Abstract：
:Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. Actual numbers of adverse events were observed for each hospital and compared to the number predicted by the RAMI, RARI, and RACI models. Then each hospital was ranked on each index. Our results showed that no relationship existed between a hospital's ranking on any one of these indexes and its ranking on the other two indexes. This result provides some evidence that no measure of quality should be used by itself to represent different aspects of the quality of hospital care. Adequate overall measures of hospital quality will need to include multiple measures in order to be credible and to reflect the complexity of hospital care. The findings suggest that consumers, payers, and policymakers cannot simply choose one hospitalwide measure, such as the mortality rate, to validly represent a hospital's performance: those hospitals with high rankings on their mortality rates do not necessarily rank high on their readmission rates or complication rates.
journal_name
Health Serv Resjournal_title
Health services researchauthors
DesHarnais S,McMahon LF Jr,Wroblewski Rsubject
Has Abstractpub_date
1991-10-01 00:00:00pages
425-45issue
4eissn
0017-9124issn
1475-6773journal_volume
26pub_type
杂志文章abstract：OBJECTIVES:To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). STUDY DES...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12739
更新日期：2017-12-01 00:00:00
abstract：:All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale ...
journal_title：Health services research
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1992-02-01 00:00:00
abstract：OBJECTIVE:To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12171a
更新日期：2014-08-01 00:00:00
abstract：OBJECTIVE:To test the accuracy of various physicians' participation in Medicaid models. DATA SOURCES/STUDY SETTING:Primary data on 221 obstetricians and gynecologists in the Chicago area by telephone interviews over a four-month period. These data were combined with secondary data from the American Medical Association...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1997-08-01 00:00:00
abstract：OBJECTIVE:An ecological framework is proposed for assessing factors important to consider in allocating funds to promote sound performance of interorganizational programs. DATA SOURCE/STUDY SETTING:This framework is used to examine the first generation of Community Clinical Oncology Programs (CCOPs) funded by the Nati...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-04-01 00:00:00
abstract：:Using a sample of 3,000 urban hospitals, this article examines the contributions of selected hospital characteristics to variations in hospital technical efficiencies, while it accounts for multiple products and inputs, and controls for local environmental variations. Four hospital characteristics are examined: hospit...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-02-01 00:00:00
abstract：OBJECTIVE:To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays. DATA SOURCES:Online Survey of Certification and Reportin...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01194.x
更新日期：2011-02-01 00:00:00
abstract：OBJECTIVE:This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING:A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service ar...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：OBJECTIVE:This article tests whether or not the factors that affect hospital choice differ for selected subgroups of the population. DATA SOURCES:1985 California Office of Statewide Health Planning and Development (OSHPD) discharge abstracts and hospital financial data were used. STUDY DESIGN:Models for hospital choi...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-06-01 00:00:00
abstract：OBJECTIVE:To assess the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. STUDY SETTING:A total of 219 small primary care p...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13571
更新日期：2020-12-01 00:00:00
abstract：OBJECTIVE:To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, des...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-04-01 00:00:00
abstract：OBJECTIVES:To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. DATA SOURCES:Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2008.00929.x
更新日期：2009-04-01 00:00:00
abstract：OBJECTIVE:Our research compares health care use by Medicaid beneficiaries with that of the uninsured and the privately insured to measure the program's effect on access to care. DATA SOURCES/STUDY SETTING:Data include the 1987 National Medical Expenditure Survey and the Survey of Income and Program Participation for 1...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1996-02-01 00:00:00
abstract：OBJECTIVE:To determine whether Massachusetts Health Reform improved health outcomes in uninsured patients with hyperlipidemia, diabetes, or hypertension. DATA SOURCE:Partners HealthCare Research Patient Data Registry (RPDR). STUDY DESIGN:We examined 1,463 patients with hyperlipidemia, diabetes, or hypertension who we...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12196
更新日期：2014-12-01 00:00:00
abstract：:A model is described that predicts hospital census and computes, for each day, the number of elective admissions that will maximize the census over the short run, subject to constraints on the probability of overflow. Where a computer is available the model provides detailed predictions of census in units as small as ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1977-01-01 00:00:00
abstract：OBJECTIVE:To assess the extent and consistency of geographic differences in the use of post-acute care (PAC), and the stability of this pattern of variation. DATA SOURCES:The 5 percent Medicare data sample for 1996, 1997, and the first eight months of 1998 were used. STUDY DESIGN:Patterns of PAC use for various Diagn...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.00043
更新日期：2002-06-01 00:00:00
abstract：OBJECTIVE:To examine the impact of the Short Stay Transfer Policy (SSTP) on practice patterns. DATA SOURCES:This study uses data from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review (MEDPAR) file, Home Health Standard Analytical File, 1999 Provider of Service file, and data from th...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00606.x
更新日期：2007-02-01 00:00:00
abstract：OBJECTIVES:To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons. DATA SOURCES/STUDY SETTING:County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12680
更新日期：2018-04-01 00:00:00
abstract：OBJECTIVE:To determine if the incidence of psychiatric emergencies involving drugs or alcohol supports the argument that mentally ill persons contribute to elevated mortality during the days following disbursement of private earnings and public income transfers. STUDY DESIGN:Interrupted time-series using Box-Jenkins m...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-10-01 00:00:00
abstract：:Limited information exists concerning lifetime use of nursing home services by the aged. This article examines the longitudinal experience, over four years, of elderly individuals at high risk of institutionalization, and develops a simple model of nursing home use based on these observations. This model allows us to ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1986-06-01 00:00:00
abstract：OBJECTIVE:To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES:A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN:HC patients were defined as those wit...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12178
更新日期：2014-10-01 00:00:00
abstract：OBJECTIVE:Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedb...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12240
更新日期：2015-04-01 00:00:00
abstract：:The axioms of utility theory are restated in terms of health outcomes, and some additional assumptions, consistent with the assumptions implicit in health status index models, are adduced to develop a consistent theory of the utility of health states. On the basis of the axioms and specific assumptions, techniques for...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1976-01-01 00:00:00
abstract：OBJECTIVE:The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight othe...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12444
更新日期：2016-08-01 00:00:00
abstract：OBJECTIVE:Examine the endogenous relationship between uncompensated care and hospital patient experience scores. DATA SOURCES/STUDY SETTING:The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, CMS Healthcare Cost Report Information System, and the US Census Bureau. STUDY DESIGN:The exogenous c...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13111
更新日期：2019-06-01 00:00:00
abstract：OBJECTIVE:To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. DATA SOURCE/STUDY SETTING:Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. STUDY DESI...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00328.x
更新日期：2004-12-01 00:00:00
abstract：OBJECTIVE:To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life-a group that accounts for more than one-quarter of Medicare's annual exp...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00218.x
更新日期：2004-02-01 00:00:00
abstract：:This paper addresses two questions: (1) Does adjusting for case mix have any effect on prospective admission-based reimbursement? and (2) How does the way in which case type is defined (DRG, ICD9CM, Age, etc) affect reimbursement systems? Data from 20 Maryland hospitals provided the basis for analysis, and the results...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1983-07-01 00:00:00
abstract：:This article examines factors related to hospital closures, using a longitudinal sample of surviving and closed hospitals. The hospitals are drawn from three states with different regulatory programs. Size of hospital and occupancy rate are shown to be related to likelihood of closure, while ownership, length of stay,...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1983-01-01 00:00:00
abstract：OBJECTIVE:To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months. DATA SOURCES/STUDY SETTING:Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary ca...
journal_title：Health services research
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1111/1475-6773.01086
更新日期：2002-10-01 00:00:00
