Definition

A Provider Preventable Condition (PPC) is defined as "harm experienced by a patient as a result of medical care, or harm that occurs in a medical setting, unrelated to the reason for the patient visit."

Provider Preventable Conditions (PPC) were formerly known as Healthcare Acquired Conditions (HAC). The term Provider Preventable Conditions is sometimes substituted with the terms "Adverse Event", "Never Event", and "Serious Reportable Condition". Though it is presently understood that there are subtle differences in the meanings of these terms, readers will notice that in the past, state and federal documents have used these terms interchangeably.

Who is Responsible for Potentially Preventable Conditions (PPC)

The existence of a PPC is not a statement of blame or culpability. For example, PPC 6 is "Falls/Trauma". Just as an individual can fall and break a hip while walking through the home, the same can occur in a room at a healthcare facility while walking to the restroom. If a patient falls at a medical facility, even if there is no injury, the facility is required to code the incident, and it may be displayed below. The posting of a PPC is not a report on incompetence or carelessness. PPC 2 is "Foreign Body" left in patient. This can mean a surgical sponge or utensil left in a patient after surgery (and this definitely would be an error), but it can also signify a good judgement call by an experienced physician. For example, while a physician is setting and anchoring a compound fracture, a screw may break within the bone. The physician may correctly choose to leave the screw fragment within the patient, as removing it may cause unnecessary trauma. This situation may be coded as a PPC for foreign body left in patient, but is clearly not a sign of incompetence.

Hospitals have 30 days to review each individual case prior to posting. The purpose of these web pages is to show serious events. Facilities may provide extenuating circumstances for a case that can cause its removal. For example, if a patient fell, but there was no injury, and the facility reported this to CHIA, that case will be removed prior to posting. Another example is for "Foreign Body Left in Patient". If this foreign body (such as a screw) was intentionally left in the body for the patients benefit, and CHIA was notified, that PPC would be removed prior to posting.

Purpose of Posting

The purpose of posting these events is to look at the big picture. In any endeavour, including medical care, there is always room for improvement. Although not all PPCs are preventable, a high rate of PPCs may suggest room for improvement. Medical facilities can view this page as an indicator where resources should be applied. This information can assist in the development and enhancement of existing safety policies. When you, the user, view the PPCs, keep in mind that there is not enough information to make a judgement call on a hospital. Some hospitals specialize in difficult cases and may have higher rates of PPCs. Some PPCs are difficult to code, as the attending physician may not have enough information to determine if the PPC occurred at their facility, or if the patient arrived with the condition. Even under these circumstances of missing information, the PPC is still counted and displayed on this website.

Understanding Counts and Rates

You'll notice counts and two rate values are being displayed. If only counts were displayed, large medical facilities would be misrepresented by appearing worse than small facilities. If only rates were displayed, small facilities would be misrepresented, as the addition of a single PPC at a small facility causes a large increase in the rate.

Displaying rates per 1000 discharges is a national norm, but it doesn't present the entire picture. At times a patient may reside at a facility for many days. This could be due to a chronic illness, insurance requirements, or other reasons. Each day a patient remains at a medical facility, that patient has the potential of falling, or getting a bed sore, a catheter infection and so on. Displaying a rate by 1000 bed days compensates for this.

Minimum Cell Size

To protect patient privacy, not all numbers are displayed for all hospitals. Minimum cell size is limited by the denominator, not the numerator. The numerator is the number of PPCs. The denominator is the total number of discharges at a hospital during the year. If the denominator is less than 100, the PPC information is not displayed. The numerator can be as small as 1.

To determine the best minimum denominator size, federal government documents at the CDC and the Federal Committee on Statistical Methodology were studied. It turns out there is no definitive rule. Patricia Sweeney of the CDC, in her presentation "The Balancing Act: Limiting Disclosure vs. Optimizing Data Use", at the 2010 CSTE Pre-Conference Workshop, June 7, 2010, discussed cell size limitations from 5-1000. Based on her reasoning, and the fact that no patient demographics are provided on the PPC web page, the Center for Health Information Analysis, and the State of Nevada, Division of Health Care Financing and Policy settled on 100 as the minimum cell size for the denominator.