Abstract:
OBJECTIVE:To develop and validate a disease-specific automated inpatient mortality risk adjustment system primarily using computerized numerical laboratory data and supplementing them with administrative data. To assess the values of additional manually abstracted data. METHODS:Using 1,271,663 discharges in 2000-2001, we derived 39 disease-specific automated clinical models with demographics, laboratory findings on admission, ICD-9 principal diagnosis subgroups, and secondary diagnosis-based chronic conditions. We then added manually abstracted clinical data to the automated clinical models (manual clinical models). We compared model discrimination, calibration, and relative contribution of each group of variables. We validated these 39 models using 1,178,561 discharges in 2004-2005. RESULTS:The overall mortality was 4.6 percent (n = 58,300) and 4.0 percent (n = 47,279) for derivation and validation cohorts, respectively. Common mortality predictors included age, albumin, blood urea nitrogen or creatinine, arterial pH, white blood counts, glucose, sodium, hemoglobin, and metastatic cancer. The average c-statistic for the automated clinical models was 0.83. Adding manually abstracted variables increased the average c-statistic to 0.85 with better calibration. Laboratory results displayed the highest relative contribution in predicting mortality. CONCLUSIONS:A small number of numerical laboratory results and administrative data provided excellent risk adjustment for inpatient mortality for a wide range of clinical conditions.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Tabak YP,Sun X,Derby KG,Kurtz SG,Johannes RSdoi
10.1111/j.1475-6773.2010.01126.xsubject
Has Abstractpub_date
2010-12-01 00:00:00pages
1815-35issue
6 Pt 1eissn
0017-9124issn
1475-6773pii
HESR1126journal_volume
45pub_type
杂志文章abstract:OBJECTIVE:To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics. DATA SOURCES:Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments. STUDY DESIGN:Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12344
更新日期:2016-04-01 00:00:00
abstract::In the recent past, a great deal of faith has been placed in the idea that the performance of the hospital industry could be improved significantly by relying more heavily on profit incentives. This article considers the effect of profit incentives on hospital behavior and finds that the existence of profit incentives...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1985-06-01 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:OBJECTIVE:To evaluate the effect of partisan political control on financial performance, structure, and outcomes of for-profit and not-for-profit US nursing homes. DATA SOURCES/STUDY SETTING:Nineteen-year panel (1996-2014) of state election outcomes, financial performance data from nursing home cost reports, operation...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13061
更新日期:2019-02-01 00:00:00
abstract::The concepts of class, race, and ethnicity figure prominently in health services research in Britain. Occupational class has been employed for nearly a century to investigate social inequalities in health and access to care. More recently, researchers have identified differences in health status and utilization betwee...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVES:To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. DATA SOURCES/STUDY SETTING:Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eig...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00622.x
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To determine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes. DATA SOURCE:The Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The PSID provides extensive data on the income and well-being of a representative sa...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01115.x
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVES:(1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utiliz...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-02-01 00:00:00
abstract::Alternative delivery systems, such as HMOs, PPOs, and primary care case-management programs, have a long history in rural America despite significant impediments to their development. However, little is known about the effect of these systems on rural communities and their medical care delivery systems. Existing studi...
journal_title:Health services research
pub_type: 历史文章,杂志文章,评审
doi:
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To measure the effects of race/ethnicity, area measures of socioeconomic status (SES) and geographic residency status, and health care supply (HCS) characteristics on breast cancer (BC)-related outcomes. DATA SOURCES/STUDY SETTING:Female patients in Georgia diagnosed with BC in the years 2000-2009. STUDY DE...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12096
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on qual...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12035
更新日期:2013-08-01 00:00:00
abstract:RESEARCH OBJECTIVE:To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). DATA SOURCES:Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. STUDY DES...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00795.x
更新日期:2007-12-01 00:00:00
abstract::This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using m...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1992-04-01 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:To determine whether assigning a dedicated general practitioner (GP) to a nursing home reduces hospitalizations and readmissions. DATA SOURCES/STUDY SETTING:Secondary data on hospitalizations and deaths by month for the universe of nursing home residents in Denmark from January 2011 through February 2014. S...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13112
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:Our intention is to determine newborn costs and lengths of stay attributable to prenatal exposure to cocaine and other illicit drugs. DATA SOURCES AND STUDY SETTING:All parturients who delivered at a large municipal hospital in New York City between November 18, 1991 and April 11, 1992. STUDY DESIGN:A cross...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1995-06-01 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 understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiari...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01279.x
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994). DATA SOURCES/STUDY SETTING:State of Mar...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:To test the effectiveness of financial incentives for smoking cessation in the Medicaid population. DATA SOURCES:Secondary data from the Medicaid Incentives for Prevention of Chronic Disease (MIPCD) program and Medicaid claims/encounter data from 2010 to 2015 for five states. STUDY DESIGN:Beneficiaries were...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12994
更新日期:2018-12-01 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 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
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journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12312
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES:Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Ass...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12032
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. STUDY SETTING:Forty-five adult, medical-surgical units in nine hospitals in upstate New York. STUDY DESIGN:Cross-sectional study. DATA COLLECTION:Surveys were collected from 1,527 unit-based hospit...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01438.x
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:To test how Certificate of Need laws affect all-cause mortality in the United States. DATA SOURCES:The data of 1992-2011 all-cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance Syste...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12619
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To examine the effect of worker heterogeneity, firm size, and establishment size on the breadth of employer health insurance offerings. DATA SOURCES:The data were drawn from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey of 22,000 business establishments selected randomly from ten s...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments. DATA SOURCES:Chart abstraction on initial therapy received by 868 wom...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12269
更新日期:2015-08-01 00:00:00
abstract::Mr. Zamberlan is one of seven major executives in the Department of Veterans Affairs (VA) Veterans Health Services and Research Administration (VHS&RA), directing health care in a five-state region that includes 21 medical centers, 7 outpatient clinics, and 19 veterans outreach centers. As a medical center director in...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States. DATA SOURCES/STUDY SETTING:Data come from the 2012 National Survey of Substance Abuse Treatment Services. STUDY DESIGN/DATA COLLECTION:We used lo...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12686
更新日期:2018-02-01 00:00:00