Impact of Including Readmissions for Qualifying Events in the Patient Safety Indicators

Sheryl M. Davies, Olga Saynina, Laurence C. Baker, Kathryn M. McDonald

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) do not capture complications arising after discharge. This study sought to quantify the bias related to omission of readmissions for PSI-qualifying conditions. Using 2000-2009 California Office of Statewide Health Planning and Development Patient Discharge Data, the study team examined the change in PSI rates when including readmissions in the numerator, hospitals performing in the extreme deciles, and longitudinal performance. Including 7-day readmissions resulted in a 0.3% to 8.9% increase in average hospital PSI rates. Hospital PSI rates with and without PSI-qualifying 30-day readmissions were highly correlated for point estimates and within-hospital longitudinal change. Most hospitals remained in the same relative performance decile. Longer length of stay, public payer, and discharge to skilled nursing facilities were associated with a higher risk of readmission for a PSI-qualifying event. Failure to include readmissions in calculating PSIs is unlikely to lead to erroneous conclusions.

Original languageEnglish (US)
Pages (from-to)114-118
Number of pages5
JournalAmerican Journal of Medical Quality
Issue number2
StatePublished - Mar 16 2015
Externally publishedYes


  • Patient Safety Indicators
  • hospital quality
  • quality metrics
  • readmissions

ASJC Scopus subject areas

  • Health Policy


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