The Leapfrog Group Issues a Response to Findings in Medical Care

May 12, 2016

In response to the article published this week in the journal Medical Care, The Leapfrog Group would like to clarify the measures used in the Hospital Safety Score and how these measures relate to the study’s findings.

Since the launch of the Hospital Safety Score in 2012, Leapfrog has worked with a volunteer panel of patient safety experts to develop and update the methodology for the Hospital Safety Score. All measures included in the Score are publicly available and have gone through rigorous scientific testing. Most are endorsed by the National Quality Forum. For the last four years, The Hospital Safety Score Expert Panel has advised Leapfrog to include three Hospital-acquired Conditions (HACs) and seven Patient Safety Indicators (PSIs) among the 30 measures used to calculate the Hospital Safety Score composite.

We and our Expert Panel agree that, like all measures, the measures used in the Hospital Safety Score are not perfect. However, they represent the best assessment of patient safety available today, and provide consumers with meaningful information to assist in choosing a hospital. All 30 measures meet exceptionally high standards for integrity and Leapfrog stands behind them.

With regard to the specific measures examined in the study and their relation to the Hospital Safety Score, we would like to note the following:

  1. The study looked at PSIs that are not currently used in any CMS or Leapfrog program (such as PSI 5, retained foreign body).
  2. The study did not examine any of the HAC measures utilized in the Hospital Safety Score (e.g., foreign object retained, air embolism, falls/trauma).
  3. Of the PSI measures used in the Hospital Safety Score, 4 of the 7 (bolded below) are endorsed by the National Quality Forum:
    1. PSI 3: Pressure Ulcer
    2. PSI 4: Death Among Surgical Inpatients
    3. PSI 6: Iatrogenic Pneumothorax
    4. PSI 11: Postoperative Respiratory Failure
    5. PSI 12: Postoperative PE/DVT
    6. PSI 14: Postoperative Wound Dehiscence
    7. PSI 15: Accidental Puncture or Laceration

With safety and quality metrics increasingly being used in value-based purchasing programs, it is not surprising to see a higher tenor of reaction to measure imperfections. Our team continues to work closely with our colleagues at NQF, AHRQ, and with many of you to advocate for improved measurement. If and when improved measures become publicly available, we will consider them for inclusion in the Hospital Safety Score. In the meantime, we won't allow the quest for measure perfection to delay us in doing good. Consumers and their families need and deserve the best possible information on the safety of American hospitals, and that is what our Hospital Safety Score gives them.

Please do not hesitate to contact us with any questions.


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