So if PSI-12 is so flawed, how did it get to be a performance measure? It was endorsed by the National Quality Forum in 2008, and was quickly adopted by the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) and by UHC, a performance improvement organization serving 118 academic medical centers, in their quality endeavors.
Apparently there's been little attempt to look back.
Greg Maynard, MD, director of the University of California San Diego Medical Center's Center for Innovation and Improvement Science and a VTE researcher, says he's been working with officials from the Centers for Disease Control and Prevention and with the Society of Hospital Medicine to get the measure amended or un-endorsed.
"We have sent letters to the National Quality Forum saying this measure for outcomes, and a measure for DVT prophylaxis, are not very good and we urged them to make changes," he says. "But they did not make those changes. They sent a response saying, 'we know we're not perfect, but we need to raise the bar.' "
Maynard adds, "to some extent, (the NQF and other PSI-12 defenders) generally make the argument that they raise awareness, and they get people to think about it. It's hard to argue with that. But to withhold payment based on that these (PSI-12) rates, as opposed to just looking at an increase or decrease within one institution, that's fraught with difficulty."
He adds that there are just too many factors that skew the results for any one hospital when it's compared with other hospitals across the country, such as the way hospitals code illness, other testing some hospitals do, the mix of patients with cancer or trauma, and many other variables.