DOI: 10.3886/e233933
title: Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 11 (PSI-11) Measure Rates

description: Information on provider-level measure rates for the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 11 (PSI-11) Postoperative Respiratory Failure measure.<br><br>The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 11 (PSI-11) Measure Rates dataset provides information on provider-level measure rates regarding one preventable complication (postoperative respiratory failure) for Medicare fee-for-service discharges. The PSI-11 measure data is solely reported for providers’ information and quality improvement purposes and are not a part of the Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Payment Provision or HAC Reduction Program.<br><br>Q: What is the history of the PSI-11 measure reporting?In August 2015, CMS calculated and publicly reported the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) 11 – Postoperative Respiratory Failure Rate on data.cms.gov. CMS publicly reported the same PSI-11 measure again in August 2016. CMS reports the AHRQ PSI-11 – Postoperative Respiratory Failure Rate measure for information and quality improvement purposes only; PSI-11 is not a part of the Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Payment Provision or HAC Reduction Program.<br><br>Q: How do the PSI-11 results being posted in August 2016 differ from the PSI-11 results from August 2015?CMS made the following changes since the previous reporting of the PSI-11 measure:Updated time period for measures calculation — CMS updated the time period used for the PSI-11 measure calculations to include discharges from July 1, 2013 through June 30, 2015 (as opposed to July 1, 2011 through June 30, 2013).Updated and recalibrated AHRQ PSI software for PSI-11 — CMS calculated the PSI-11 measure using recalibrated version 5.0.1 of the AHRQ PSI software, as opposed to version 4.5a. In general, CMS recalibrated the risk-adjustment coefficients, signal variance, smoothing target, and composite weights based on the Medicare Fee-for-Service (FFS) population rather than the Healthcare Cost and Utilization Project (HCUP) population.Inclusion of Maryland hospitals – CMS will include Maryland hospitals in the calculation of the PSI-11 measure for the first time in August 2016 because Maryland hospitals were required to start reporting POA Indicators, a field on an inpatient claim necessary for the PSI-11 measure calculations, as of October 1, 2013. <br>Q: Why is CMS reporting the PSI-11 measure rate?In addition to researcher and stakeholder interest, CMS is publicly reporting the PSI-11 measure rate to identify complications and undesirable conditions that patients experience in hospital settings which can reasonably be prevented by changes at the hospital level. Improving patient safety is one of the ultimate goals of quality improvement. The PSI-11 measure remains an important aspect of CMS’s commitment to patient safety.<br><br>Q: Which hospitals are included in the PSI-11 measure calculations?The PSI-11 measure depends on complete and accurate coding of POA Indicator fields. Hospitals participating in the IPPS program and Maryland hospitals must submit complete POA coding, although other types of hospitals can and will report these codes. To avoid any bias against exempt hospitals that are not reporting POA indicators, the PSI-11 measure is only calculated for IPPS and Maryland hospitals.<br>A list of hospital types exempt from POA reporting is provided on the CMS Hospital-Acquired Conditions webpage under the link for Affected Hospitals located at the following website: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/AffectedHospitals.html<br><br>Q: How is the PSI-11 measure rate calculated?CMS calculates the PSI-11 measure rate using claims for Medicare Fee-for-Service (FFS) discharges.<br>The PSI-11 measure rate is reported as a smoothed rate. The measure uses the count of actual occurrences identified at a hospital (numerator) divided by the eligible number of discharges at that hospital (denominator). This ratio is then risk-adjusted to account for the hospital’s case mix and reliability-adjusted (or “smoothed”) to account for statistical uncertainty.<br><br>Q: Is the PSI-11 measure adjusted for our hospital’s patient case-mix?The PSI-11 measure is risk and reliability-adjusted, according to AHRQ’s specifications.<br><br>Q: How are multiple HACs on the same claim treated when calculating hospitals' PSI-11 measure rate?The PSI-11 measure methodology adopted for public reporting counts unique occurrences of HAC diagnosis codes, not a count of discharges with a HAC. One discharge record could contain multiple HACs. However, only one HAC (e.g., a postoperative respiratory failure for PSI-11) is counted for the PSI-11 measure numerator if a record has multiple diagnosis codes for that same HAC category (i.e., if a record has additional postoperative respiratory failures for PSI-11).<br><br>Q: Where can I get more information on the PSI-11 measure?Please see these websites for additional information regarding the PSI-11 measure:CMS’s Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.htmlAHRQ Specifications for the PSI-11 measure: http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/TechSpecs/PSI_11_Postoperative_Respiratory_Failure_Rate.pdf. Please note that the specifications for AHRQ PSI software version 5.0 still apply for recalibrated version 5.0.1.AHRQ PSI Overview and Resources: http://www.qualityindicators.ahrq.gov/modules/psi_resources.aspxAHRQ PSI Information on the QualityNet website: https://www.qualitynet.org/inpatient/measures/psi.<br>