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BACKGROUND/RATIONALE:
VAMC: Tennessee Valley Healthcare System VISN 9
Solicitation/Targeted Area: HSR&D Priorities for Investigator-Initiated Research, Research Methodology.
Background/Rationale: Adverse events (AEs) are injuries that occur to patients as a result of their medical management and not their underlying disease process. The Veterans Health Administration’s (VHA) commitment to deliver the safest medical care possible for its veterans hinges on its ability to detect patient injuries and make systematic improvements. The primary purpose of this proposal is to evaluate a concept-based indexing tool that electronically identifies adverse events within clinical narratives and compare this method to other adverse event surveillance methods.
OBJECTIVE(S):
The objectives of this study are to:
Objectives: The primary adverse event outcome of interest will be nine post-operative surgical complications that are currently routinely collected as part of the well established and successful, VA National Surgical Quality Improvement Program (NSQIP). A manual chart review process is currently employed to detect post-operative complications for the NSQIP program and will serve as our “gold standard”. We will determine the sensitivity and specificity of our Post-Operative Event Monitor (POEM) at identifying the target post-operative complications. Several non-VA organizations have recommended using administrative data, such as PSI, to electronically screen for post-surgical complications and thus comparing this novel screening technique to administrative screening might identify the most accurate electronic screening methodology. The objectives of this study are to:
Objective 1: To determine the feasibility of using concept-based indexing as an event finder for surgical complications (Post-Operative Event Monitor POEM).
Objective 2: To determine the test characteristics (sensitivity and specificity) of the POEM using the trained NSQIP nurse reviewers as the gold standard.
Objective 3: To determine the test characteristics (sensitivity and specificity) of the Patient Safety Indicators on matching NSQIP surgical complications and compare the performance of POEM with PSI screening modalities for detecting specific types of post-operative adverse events.
Objective 4: To design a composite event monitor tool combing the POEM system and PSI and compare the composite tool to the singular POEM and PSI monitoring systems.
Methods: Sensitivity and positive predictive value will be derived from the surgical cases in the NSQIP database for VISN 9 from 1999 through 2006. The POEM and PSI algorithms will be applied to the narrative records and administrative data of these cases and then evaluated against the gold standard.
METHODS:
Methods: Sensitivity and positive predictive value will be derived from the surgical cases in the NSQIP database for VISN 9 from 1999 through 2006. The POEM and PSI algorithms will be applied to the narrative records and administrative data of these cases and then evaluated against the gold standard.
FINDINGS/RESULTS:
Early stages of our study; no results at this time.
IMPACT:
Impact: Ensuring the highest quality of care for veterans cared for by the VHA requires treating safety as an utmost priority. Successful quality improvement programs like NSQIP still rely on manual chart review, a costly approach, and much of this information could be electronically identified. Mining the electronic record would enable the redistribution of resources into interventions, allow for performance measures that evaluate the impact of those interventions and provide new sources of information that would stimulate innovative applications of implementation research. This tool could afford VHA the ability to monitor and identify a broad range of patient safety concerns and quality indicators.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Technology Development and Assessment, Resource Use and Cost
Keywords:
Cost, Research measure, Research method, Safety, Informatics
MeSH Terms:
none
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