Abstract:
BACKGROUND:Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES:To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN:Retrospective cohort. SUBJECTS:Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES:Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS:The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35%, 98%, 82%, and 84%, respectively. The weighted sensitivity was 30% for serious, 40% for minor, and 10% for questionable complications. It varied from 21% among hospitals with fewer complications than expected to 45% among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60% sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS:ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.
journal_name
Med Carejournal_title
Medical careauthors
Romano PS,Chan BK,Schembri ME,Rainwater JAdoi
10.1097/00005650-200210000-00004keywords:
subject
Has Abstractpub_date
2002-10-01 00:00:00pages
856-67issue
10eissn
0025-7079issn
1537-1948journal_volume
40pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND:Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) and conduct a sensitivity analysis comparing analytic methods. METHODS:A random sample of high-risk adults hospitalized in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181ef60a2
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. OBJECTIVES:To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptio...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200103000-00006
更新日期:2001-03-01 00:00:00
abstract::In the Seattle Prepaid Health Care Project, we studied medical records and claims information for all 97 children undergoing tonsillectomy and/or adenoidectomy in an independent practice plan from February 1971, through January 1975. Overall only 32 per cent of the procedures met commonly promulgated indications of su...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197811000-00005
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:A prerequisite for using administrative data to study the care of critically ill patients in intensive care units (ICUs) is that it accurately identifies such care. Only limited data exist on this subject. OBJECTIVE:To assess the accuracy of administrative data in the Canadian province of Manitoba for ident...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318245a754
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown. OBJECTIVES:To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience. PARTICIPANTS:A total ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000336
更新日期:2015-05-01 00:00:00
abstract::The increasing prominence of drug therapies in health care and their rapidly rising costs have led to a dramatic escalation of interest in the use of outcomes data for therapeutics and formulary decisions. The expanded use of formulary submission dossiers, effectiveness data, health outcomes analysis, and pharmacoecon...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000119396.81986.19
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:The practice of ordering "Do-Not-Resuscitate" (DNR) varies across hospitals. No research has explored how the DNR variation would affect cross-institutional performance reporting when DNR status is used as a risk adjustor. OBJECTIVE:We sought to assess the impact of DNR variation on performance reporting. ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000167106.09265.4e
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Although mental disorders constitute a significant public health problem in military populations, little is known about whether military members seek mental health treatment in a timely manner. OBJECTIVE:The objective of this study was to examine delays in making the initial treatment contact for various me...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181bd4bf9
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Population-based cancer registries represent a potentially valuable tool to evaluate treatment; however, information on the completeness of registry treatment data is sparse. OBJECTIVE:To evaluate the completeness of registry treatment data for patients with colorectal cancer and to identify predictors of c...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000083740.12949.88
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES:To examine accuracy of cardiac procedure coding in a...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182329778
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:A requirement of the Arkansas Medicaid Section 1115 demonstration waiver was to evaluate the level of care received for Medicaid expansion eligible beneficiaries enrolled in commercial Qualified Health Plans (QHPs) in the Health Care Independence "Private Option" Program. This allowed for a direct comparison...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001248
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) o...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181589b92
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:A number of health care initiatives seek to improve health outcomes by increasing access to outpatient services while reducing preventable acute events. We evaluated disparities between American Indian and Alaska Native (AI/AN) and non-Hispanic white (white) Medicare enrollees in access to outpatient preventi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000698
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Latino populations have disproportionately moved to areas in the Southeast and Midwest (emerging destinations), outside traditional Latino enclaves, in recent years. OBJECTIVE:To examine whether health care experiences differ between traditional and emerging destinations for Latino children. RESEARCH DESIG...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000504
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVES:An important factor contributing to the steep rise in health care costs in the late 1960s was a reversal from the predominance of acute illness to that of chronic disease. Beginning with the philosophy of Illich and Levin, and the practical instruments of Fries, Sehnert, Vickery, and Ferguson, a new movement...
journal_title:Medical care
pub_type: 历史文章,杂志文章,评审
doi:10.1097/00005650-200204001-00007
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND:Cardiac risk assessment may not be routinely performed. Electronic health records (EHRs) offer the potential to automate risk estimation. We compared EHR-based assessment with manual chart review to determine the accuracy of automated cardiac risk estimation and determination of candidates for antiplatelet o...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31818dce21
更新日期:2009-04-01 00:00:00
abstract::In this paper the individual is employed as the unit of analysis to examine the extent to which the use of physician care by beneficiaries insured under the Canadian Medicare program is determined by medical needs and sociodemographic characteristics as opposed to economic considerations. The data were derived from th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198311000-00001
更新日期:1983-11-01 00:00:00
abstract:BACKGROUND:Many state Medicaid programs use prior authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the prior authorization criteria has not been examined previously. METHODS:We determined whether prior authorization was...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000218775.04675.fd
更新日期:2006-07-01 00:00:00
abstract::The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence t...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198206000-00003
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:Numerous studies have examined the impacts of pay-for-performance programs, yet little is known about their long-term effects on health care expenses. OBJECTIVES:This study aimed to examine the long-term effects of a pay-for-performance program for diabetes care on health care utilization and expenses. MET...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31822d5d36
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess the impact of removing prior-authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS:In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with differe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000006
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The medical record serves as an important source of information regarding the care process, but few studies have examined whether thoroughness of documentation is associated with outcomes. OBJECTIVE:The objectives of this study were to analyze the initial visit note for 513 patients presenting with acute mu...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200004000-00005
更新日期:2000-04-01 00:00:00
abstract::Patients often receive medical care from many different providers. Consequently, the various episodes of care may not be integrated into a meaningful whole, and the quality of care may suffer. Before this possibility can be evaluated, it is necessary to develop a measure of the integrating process. The authors studied...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198405000-00004
更新日期:1984-05-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to estimate the effect of Medicare Health Maintenance Organization (HMO) enrollment on hospitalization rates and total inpatient days for ambulatory care-sensitive conditions (ACSCs) after controlling for selection. RESEARCH DESIGN:Simultaneous equations using a discrete facto...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000220699.58684.68
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:The negative impact of pain on health-related quality of life has been documented for persons with human immunodeficiency virus (HIV). Furthermore, pain could be an important factor in seeking medical care. However, the relationship between pain and health service utilization is poorly understood. OBJECTIVE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000108744.45327.d4
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31826b1087
更新日期:2012-11-01 00:00:00
abstract::Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199012000-00005
更新日期:1990-12-01 00:00:00
abstract::In-hospital cardiopulmonary resuscitation (CPR) is associated with substantial costs beyond those of the resuscitation itself. These costs are important to understand because health care resources are limited. To that end, a model of CPR is proposed, including an examination of the effect of several variables on the c...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199406000-00008
更新日期:1994-06-01 00:00:00
abstract::In a longitudinal, prospective study of patient's decisions about influenza vaccination, the stability of attitudes about the flu and flu shots, the stability of flu shot decisions, and the relationship of attitude shifts to compliance were studied. In both 1981 and 1982 for 216 patients at high risk for complications...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198506000-00002
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND:The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid. OBJECTIVES:To examine the association of the UC...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000020
更新日期:2014-01-01 00:00:00