Patient Safety and Public Health Informatics

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Patient Safety and Public Health Informatics

• Iona Thraen, ACSW
• Patient Safety Director

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Agenda

• DATA
• Past - designed specifically for patient safety
  purposes and can be easily changed
• Present - designed for others 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

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The Past Data designed for patient safety
reportingVoluntary - 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

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Sentinel Events Hospitals/Ambulatory Surgical
Centers
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Utah Wrong Site Surgery InitiativeC³
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The Present Data designed for others 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

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Misadventures
Rate of Misadventures per 100 Inpatient
Discharges in Utah Acute Care Hospitals,
1999-2004
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,
998.7. Utah Adverse Event Classes, 2001
Version. Data Sources Utah Inpatient Hospital
Discharge Data, Office of Health Care Statistics,
Utah Department of Health 
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Adverse Events Inpatient Hospitalizations
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Adverse Drug Events Inpatient Hospitalizations
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AHRQ - PSIs
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AHRQ-PSIs
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Adverse Drug Events Prescription Drug Overdoses
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Prescription medication overdose deaths by
implicated medicationUtah 1997-2005
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The FutureData 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)

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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)

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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

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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

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Clinical Informatics - RHIOs

• Pharmacy data
• Selected medications
• Number of prescriptions
• Mixture of prescriptions
• Dosages
• Other
• Laboratory data
• Outliers
• Ranges
• Timing

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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

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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

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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

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Adverse Event Detection, Processing and Reporting
using Registries

• Specification of protections
• Use of information
• Public disclosure
• Trend analysis
• Intervention
• Other