Comorbidity-adjusted complication risk: a new outcome quality measure.

Abstract:

:The measurement of inpatient complications his received substantial attention in recent years because mortality rates and other outcome measures often appear unable to discriminate superior from inferior hospital care. Complication measurement holds out the promise of being more sensitive to variations in patient care because complications occur more frequently than do mortalities, and because complications are more direct consequences of the process of care. The authors developed a new measure of complications that seeks to give insight into the patient care given by different hospitals or physicians by using commonly available data. Specifically, this measure is based on a decision-theoretic model that estimates the probability of a complication for combinations of admitting and secondary International Classification of Diseases, 9th Revision, Clinical Modification diagnoses. The measure can be evaluated at the patient level, or aggregated and risk-adjusted for the population of a given care provider (eg, physician or hospital). When applied to a set of patient-level UB- 82/92 data, this measure estimates the risk of complication for any member of a population, controlling for comorbidity, and hence is designated comorbidity-adjusted complication risk (CACR). The authors describe the development of CACR and its testing and validation using data acquired from the states of Pennsylvania, California, and Florida, as well as facility data obtained directly from hospitals. The data set includes 480,000 patients from 50 Pennsylvania hospitals, 300,000 patients from 33 Florida hospitals, 370,000 patients from 35 California hospitals, and 37,000 patients from six validation hospitals. Comorbidity-adjusted complication risk is constructed from widely available data common to most patient cases. Comorbidity-adjusted complication risk can be adjusted for its case mix, but such risk adjustment has much less effect on CACR than on other adverse outcomes such as mortality and morbidity. Comorbidity-adjusted complication risk varies widely across the hospitals in this sample, yet it is stable across time and is correlated with other known quality outcomes, including such accepted "gold standards" as hospital-documented adverse event rates and chart review determinations of complications.

journal_name

Med Care

journal_title

Medical care

authors

Brailer DJ,Kroch E,Pauly MV,Huang J

doi

10.1097/00005650-199605000-00010

subject

Has Abstract

pub_date

1996-05-01 00:00:00

pages

490-505

issue

5

eissn

0025-7079

issn

1537-1948

journal_volume

34

pub_type

杂志文章
  • Is there an association between quality of in-hospital cardiac care and proportion of low-income patients?

    abstract:BACKGROUND:Process measures have been developed and implemented to evaluate the quality of care patients receive in the hospital. This study examines whether there is an association between the quality of in-hospital cardiac care and a hospital's proportion of low-income patients. METHODS AND RESULTS:A retrospective a...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MLR.0b013e3181c161ba

    authors: Culler SD,Schieb L,Casper M,Nwaise I,Yoon PW

    更新日期:2010-03-01 00:00:00

  • Will Veterans Answer Sexual Orientation and Gender Identity Questions?

    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

    authors: Ruben MA,Blosnich JR,Dichter ME,Luscri L,Shipherd JC

    更新日期:2017-09-01 00:00:00

  • Practice mobility among young physicians.

    abstract::This study examines practice mobility among young physicians, based on a large nationwide 1987 survey of physicians under age 40 years and in their second through fifth years of practice. Averaged across all physicians, there is a 10% to 12% chance of changing practices for each of the first 3 years, and about one in ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199110000-00004

    authors: Willke RJ

    更新日期:1991-10-01 00:00:00

  • Validly interpreting patients' reports: using bifactor and multidimensional models to determine whether surveys and scales measure one or more constructs.

    abstract:INTRODUCTION:Validly interpreting scores based on patients' reports of their experiences using scales depends on a valid scoring system. The possibility exists that, although the creators of a scale intended to create a scale measuring a single construct, the questions may seem to measure more than one construct. Howev...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318266519e

    authors: Carle AC,Weech-Maldonado R

    更新日期:2012-09-01 00:00:00

  • Pediatric nurse practitioner functions in the outpatient clinics of a tertiary care center.

    abstract::Previous research has neglected to delineate pediatric nurse practitioner (PNP) roles in tertiary care settings (TCS). New PNP roles have developed as TCS seek cost-effective solutions to providing quality patient care and to meeting new demands for outpatient care. The authors evaluated the roles of 11 PNPs in eight ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198604000-00005

    authors: Cruikshank BM,Clow TJ,Seals B

    更新日期:1986-04-01 00:00:00

  • Health Care Experiences of Latino Children in Emerging and Traditional Destinations.

    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

    authors: Saloner B,Gresenz CR

    更新日期:2016-05-01 00:00:00

  • Long-term impact of Medicare managed care on patients treated for coronary artery disease.

    abstract:BACKGROUND:Planned health insurance reform promises and has started to cut reimbursement to Medicare managed care (MMC) plans. If such plans provide better care, adjusting for possible better health of their enrollees, then such reimbursement changes may have unforeseen quality consequences. OBJECTIVES:To examine whet...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182294a20

    authors: Huesch MD

    更新日期:2012-01-01 00:00:00

  • Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders: Experience of the Department of Veterans Affairs Evidence Synthesis Program.

    abstract:BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by syst...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001158

    authors: Wilt TJ,Greer N,Duan-Porter W

    更新日期:2019-10-01 00:00:00

  • The application of official policy. Prophylaxis recommendations for patients with mitral valve prolapse.

    abstract::In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Retchin SM,Fletcher RH,Buescher PC,Waugh RA,Battaglini SW

    更新日期:1985-10-01 00:00:00

  • Application of an analytic model to early readmission rates within the Department of Veterans Affairs.

    abstract:OBJECTIVES:Adverse outcome rates are increasingly used as yardsticks for the quality of hospital care. However, the validity of many outcome studies has been undermined by the application of one outcome to all patients in large, diagnostically diverse populations, many of which lack evidence of a link between anteceden...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199708000-00003

    authors: Wray NP,Peterson NJ,Souchek J,Ashton CM,Hollingsworth JC

    更新日期:1997-08-01 00:00:00

  • Healthcare disparities for American Indian veterans in the United States: a population-based study.

    abstract:OBJECTIVE:To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS:We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 an...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181d5f9e1

    authors: Johnson PJ,Carlson KF,Hearst MO

    更新日期:2010-06-01 00:00:00

  • Beyond health plans: behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries.

    abstract:BACKGROUND:Most health insurance plans monitor ambulatory care quality using the Healthcare Effectiveness Data and Information Set (HEDIS), publicly reporting results at the plan level. Plan-level comparisons obscure the influence of patients served or settings where care is delivered. Mental illness, substance abuse, ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318190db45

    authors: Clark RE,Weir S,Ouellette RA,Zhang J,Baxter JD

    更新日期:2009-05-01 00:00:00

  • Disproportionate share hospital subsidies for treating the uninsured.

    abstract:BACKGROUND:Federal, state, and local governments provide substantial subsidies to so-called "safety-net" hospitals, in part, to offset the loss in revenue associated with providing a disproportionate share (DSH) of care to low-income and uninsured patients, with the goal to improve access to care for uninsured and ensu...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181e3572c

    authors: Fonkych K,Melnick G

    更新日期:2010-09-01 00:00:00

  • Evaluating long-term care demonstrations in real time with study design and plan performance interactions.

    abstract::The evaluation of long-term care demonstrations has to deal with complex organizational entities, with large, heterogeneous client populations that, during the course of study, may have to change features of their organization or operation. The implications of such "real-time" changes are discussed for analyses of the...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199512000-00004

    authors: Manton KG,Newcomer R,Lowrimore GR,Vertrees JC,Harrington C

    更新日期:1995-12-01 00:00:00

  • Management, cost, and quality of acute inpatient psychiatric services.

    abstract::A common objective of health services is to provide high quality care at the least cost, yet some services achieve these objectives better than others. Moreover, there are questions about relationships between cost and quality: do higher expenditures usually result in higher quality, or, conversely, is it possible to ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198309000-00007

    authors: Schulz RI,Greenley JR,Peterson RW

    更新日期:1983-09-01 00:00:00

  • Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.

    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:

    authors: Horner RD,Oddone EZ,Stechuchak KM,Grambow SC,Gray J,Khuri SF,Henderson WG,Daley J

    更新日期:2002-01-01 00:00:00

  • The Self-Adapting Focused Review System. Probability sampling of medical records to monitor utilization and quality of care.

    abstract::Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Ash A,Schwartz M,Payne SM,Restuccia JD

    更新日期:1990-11-01 00:00:00

  • Health perceptions of primary care patients and the influence on health care utilization.

    abstract::This prospective study was conducted to determine the influence of primary care patients' health perceptions on their utilization of health care services. Patients' health perceptions were measured using the RAND Corporation's General Health Perceptions Questionnaire. Physicians provided scores of how they thought the...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198903001-00009

    authors: Connelly JE,Philbrick JT,Smith GR Jr,Kaiser DL,Wymer A

    更新日期:1989-03-01 00:00:00

  • Statistical methods and strategies for working with large data bases.

    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

    authors: Marshall G,Henderson WG,Moritz TE,Shroyer AL,Grover FL,Hammermeister KE

    更新日期:1995-10-01 00:00:00

  • The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals: Barriers, Facilitators, and Opportunities.

    abstract:BACKGROUND:Minority breast cancer patients tend to have higher rates of adjuvant treatment underuse. We implemented a web-based intervention that closes referral loops between surgeons and oncologists at inner-city safety-net hospitals serving high volumes of minority breast cancer patients to assist these hospitals an...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MLR.0000000000000458

    authors: McAlearney AS,Murray K,Sieck C,Lin JJ,Bellacera B,Bickell NA

    更新日期:2016-02-01 00:00:00

  • Access to inpatient or residential substance abuse treatment among homeless adults with alcohol or other drug use disorders.

    abstract:OBJECTIVES:We conducted a theoretically guided study of access to inpatient or residential treatment among a probability sample of homeless adults with alcohol or drug use disorders in Houston, Texas. METHODS:This study used a cross-sectional, retrospective design with data collected from a multistage random sample of...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200111000-00003

    authors: Wenzel SL,Audrey Burnam M,Koegel P,Morton SC,Miu A,Jinnett KJ,Greer Sullivan J

    更新日期:2001-11-01 00:00:00

  • Nonelective Rehospitalizations and Postdischarge Mortality: Predictive Models Suitable for Use in Real Time.

    abstract:BACKGROUND:Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE:To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN:Retrospective cohort study using split va...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000435

    authors: Escobar GJ,Ragins A,Scheirer P,Liu V,Robles J,Kipnis P

    更新日期:2015-11-01 00:00:00

  • Comparison of use of outpatient mental health services in an HMO and fee-for-service plans. Sensitivity to definition of a visit.

    abstract::Whereas previous authors have used a variety of strategies to identify use of mental health services, the sensitivity of estimates to the definition of a visit has been little studied. The authors examined the sensitivity of estimates of use of outpatient mental health services in both HMO and fee-for-service plans to...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Wells KB,Manning WG Jr,Benjamin B

    更新日期:1987-09-01 00:00:00

  • Promoting access and reducing expected out-of-pocket prescription drug costs for vulnerable Medicare beneficiaries: a pharmacist-directed model.

    abstract:BACKGROUND:The Medicare Part D benefit is complicated and may be costly, especially for vulnerable low-income populations where lack of resources and limited English proficiency may be barriers to optimal plan selection. OBJECTIVES:To identify vulnerable Medicare beneficiaries and lower their expected annual out-of-po...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318202a9f2

    authors: Cutler TW,Stebbins MR,Smith AR,Patel RA,Lipton HL

    更新日期:2011-04-01 00:00:00

  • Lowering generic drug prices: less regulation equals more competition.

    abstract:BACKGROUND:In Ontario, Canada, the 70/90 regulations were instituted in May 1993 to establish provincial government procurement prices for generic drugs. Accordingly, the first generic entrant's price could not exceed 70% of the incumbent's branded price. Subsequent entrants' prices could not exceed 90% of the first en...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200301000-00015

    authors: Anis AH,Guh DP,Woolcott J

    更新日期:2003-01-01 00:00:00

  • Inter-area variations in age-adjusted health status.

    abstract::Data from the 1980 to 1981 National Health Interview Survey on morbidity, principally bed-disability days, was age standardized and indexed by region of the United States and metropolitan and nonmetropolitan residence within region. There were substantial differences in both age-specific and age-adjusted morbidity by ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198704000-00007

    authors: Blumberg MS

    更新日期:1987-04-01 00:00:00

  • The accuracy of administrative data for identifying the presence and timing of admission to intensive care units in a Canadian province.

    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

    authors: Garland A,Yogendran M,Olafson K,Scales DC,McGowan KL,Fransoo R

    更新日期:2012-03-01 00:00:00

  • The effects of payment method on clinical decision-making: physician responses to clinical scenarios.

    abstract:BACKGROUND:The influence of payment mechanisms on physician decisions is not well understood. OBJECTIVES:The objective of this study was to test 2 null hypotheses: 1) physicians' clinical decisions would not be influenced by payment incentives; and 2) physicians would have equal concern about medical decisions made un...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000114918.50088.1c

    authors: Shen J,Andersen R,Brook R,Kominski G,Albert PS,Wenger N

    更新日期:2004-03-01 00:00:00

  • Beyond the uninsured: problems in access to care.

    abstract::This paper investigates the difficulties that people encounter in their attempt to obtain needed health services, other than their third-party coverage or lack of it. These problems can be temporal, geographic, attitudinal, or financial (even with insurance). A state-wide sample survey conducted in 1989 revealed that ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199405000-00001

    authors: Bashshur RL,Homan RK,Smith DG

    更新日期:1994-05-01 00:00:00

  • Waiting for care. Queuing and resource allocation.

    abstract::Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days f...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198702000-00006

    authors: Bloom BS,Fendrick AM

    更新日期:1987-02-01 00:00:00