The Medicare Patient Safety Monitoring System (MPSMS) is a national surveillance project aimed at identifying the rates of specific adverse events within the Medicare population. It is administered by the Quality Improvement Group (QIG) in the Office of Clinical Standards and Quality (OCSQ). The goal of the project is not to monitor physicians for best practices or determine physician errors. Instead, the project is limited solely to detecting harm which comes to patients from the fault of the physician.
To identify patients who experience harm, the MPSMS system uses hospital records from over 40,000 hospital discharges. Whereas AHRQ’s Patient Safety Indicators (PSI) relies exclusively on claims data to identify patient safety problems, the MPSMS sends medical records from these 40,000 discharges for review at one of two Clinical Data Abstraction Centers (CDAC). Using medical records has the advantage of being able to access more data than is available in the claim; using medical record data, however, is expensive, time-consuming, and relies on providers entering information into the patient’s chart in an honest fashion.
The safety measures cover these topics. Any adverse medical event selected for monitoring must met the following criteria:
- The adverse event can be found.
- The adverse event is common
- The adverse event is likely to be associated with exposure to a specific process of care
- The adverse event is responsible for serious morbidity/mortality
- The adverse event is preventable or repairable
Examples of the events monitored include adverse events associated with hip/knee replacement and post-operative pneumonia (the second most frequent postoperative complication after major surgery). The most frequent postoperative complication after major surgery is wound infection, but it was not selected as a topic because the wound infection often appears during post-acute care, and thus many wound infections are missed in the data.
One drawback of the MPSMS program is that it is simply a monitoring program. If MPSMS detects that a provider is harming a large number of patient, no action is taken since MPSMS’s mandate is simply to monitor trends in harm to patient. Additionally, MPSMS is much more expensive to administer than a safety monitoring program relying on claims data. Further, even if a harmful provider were identified, the delay caused by medical record review may mean that the provider has corrected his action or no longer practices.