Abstract:
BACKGROUND:Failure to rescue (FTR), the rate of death in patients suffering 1 of 6 in-hospital complications, is an Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator calculated from administrative data. OBJECTIVE:: We sought to assess the accuracy of the AHRQ FTR algorithm. METHODS:We undertook a retrospective chart review of 60 denominator cases of FTR identified by the algorithm at each of 40 University HealthSystem Consortium institutions. The primary outcome was the overall accuracy of the algorithm compared with chart review. We also assessed accuracy by complication type, patient characteristics, institution, service assignment, and mortality. RESULTS:Of 2354 cases, 1193 (50.7%) were accurately identified by the algorithm as having had at least one of the FTR-qualifying complications during hospitalization. Of the 3073 complications identified in these patients, 1497 (48.7%) were correctly flagged by the algorithm, 907 (29.5%) were present on admission, 419 (13.6%) were not confirmed by chart review, and 250 (8.1%) met a predefined complication-specific criterion for exclusion. The case accuracy rate varied significantly by institution (mean, 50.7%; range, 18.3-100%; P < 0.001), service assignment (surgical service, 62.9% vs. nonsurgical service, 42.9%; P < 0.001), and mortality (alive, 43.9% vs. dead, 67.5%; P < 0.001) but was not affected by patients' age, gender, race, or insurance status. CONCLUSIONS:As currently calculated from administrative data, the FTR algorithm misidentifies half of the cases on average, is least accurate for nonsurgical cases, and is widely variable across institutions. This indicator may be useful internally to flag possible cases of quality failure but has limitations for external institutional comparisons. Improvements in coding quality and consistency across institutions are needed.
journal_name
Med Carejournal_title
Medical careauthors
Horwitz LI,Cuny JF,Cerese J,Krumholz HMdoi
10.1097/01.mlr.0000250226.33094.d4subject
Has Abstractpub_date
2007-04-01 00:00:00pages
283-7issue
4eissn
0025-7079issn
1537-1948pii
00005650-200704000-00003journal_volume
45pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::As part of a comprehensive evaluation of care received by enrollees in a prepaid community health care project, we studied the process of care for enrollees reported to have a urinary tract infection. The care given to 98 patients enrolled in a large prepaid group practice (PGP) and 69 patients seen by 45 physicians i...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197806000-00005
更新日期:1978-06-01 00:00:00
abstract::This article analyzes reported data on length of stay of discharged patients from the 1977 National Nursing Home Survey. Assuming that patients admitted to nursing homes are one of two types, short-stayers and long-stayers, the statistically best-fitting proportions and expected lengths of stay for the two types are d...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198103000-00011
更新日期:1981-03-01 00:00:00
abstract:BACKGROUND:Medication error occurring during the care of HIV-infected patients may lead to treatment failure, drug toxicity, or even death. OBJECTIVE:The objective of this study was to ascertain and confirm 5 categories of medication error in the care of HIV-infected patients. RESEARCH DESIGN:This study was a retrosp...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000175622.81335.4d
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. OBJECTIVE:To quantify the rel...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000342
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:A need exists for adapting existing perioperative risk stratification methods such as the Charlson Comorbidity Index (CCI) for application with hospital administrative data in noncardiac surgery populations. OBJECTIVE:Develop and validate outcome-specific CCIs for predicting inpatient mortality, and cardiac...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000592
更新日期:2016-12-01 00:00:00
abstract::Data abstracted from transportation company records showed that nursing home patients made an average of 3.6 trips per year for care out of the nursing home. The bulk of this care (55 per cent) was provided at University Hospital with over a quarter provided at private physicians' offices and community health centers....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197702000-00006
更新日期:1977-02-01 00:00:00
abstract:BACKGROUND:Demand for surgical treatment is rising while operating room (OR) resources are limited. Requests for more resources therefore can only be partly met by repartitioning the existing sparse resources. OBJECTIVE:Our goal is to define a method to allocate OR block times among surgical disciplines in such a way ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182549eb9
更新日期:2012-09-01 00:00:00
abstract:CONTEXT:Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority group patients. OBJECTIVE:To determine if there are racial differenc...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:With the increasing use of colonoscopy there is growing concern about the quality of these procedures. OBJECTIVE:To evaluate the rates of complete colonic evaluation after an incomplete colonoscopy and their associated factors. METHODS:Men and women > or =50 years old living in Ontario on January 1, 1997 w...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31817d92bc
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health s...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000693
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Several organizations are advocating for patients' preferences to be considered in clinical practice guideline development and implementation. However, lack of agreement on the goal and meaning of this policy curtails evaluation and development of patient involvement programs. GOAL:To describe guideline dev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a81158
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVES:The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting. METHODS:The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachuset...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199803000-00012
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and co...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001228
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVES:Patient perceptions are increasingly used to measure quality of care in a diversity of health-care delivery settings. The goals of this article are to review the current use of patient perceptions and to review what is known about the sensitivity of patient perceptions for discerning variations in care acros...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199711001-00007
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:Multiple claims-based proxy measures of poor function have been developed to address confounding in observational studies of drug effects in older adults. We evaluated agreement between these measures and their associations with treatment receipt and mortality in a cohort of older colon cancer patients. MET...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001073
更新日期:2019-04-01 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:BACKGROUND:Except in cardiac surgery, measuring quality with procedure-specific mortality rates is unreliable because of small sample sizes at individual hospitals. Statistical power can be improved by combining mortality data from multiple operations. We sought to determine whether this approach would still be useful ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215898.33228.c7
更新日期:2006-08-01 00:00:00
abstract::An expository account of multiple time series analysis is presented. Modeling several related time series together makes it possible to ascertain dynamic leading, lagging, and feedback relationships among the series; to produce more efficient forecasts and, in some situations; to develop control schemes. Procedures fo...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1993-05-01 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:BACKGROUND:Personal health records offer patients access to view their own health information and to manage their care online through secure patient portal tools. Little is known about the patient-reported experience in using health portals to manage chronic conditions. OBJECTIVE:In a patient-centered research study, ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001178
更新日期:2019-10-01 00:00:00
abstract::The federal Omnibus Budget Reconciliation Act of 1981 (OBRA) produced substantial changes in the Aid to Families With Dependent Children (AFDC) program. The main effect of the changes has been the denial of assistance and hence Medicaid coverage to many AFDC recipients with jobs. Our analysis of the health care and in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198705000-00005
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVES:To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs). RESEARCH DESIGN:Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist s...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000311
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:This study was the first of its kind to evaluate and compare the quality of private and public community health centers (CHCs) in urban China. METHODS:A total of 2501 CHCs in 35 cities were chosen in 2011 using a multistage sampling method, and data on human resources, medical equipment and drug inventory w...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000414
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:To assess the likely effects of the 1996 Health Insurance Portability and Accessibility Act (HIPAA), based on small firms' experiences under state small group insurance reforms that were similar in design to HIPAA. METHODS:Data on 17,818 small businesses (range, 2-50 employees) nationwide from the 1994 Nati...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199907000-00009
更新日期:1999-07-01 00:00:00
abstract::This study was initiated to determine the extent of hospital capacity reduction in large U.S. cities. In addition, hospital bed and service additions were analyzed. Study data indicate that between 1976 and 1978 more than 5,000 beds were closed in the 36 cities surveyed. This constitutes 2.7% of total hospital beds in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198007000-00004
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations. MATERIALS AND METHODS:We used the 2002 National Survey of America's Families to analyze out-of-pocket health spending. P...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000199692.78295.7c
更新日期:2006-03-01 00:00:00
abstract::A combined optimization-simulation model is used to examine the extent of productivity and economic benefits to be gained from adding a physician's assistant to a one-physician ambulatory health care practice. It is shown that previous models (which have predicted productivity gains as large as 90 per cent) have overs...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197906000-00004
更新日期:1979-06-01 00:00:00
abstract::This article reports on a study of the labor efficiency of 461 nursing homes located in Pennsylvania. Data envelopment analysis was used to estimate efficiency scores. Tobit equations were estimated for the entire sample and for subsamples consisting of for-profit (FP) and not-for-profit (NFP) nursing homes. The autho...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199510000-00003
更新日期:1995-10-01 00:00:00
abstract::The management information system (FP/MIS) used by the Howard University Center for Family Planning Services, which operates community family planning clinics in Washington, D.C. is described. The system was developed to satisfy program objectives in patient management, program planning and evaluation, resource manage...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1977-05-01 00:00:00
abstract:OBJECTIVE:To compare primary care and traditional Internal Medicine residents in their adherence to preventive medicine guidelines, performance in the management of chronic diseases, and utilization of resources. DESIGN:Prospective cohort study. SETTING:Urban Internal Medicine residency program. PARTICIPANTS:Sixteen...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199908000-00007
更新日期:1999-08-01 00:00:00