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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

3059 — Hospitalizations Due to Medical Interventions: Developing a Patient-Centric VHA Monitoring System

Author List:
Campbell RR (VISN 8 Patient Safety Center)
Spehar AM (VISN 8 Patient Safety Center)
Werner DC (VISN 8 Patient Safety Center)
Bradham DD (VISN 5 HSR&D)
Sanchez-Anguiano A (VISN 8 Patient Safety Center)

The objective of this research program is to develop a national VHA monitoring system for adverse event (AE) due to medical interventions. The objective of this study was to examine the feasibility of applying the State and Territorial Injury Prevention Directors Association (STIPDA) case-finding recommendations for AE surveillance in the VHA. The ultimate goal is to improve patient safety and reduce the number and types of hospitalizations for AE in veterans.

Selected variables from all VHA hospital inpatient discharges for five fiscal years (1998-2002) were extracted from the National Patient Care Dataset. The resultant dataset had over 2.8 million records. The selected variables extracted included demographic and clinical information. Direct medical costs were analyzed using the average cost per discharge for these AE extracted from the Decision Support System (DSS). Discharges for AEs were identified using the primary admitting diagnosis in accordance with criteria and recommendations from STIPDA. The specific ICD-9-CM codes for these AEs were based on the Agency for Healthcare Research and Quality (AHRQ) Clinical Classification Software (CCS) categories 237 (complication of device, implant or graft), and 238 (complications of surgical procedures or medical care).

There were over 44,000 hospital discharges during the five-year period associated with medical interventions in CCS class 237 in the VHA. These hospitalizations resulted in over 388,000 bed days of care, an average length of stay of 8.7 days, and over $660 million of direct medical expenses. AEs associated with CCS class 238 resulted in over 37,000 hospital discharges, over 371,000 bed days of care, an average length of stay of 9.8 days, and over $440 million in direct medical expenses.

We established the feasibility of using extant VHA administrative hospital discharge datasets to monitor trends in the incidence and costs of veterans’ hospitalizations for AEs.

This type of serious adverse event monitoring system provides a cost effective method to monitor medical interventions in important clinical areas within the VHA from a patient’s perspective. This study has the potential to positively impact veterans’ quality of care by focusing interventions on these serious AEs.

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