Does Surveillance Bias Influence the Validity of Measures of Inpatient Complications? A Systematic Review

Abstract

Surveillance bias may threaten the accuracy of inpatient complication measures. A systematic literature review was conducted to examine whether surveillance bias influences the validity of selected Patient Safety Indicator- and health care associated infection-related measures. Ten venous thromboembolism (VTE) articles were identified: 7 trauma related, 3 postoperative, and 1 central line-associated bloodstream infection (CLABSI) article. Nine VTE articles found positive associations between deep vein thrombosis imaging and VTE diagnoses. Because imaging also may be symptom driven, most studies performed additional analyses to corroborate findings. Six trauma-related and 2 postoperative VTE studies concluded that surveillance bias was present, the latter based on circumstantial evidence. The non-VTE study found a significant positive correlation between surveillance aggressiveness and intensive care unit CLABSI rates. Even considering VTE, relatively little is known about the impact of surveillance bias on inpatient complication measures. Given the implications of misclassifying hospitals on quality, this issue requires further investigation using more direct measurement methods.

A shift in perspective on secondary disabilities in fetal alcohol spectrum disorders

“…Based on retrospective life event interviews, this early work had no comparison group, and there was likely a detection (or surveillance) bias toward those with more difficulties. This is common in clinic-derived samples, but does raise threats to validity and issues of generalizability (Drake et al, 2017;Chen et al, 2018). These must be considered in data interpretation for both earlier and more recent clinic-based studies.…”

Hospital-Acquired Condition Rate of Admitting Facility Does Not Predict Mortality in Traumatically Injured Patients

“…A systematic review of surveillance bias in outcome measures concluded that this issue particularly affects venous thromboembolism (VTE) diagnosis. They found that six trauma-related and two post-operative VTE studies reported evidence of surveillance bias [ 16 ]. Previous work on VTE reported a paradoxical relationship between VTE and outcome measures similar to what we found in our analysis - high-quality centers had higher rates of VTE than low-quality centers [ 17 ].…”

A Pragmatic Method for Measuring Inpatient Complications and Complication-Specific Mortality

“…10,[14][15][16] Although standardized comparative metrics facilitate comparison among peer groups, review of the literature suggests that gaps remain about their actionability due to the lack of specificity and detail needed to allow hospital leaders to understand specific areas of high and low performance and target quality improvement efforts accordingly. 14,15,[17][18][19][20][21] Consider as an example PSI 04, the death rate among surgical inpatients with serious treatable complications. 7,22 This metric is largely recognized as the measure of a health care institution's "failure to rescue" (FTR) performance and is a critical patient safety measure, as it is associated with a 2.5-fold variation in highest-versus lowest-quintile hospital mortality rates.…”

“…Large-scale adoption of PSIs and IQIs has produced extensive amounts of hospital-specific and comparative performance data and allowed for critical review of validity 10,14–16 . Although standardized comparative metrics facilitate comparison among peer groups, review of the literature suggests that gaps remain about their actionability due to the lack of specificity and detail needed to allow hospital leaders to understand specific areas of high and low performance and target quality improvement efforts accordingly 14,15,17–21 …”