PMID- 30151826
OWN - NLM
STAT- MEDLINE
DCOM- 20190314
LR  - 20210910
IS  - 1475-6773 (Electronic)
IS  - 0017-9124 (Print)
IS  - 0017-9124 (Linking)
VI  - 53
IP  - 6
DP  - 2018 Dec
TI  - Development of an Adverse Event Surveillance Model for Outpatient Surgery in the 
      Veterans Health Administration.
PG  - 4507-4528
LID - 10.1111/1475-6773.13037 [doi]
AB  - OBJECTIVE: Develop and validate a surveillance model to identify outpatient 
      surgical adverse events (AEs) based on previously developed electronic triggers. 
      DATA SOURCES: Veterans Health Administration's Corporate Data Warehouse. STUDY 
      DESIGN: Six surgical AE triggers, including postoperative emergency room visits 
      and hospitalizations, were applied to FY2012-2014 outpatient surgeries 
      (n = 744,355). We randomly sampled trigger-flagged and unflagged cases for nurse 
      chart review to document AEs and measured positive predictive value (PPV) for 
      triggers. Next, we used chart review data to iteratively estimate multilevel 
      logistic regression models to predict the probability of an AE, starting with the 
      six triggers and adding in patient, procedure, and facility characteristics to 
      improve model fit. We validated the final model by applying the coefficients to 
      FY2015 outpatient surgery data (n = 256,690) and reviewing charts for cases at 
      high and moderate probability of an AE. PRINCIPAL FINDINGS: Of 1,730 FY2012-2014 
      reviewed surgeries, 350 had an AE (20 percent). The final surveillance model 
      c-statistic was 0.81. In FY2015 surgeries with >0.8 predicted probability of an 
      AE (n = 405, 0.15 percent), PPV was 85 percent; in surgeries with a 0.4-0.5 
      predicted probability of an AE, PPV was 38 percent. CONCLUSIONS: The surveillance 
      model performed well, accurately identifying outpatient surgeries with a high 
      probability of an AE.
CI  - Published 2018. This article is a U.S. Government work and is in the public 
      domain in the USA.
FAU - Mull, Hillary J
AU  - Mull HJ
AUID- ORCID: 0000-0002-4484-0445
AD  - Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston 
      Healthcare System, Boston, MA.
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA.
FAU - Itani, Kamal M F
AU  - Itani KMF
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA.
AD  - Department of Surgery, VA Boston Healthcare System, Boston, MA.
AD  - Harvard Medical School, Boston, MA.
FAU - Pizer, Steven D
AU  - Pizer SD
AD  - Department of Veterans Affairs, Partnered Evidence-based Policy Resource Center 
      (PEPReC), Boston, MA.
AD  - Department of Health Law, Policy and Management, Boston University School of 
      Public Health, Boston, MA.
FAU - Charns, Martin P
AU  - Charns MP
AD  - Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston 
      Healthcare System, Boston, MA.
AD  - Department of Health Law, Policy and Management, Boston University School of 
      Public Health, Boston, MA.
FAU - Rivard, Peter E
AU  - Rivard PE
AD  - Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston 
      Healthcare System, Boston, MA.
AD  - Healthcare Administration, Sawyer Business School Suffolk University, Boston, MA.
FAU - McIntosh, Nathalie
AU  - McIntosh N
AD  - Massachusetts Health Quality Partners (MHQP), Boston, MA.
FAU - Hawn, Mary T
AU  - Hawn MT
AD  - Palo Alto VA Medical Center, Palo Alto, CA.
AD  - Stanford University School of Medicine, Stanford, CA.
FAU - Rosen, Amy K
AU  - Rosen AK
AUID- ORCID: 0000-0002-7539-7749
AD  - Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston 
      Healthcare System, Boston, MA.
AD  - Department of Surgery, Boston University School of Medicine, Boston, MA.
LA  - eng
GR  - IK2 HX001520/HX/HSRD VA/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20180827
PL  - United States
TA  - Health Serv Res
JT  - Health services research
JID - 0053006
SB  - IM
MH  - Algorithms
MH  - Ambulatory Surgical Procedures/*adverse effects
MH  - Databases, Factual
MH  - Hospitalization
MH  - Humans
MH  - Patient Readmission
MH  - *Patient Safety
MH  - *Postoperative Complications/etiology
MH  - Quality Indicators, Health Care/*standards
MH  - Quality of Health Care
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - United States
MH  - United States Department of Veterans Affairs
MH  - Veterans
PMC - PMC6232409
OTO - NOTNLM
OT  - Modeling: multilevel
OT  - VA health care system
OT  - ambulatory/outpatient care
OT  - quality of care/ patient safety (measurement)
OT  - surgery
EDAT- 2018/08/29 06:00
MHDA- 2019/03/15 06:00
PMCR- 2019/12/01
CRDT- 2018/08/29 06:00
PHST- 2018/08/29 06:00 [pubmed]
PHST- 2019/03/15 06:00 [medline]
PHST- 2018/08/29 06:00 [entrez]
PHST- 2019/12/01 00:00 [pmc-release]
AID - HESR13037 [pii]
AID - 10.1111/1475-6773.13037 [doi]
PST - ppublish
SO  - Health Serv Res. 2018 Dec;53(6):4507-4528. doi: 10.1111/1475-6773.13037. Epub 
      2018 Aug 27.