs de la qualité des soins et services de santé comparables au niveau international. 5 DELSA/ELSA/WD/HTP(2008)1 TABLE OF CONTENTS ACKNOWLEDGEMENTS ............................................................................................................................ 3 SUMMARY .................................................................................................................................................... 4 RÉSUMÉ ........................................................................................................................................................ 5 INTRODUCTION .......................................................................................................................................... 7 Background ................................................................................................................................................. 7 METHODOLOGICAL ISSUES ................................................................................................................... 10 Introduction ............................................................................................................................................... 10 Cross Walking from ICD-9 to ICD-10 ...................................................................................................... 12 Process of Calculation ..............................................................................................................................
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