Hospitals in the United States provide the setting for some of life's most pivotal events - the birth of a child, major surgery, treatment for otherwise fatal illnesses. These hospitals house the most sophisticated medical technology in the world and provide state-of-the-art diagnostic and therapeutic services. But access to these services comes with certain costs. About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.
Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for safety from implementing technical changes, such as electronic medical record systems, to improving staff awareness of patient safety risks. Clinical process interventions also have strong evidence for reducing the risk of adverse events related to a patient's exposure to hospital care. Patient Safety Indicators (PSIs), which are based on computerized hospital discharge abstracts from the AHRQ's Healthcare Cost and Utilization Project (HCUP), can be used to better prioritize and evaluate local and national initiatives. Analyses of these and similar inexpensive, readily available administrative data sets may provide a screen for potential medical errors and a method for monitoring trends over time.
The Decubitus Ulcer indicator* is intended to flag cases of in-hospital decubitus ulcers. Its definition is limited to decubitus ulcer as secondary diagnosis to better screen out cases that may be present on admission. In addition, this indicator excludes patients who have a length of stay of 4 days or less, as it is unlikely that a decubitus ulcer would develop within this period of time. Finally, this indicator excludes patients who are particularly susceptible to decubitus ulcer, namely patients with major skin disorders (Major Diagnostic Category 9 [MDC 9]) and paralysis.
*The following concerns affect the validity of this indicator:
- Underreporting or screening: Conditions included in this indicator may not be systematically reported (leading to an artificially low rate) or may be routinely screened for (leading to a higher rate in facilities that screen).
- Heterogeneous severity: This indicator includes codes that encompass several levels of severity of a condition that cannot be ascertained by the codes.
- Case mix bias: This indicator was felt to be particularly subject to systematic bias, and Diagnosis-Related Group (DRG) and comorbidity risk adjustment may not adequately address the concern.
Refer to the original measure documentation for further information.
