Summary of the Article: Flawed Metric Penalizes Hospitals for Treating Severe Stroke Patients
This article discusses a study revealing that a commonly used hospital quality metric, Patient Safety Indicator 04 (PSI 04), is inappropriate and misleading when applied to endovascular thrombectomy (EVT) – a life-saving procedure for removing blood clots in stroke patients.
Here are the key takeaways:
* PSI 04 is designed to identify preventable deaths by tracking complications like pneumonia, blood clots, sepsis, etc., leading to death in hospital.
* It’s flawed for stroke patients: Severe stroke patients are already critically ill and prone to these complications irrespective of treatment. The metric incorrectly attributes these complications to the procedure itself, rather than the severity of the initial stroke.
* Disproportionately high rates: PSI 04 flags stroke thrombectomy cases at a much higher rate (20.5%) than other procedures (median 0.10%), and far higher than all surgical procedures combined (14.3%).
* UCLA study findings: A detailed review of cases at UCLA found that all deaths flagged by PSI 04 were due to the severity of the stroke, not errors in the procedure. No preventable safety concerns were identified.
* Harmful consequences: The flawed metric can:
* Penalize hospitals providing excellent care to the sickest patients.
* Discourage hospitals from performing EVT on the most severe cases.
* Lead to cherry-picking of healthier patients to improve hospital ratings (as seen with heart surgery in the past).
* Proposed solution: The Centers for Medicare & Medicaid Services (CMS) is proposing to revise PSI 04 to exclude patients with acute conditions like stroke as the primary reason for admission, planned for implementation in 2027. This revision is seen as a positive step.
In essence, the article argues that using PSI 04 to evaluate stroke thrombectomy creates perverse incentives and could ultimately harm patients by discouraging life-saving treatment. The study highlights the importance of using appropriate metrics that accurately reflect the unique challenges of treating critically ill patients.
