Analysis Reveals Most Common Harm Events Associated With High Rates of Mortality, Costs and LOS

Premier, Inc. has identified 86 inpatient complications associated with significant increases in inpatient mortality, costs and length of stay.

“Our research provides clinical leaders with an invaluable list of significant complications, and we encourage providers to enhance their focus on these areas. These complications could be driving high rates of mortality, costs and length of stay,” says Richard Bankowitz, MD, Premier’s chief medical officer. “While the safety measures tracked through federal programs should be a focus for hospitals, identifying improvement areas across this set of complications is just as important to deliver more efficient, higher-quality care overall.”

To develop a more robust measure for “potential inpatient complications” (PICs), Premier examined 5.5 million federal FY 2013 patient records across 530 hospitals, and determined that 86 conditions were associated with nearly 50,000 potential deaths, $4.3 billion in costs and 1.7 million added hospital days. These conditions occurred in more than one million cases.

The analysis also revealed that hospital-acquired conditions (HACs) used by the Centers for Medicare & Medicaid Services (CMS) to determine payment adjustments through pay-for-performance programs occur much less often than the Premier PICs. For instance, eight CMS HACs occurred so infrequently that the number cases counted fewer than 50 in each. In addition, the CMS HACs accounted for:
2 percent of the total potential deaths;
13 percent of the total costs; and
12 percent of the total added days.

The methodology used to identify Premier’s PICs has been peer-reviewed and published in the American Journal of Healthcare Quality.

“CMS HACs are serious and important events to prevent, but providers need to focus on a wider set of higher-impact complications to avoid missing opportunities for quality and cost improvement,” says Ramon V. Meguiar, MD, senior vice president and chief medical officer at Memorial University Medical Center of Savannah, Ga. “Looking exclusively on a narrow list of measures fails to examine an important cause of unjustified variation, and broadly assess the quality of patient care in a particular institution.”

To help providers prioritize and focus their quality improvement efforts, Premier also developed the following list of 10 PICs that had the highest association with mortality, cost and length of stay (conditions ordered by largest to smallest number of cases):
Acute Renal Failure
Hypotension
Respiratory Failure
Sepsis/Bacteremia
Aspiration Pneumonia
Acute Myocardial Infarction
Gastrointestinal (GI) Ulceration & Hemorrhage
Cerebral Infarction
Pulmonary Embolism
Ventilator Associated Pneumonia

These 10 PICs were associated with nearly $2.5 billion in costs, 24,000 potential mortalities and 920,000 added days in the hospital across approximately 530,000 cases.

“It’s very important to zero in on complications that could have a large, simultaneous impact on multiple measures, including reimbursement,” says Sharon L. Powell, MS, RN, patient safety officer and director, performance improvement at Frederick Memorial Hospital of Frederick, Md. “Although not each and every complication is preventable, Premier’s top 10 PICs provide a starting point for providers to address those that occur frequently and could significantly impact patient outcomes.”

Premier’s PICs can help providers:
- Broaden their ability to identify and address care processes that may contribute to complications.
- Better identify which hospitals perform well on a broad range of measures-and which ones don’t-while reducing the arbitrary nature inherent in narrow measures.
- Evaluate the importance of a particular complication by quantifying the impact against other outcomes (mortality, length of stay and cost).

The work of Premier’s collaborative members coupled with Premier’s research shows that the state of measures and evidence-based processes for tracking and reducing preventable complications is a work in progress.

“Premier is conducting follow up research to better identify the drivers of complications and how they could be prevented,” says Bankowitz.

Source: Premier, Inc.