Abstract:
RESEARCH OBJECTIVE:Pharmacists are an expensive and limited resource in the hospital and outpatient setting. A pharmacist can spend up to 25% of their day planning. Time spent planning is time not spent delivering an intervention. A readmission risk adjustment model has potential to be used as a universal outcome-based prioritization tool to help pharmacists plan their interventions more efficiently. Pharmacy-specific predictors have not been used in the constructs of current readmission risk models. We assessed the impact of adding pharmacy-specific predictors on performance of readmission risk prediction models. STUDY DESIGN:We used an observational retrospective cohort study design to assess whether pharmacy-specific predictors such as an aggregate pharmacy score and drug classes would improve the prediction of 30-day readmission. A model of age, sex, length of stay, and admission category predictors was used as the reference model. We added predictor variables in sequential models to evaluate the incremental effect of additional predictors on the performance of the reference. We used logistic regression to regress the outcomes on predictors in our derivation dataset. We derived and internally validated our models through a 50:50 split validation of our dataset. POPULATION STUDIED:Our study population (n=350,810) was of adult admissions at hospitals in a large integrated health care delivery system. PRINCIPAL FINDINGS:Individually, the aggregate pharmacy score and drug classes caused a nearly identical but moderate increase in model performance over the reference. As a single predictor, the comorbidity burden score caused the greatest increase in model performance when added to the reference. Adding the severity of illness score, comorbidity burden score and the aggregate pharmacy score to the reference caused a cumulative increase in model performance with good discrimination (c statistic, 0.712; Nagelkerke R, 0.112). The best performing model included all predictors: severity of illness score, comorbidity burden score, aggregate pharmacy score, diagnosis groupings, and drug subgroups. CONCLUSIONS:Adding the aggregate pharmacy score to the reference model significantly increased the c statistic but was out-performed by the comorbidity burden score model in predicting readmission. The need for a universal prioritization tool for pharmacists may therefore be potentially met with the comorbidity burden score model. However, the aggregate pharmacy score and drug class models still out-performed current Medicare readmission risk adjustment models. IMPLICATIONS FOR POLICY OR PRACTICE:Pharmacists have a great role in preventing readmission, and therefore can potentially use one of our models: comorbidity burden score model, aggregate pharmacy score model, drug class model or complex model (a combination of all 5 major predictors) to prioritize their interventions while exceeding Medicare performance measures on readmission. The choice of model to use should be based on the availability of these predictors in the health care system.
journal_name
Med Carejournal_title
Medical careauthors
Kabue S,Greene J,Kipnis P,Lawson B,Rinetti-Vargas G,Liu V,Escobar Gdoi
10.1097/MLR.0000000000001075subject
Has Abstractpub_date
2019-04-01 00:00:00pages
295-299issue
4eissn
0025-7079issn
1537-1948journal_volume
57pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND:The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of se...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000744
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:To assess the effects on overall self-rated health of the broad range of symptoms and impairments that are routinely asked about in national surveys. DATA:We use data from adults in the nationally representative Medical Expenditure Panel Survey (MEPS) 2002 with validation in an independent sample from MEPS 2...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318179199f
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVES:This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS:A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk ad...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000065127.88685.7D
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:Accurate estimation of medical care costs raises a host of issues, both practical and methodological. OBJECTIVES:This article reviews methods for estimating the long-term medical care costs associated with a cancer diagnosis. METHODS:The authors consider data from administrative claims databases and descri...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS:The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the E...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000132397.49094.b3
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVES:Veterans Health Administration encourages auricular acupuncture (Battlefield Acupuncture/BFA) as a nonpharmacologic approach to pain management. Qualitative reports highlighted a "gateway hypothesis": providing BFA can lead to additional nonpharmacologic treatments. This analysis examines subsequent use of t...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001367
更新日期:2020-09-01 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:OBJECTIVES:Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000379
更新日期:2015-07-01 00:00:00
abstract::In 1961, Group Health Association, a large, non-hospital based, prepaid group practice in Washington, D.C. established an after-hours walk-in clinic on its premises for the care of medical problems requiring prompt attention. Within a year, this clinic's operation was extended to daytime hours for the use of the consu...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197805000-00001
更新日期:1978-05-01 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::Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying ou...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVES:Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT. RESEARCH DESIGN:We undertook a cross-sectional analysis of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000241089.98461.e5
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine the dimensions of physician work satisfaction across a variety of medical specialties and practice settings. METHODS:A modified version of the Scheckler et al survey instrument was mailed to all physicians in Marion County, Indiana. Forty-two percent (777) of the eli...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199804000-00016
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Incomplete participation is of particular concern for surveys of patient perceptions of care because patients who have negative opinions may be least likely to participate. OBJECTIVE:We sought to examine indirect evidence of nonresponse bias. DESIGN:We re-analyzed data from a cross-sectional patient survey...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000156856.36901.40
更新日期:2005-04-01 00:00:00
abstract::While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO pro...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199109000-00011
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area. OBJECTIVES:The objective of this study was to assess how 3 common health shocks, acute myocardial in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001249
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001419
更新日期:2021-01-01 00:00:00
abstract::This article describes the statistical methods and strategies to be used in establishing the linkages between processes and structures of care with risk-adjusted outcomes in a large multicenter Veterans Affairs cooperative study in health services of patients undergoing cardiac surgery. The statistical analyses consis...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199510001-00005
更新日期:1995-10-01 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::Acceptance by target populations of new programs funded by government is a phenomenon which one should be able to explain with existing innovation theory. In a study of a newly formed group health practice, funded in part by OEO, it is found that a commonly used set of predictors has little utility in explaining indi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197904000-00008
更新日期:1979-04-01 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:Physician and patient gender both influence medical communication. Nonverbal behavior is generally under-researched in the medical encounter but plays an important role for patient outcomes such as satisfaction. OBJECTIVE:This article aims at identifying how specific physician nonverbal behaviors predict an...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31817e1877
更新日期:2008-12-01 00:00:00
abstract::Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmo...
journal_title:Medical care
pub_type: 临床试验,杂志文章
doi:
更新日期:1984-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the psychometric assumptions underlying the construction and scoring of SF-36 scales and summary measures among clinical trial participants with arthritis. METHODS:Cross-sectional SF-36 data from the baseline assessment of adult patients (n = 1,016) participating in four placebo-controlled clinic...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199905001-00002
更新日期:1999-05-01 00:00:00
abstract::In this article, we compared hospital efficiency using a multiple input-output approach in two ways: one way used a straightforward count of inpatient days and outpatient services as outputs; and the second used a case mix-adjusted count of inpatient services and outpatient care as outputs. Our results show that there...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199306000-00006
更新日期:1993-06-01 00:00:00
abstract::A randomized clinical trial was performed to assess whether the results of a depression screening instrument, when provided to physicians, could influence their recognition and treatment of depression in a primary care setting. The intervention consisted of randomly informing or not informing physicians of the depress...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199003000-00004
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. OBJECTIVE:To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred p...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200101000-00004
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Relative to traditional fee-for-service Medicare, managed care plans caring for Medicare beneficiaries may be better positioned to promote recommended services and discourage burdensome procedures with little clinical value at the end of life. OBJECTIVE:To compare end-of-life service use for enrollees in Me...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182a50278
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:The Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) 10, "Postoperative Physiologic and Metabolic Derangement" (PPMD), uses administrative data to detect postoperative acute kidney injury (AKI) requiring dialysis and diabetes-related complications. We sought to evaluate the indicator'...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31829c8b91
更新日期:2013-09-01 00:00:00
abstract::It has been suggested that the efficiency of claim-based utilization review systems could be improved by focusing on providers with very high utilization rates. This strategy assumes that 1) high utilizers are more likely to be overutilizers, 2) labeling claims (e.g., "high utilizer") do not bias the review, and 3) th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198305000-00001
更新日期:1983-05-01 00:00:00