• Patrick S Romano, Hillary J Mull, Peter E Rivard, Shibei Zhao, William G Henderson, Susan Loveland, Dennis Tsilimingras, Cindy L Christiansen, and Amy K Rosen.
• UC Davis Division of General Medicine and Center for Healthcare Policy and Research, 4150 V Street, PSSB Suite 2400, Sacramento, CA 95817, USA. psromano@ucdavis.edu
• Health Serv Res. 2009 Feb 1; 44 (1): 182-204.

ObjectivesTo examine the criterion validity of the Agency for Health Care Research and Quality (AHRQ) Patient Safety Indicators (PSIs) using clinical data from the Veterans Health Administration (VA) National Surgical Quality Improvement Program (NSQIP).Data SourcesFifty five thousand seven hundred and fifty two matched hospitalizations from 2001 VA inpatient surgical discharge data and NSQIP chart-abstracted data.Study DesignWe examined the sensitivities, specificities, positive predictive values (PPVs), and positive likelihood ratios of five surgical PSIs that corresponded to NSQIP adverse events. We created and tested alternative definitions of each PSI.Data CollectionFY01 inpatient discharge data were merged with 2001 NSQIP data abstracted from medical records for major noncardiac surgeries.Principal FindingsSensitivities were 19-56 percent for original PSI definitions; and 37-63 percent using alternative PSI definitions. PPVs were 22-74 percent and did not improve with modifications. Positive likelihood ratios were 65-524 using original definitions, and 64-744 using alternative definitions. "Postoperative respiratory failure" and "postoperative wound dehiscence" exhibited significant increases in sensitivity after modifications.ConclusionsPSI sensitivities and PPVs were moderate. For three of the five PSIs, AHRQ has incorporated our alternative, higher sensitivity definitions into current PSI algorithms. Further validation should be considered before most of the PSIs evaluated herein are used to publicly compare or reward hospital performance.

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