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


: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.


Med Care


Medical care


Brailer DJ,Kroch E,Pauly MV,Huang J




Has Abstract


1996-05-01 00:00:00












  • Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

    abstract:OBJECTIVE:To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN:Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING:The Baltimore Epidemiologic Catchment Area (ECA)...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Cooper-Patrick L,Gallo JJ,Powe NR,Steinwachs DM,Eaton WW,Ford DE

    更新日期:1999-10-01 00:00:00

  • Influence of Peer Physicians on Intensity of End-of-Life Care for Cancer Decedents.

    abstract:BACKGROUND:The intensity of end-of-life care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers. OBJECTIVE:To assess whether intensity of end-of-life care previously provided by a physician's peers influences patterns of care at...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Keating NL,O'Malley AJ,Onnela JP,Gray SW,Landon BE

    更新日期:2019-06-01 00:00:00

  • Variation in the rate of cervical spine surgery in Washington State.

    abstract::Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluation of regional variation for the surgical treatment of neck pain. This report examines the geographic variati...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Einstadter D,Kent DL,Fihn SD,Deyo RA

    更新日期:1993-08-01 00:00:00

  • The impact of symptoms and impairments on overall health in US national health data.

    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


    authors: Stewart ST,Woodward RM,Rosen AB,Cutler DM

    更新日期:2008-09-01 00:00:00

  • Predicting inpatient costs with admitting clinical data.

    abstract::Hospital cost-containment programs should themselves be cost-effective, targeting high-cost physicians (which requires adjusting for case mix) and patients (which requires early identification). In this study, clinical data available within 24 hours of admission from an electronic medical record system were used to de...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Tierney WM,Fitzgerald JF,Miller ME,James MK,McDonald CJ

    更新日期:1995-01-01 00:00:00

  • Evaluation of a focused dental utilization review system.

    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


    authors: Bailit HL,Balzer JA,Clive J

    更新日期:1983-05-01 00:00:00

  • Impact of an Advanced Imaging Utilization Review Program on Downstream Health Care Utilization and Costs for Low Back Pain.

    abstract:BACKGROUND:Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. OBJECTIVES:To assess the impact of a state policy implemented in June 2010 that required prospect...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Graves JM,Fulton-Kehoe D,Jarvik JG,Franklin GM

    更新日期:2018-06-01 00:00:00

  • ICD Social Codes: An Underutilized Resource for Tracking Social Needs.

    abstract:BACKGROUND:Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classifica...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Torres JM,Lawlor J,Colvin JD,Sills MR,Bettenhausen JL,Davidson A,Cutler GJ,Hall M,Gottlieb LM

    更新日期:2017-09-01 00:00:00

  • Measurement of the validity of utility elicitations performed by computerized interview.

    abstract:OBJECTIVES:The authors evaluate a measure of the validity of utility elicitations and study the potential effects of invalid elicitations on population utility values. METHODS:The authors used a computerized survey to describe and measure preferences for three common side-effects of anti-psychotic drugs (tardive dyski...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Lenert LA,Morss S,Goldstein MK,Bergen MR,Faustman WO,Garber AM

    更新日期:1997-09-01 00:00:00

  • The estimation of a preference-based measure of health from the SF-12.

    abstract:BACKGROUND:The SF-12 is a multidimensional generic measure of health-related quality of life. It has become widely used in clinical trials and routine outcome assessment because of its brevity and psychometric performance, but it cannot be used in economic evaluation in its current form. OBJECTIVES:We sought to derive...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Brazier JE,Roberts J

    更新日期:2004-09-01 00:00:00

  • Higher Rates of Preventive Health Care With Commercial Insurance Compared With Medicaid: Findings From the Arkansas Health Care Independence "Private Option" Program.

    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


    authors: Goudie A,Martin B,Li C,Lewis K,Han X,Kathe N,Wilson JC,Thompson J

    更新日期:2020-02-01 00:00:00

  • Expanding the uses of AHRQ's prevention quality indicators: validity from the clinician perspective.

    abstract:BACKGROUND:The Agency for Healthcare Research and Quality's prevention quality indicators (PQIs) are used as a metric of area-level access to quality care. Recently, interest has expanded to using the measures at the level of payer or large physician groups, including public reporting or pay-for-performance programs. H...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Davies S,McDonald KM,Schmidt E,Schultz E,Geppert J,Romano PS

    更新日期:2011-08-01 00:00:00

  • A Comparison of Quality of Community Health Services Between Public and Private Community Health Centers in Urban China.

    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


    authors: Yin X,Gong Y,Yang C,Tu X,Liu W,Cao S,Yang H,Lu Z

    更新日期:2015-10-01 00:00:00

  • Insurance coverage and prenatal care among low-income pregnant women: an assessment of states' adoption of the "Unborn Child" option in Medicaid and CHIP.

    abstract:BACKGROUND:The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid. OBJECTIVES:To examine the association of the UC...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Jarlenski MP,Bennett WL,Barry CL,Bleich SN

    更新日期:2014-01-01 00:00:00

  • Mapping the SF-12 to preference-based instruments: convergent validity in a low-income, minority population.

    abstract:BACKGROUND:The profile-based SF-12 has a low respondent burden and is used widely in clinical settings to monitor health and evaluate programs. Deriving preference scores for the SF-12 health profile would permit its use in cost-effectiveness analyses. Previous mapping studies of SF family instruments to preference-bas...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Franks P,Lubetkin EI,Gold MR,Tancredi DJ

    更新日期:2003-11-01 00:00:00

  • Examining Women Veteran's Experiences, Perceptions, and Challenges With the Veterans Choice Program.

    abstract:BACKGROUND:The Veterans Choice Program (VCP) was launched in 2014 to address the growing concerns about the timeliness and quality of Veterans Health Administration (VHA) care. Given that many sex-specific health services, such as mammography and maternity care, are not routinely provided in all VHA facilities, women V...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Mattocks KM,Yano EM,Brown A,Casares J,Bastian L

    更新日期:2018-07-01 00:00:00

  • A national catalog of preference-based scores for chronic conditions in the United States.

    abstract:BACKGROUND:The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Sullivan PW,Lawrence WF,Ghushchyan V

    更新日期:2005-07-01 00:00:00

  • Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?

    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


    authors: Shen YC,McFeeters J

    更新日期:2006-03-01 00:00:00

  • Antipsychotic use in nursing homes varies by psychiatric consultant.

    abstract:BACKGROUND:The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown. OBJECTIVE:To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics. RESEARCH ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Tjia J,Field T,Lemay C,Mazor K,Pandolfi M,Spenard A,Ho SY,Kanaan A,Donovan J,Gurwitz JH,Briesacher B

    更新日期:2014-03-01 00:00:00

  • Measuring the necessity of medical procedures.

    abstract::This is a report on the extension of the concept of the appropriateness of a procedure to the necessity, or crucial importance, of that procedure. To state that a procedure is crucial means that withholding the procedure would be deleterious to the patient's health. Appropriateness and necessity ratings for six proced...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Kahan JP,Bernstein SJ,Leape LL,Hilborne LH,Park RE,Parker L,Kamberg CJ,Brook RH

    更新日期:1994-04-01 00:00:00

  • The Early Impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-Day Hospital Readmissions Among Adults With Diabetes.

    abstract:BACKGROUND:The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM's effect on 30-day readmissions among adults with diabetes remains unclear. METHODS:A quasi-exp...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Rodríguez HP,Fulton BD,Phillips AZ

    更新日期:2020-06-01 00:00:00

  • Office visit copayments: patient knowledge, response, and communication with providers.

    abstract:BACKGROUND:There is limited information on patients' knowledge about their cost-sharing requirements and how that influenced their care-seeking behavior. OBJECTIVE:To examine patients' knowledge of their office visit copayments, their self-reported responses to perceived and actual copayments, and discussions with phy...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Benedetti NJ,Fung V,Reed M,Price M,Brand R,Newhouse JP,Hsu J

    更新日期:2008-04-01 00:00:00

  • Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays.

    abstract:BACKGROUND:Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Glance LG,Osler T,Li Y,Lustik SJ,Eaton MP,Dutton RP,Dick AW

    更新日期:2016-06-01 00:00:00

  • Intensive Outpatient Program Effects on High-need Patients' Access, Continuity, Coordination, and Engagement.

    abstract:OBJECTIVE:The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patient...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Wu FM,Slightam CA,Wong AC,Asch SM,Zulman DM

    更新日期:2018-01-01 00:00:00

  • Using medical records for older patient education in ambulatory practice.

    abstract::The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week afte...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Bronson DL,Costanza MC,Tufo HM

    更新日期:1986-04-01 00:00:00

  • Health care utilization and costs in a Medicare population by fall status.

    abstract:OBJECTIVES:The economic impact of trauma in older persons is a matter of increasing concern to public health practitioners and planners, yet it is an issue that has not been widely studied. Available evidence does suggest, however, that falls are the costliest category of injury among older persons. METHODS:This study...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Rizzo JA,Friedkin R,Williams CS,Nabors J,Acampora D,Tinetti ME

    更新日期:1998-08-01 00:00:00

  • Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

    abstract:OBJECTIVE:This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project. SUBJECTS:There were...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Chapko MK,Borowsky SJ,Fortney JC,Hedeen AN,Hoegle M,Maciejewski ML,VanDeusen Lukas C

    更新日期:2002-07-01 00:00:00

  • Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss.

    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


    authors: Reed NS,Boss EF,Lin FR,Oh ES,Willink A

    更新日期:2021-01-01 00:00:00

  • Comparing Population-based Risk-stratification Model Performance Using Demographic, Diagnosis and Medication Data Extracted From Outpatient Electronic Health Records Versus Administrative Claims.

    abstract:BACKGROUND:There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, howev...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Kharrazi H,Chi W,Chang HY,Richards TM,Gallagher JM,Knudson SM,Weiner JP

    更新日期:2017-08-01 00:00:00

  • The continuity of care provided to primary care patients. A comparison of family physicians, general internists, and medical subspecialists.

    abstract::The authors compared the continuity of care that family physicians, general internists, and medical subspecialists provided to their adult primary care patients. The 40 study physicians came from large, private multispecialty practices in the San Francisco Bay Area. The three physician types did not differ significant...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Goldberg HI,Dietrich AJ

    更新日期:1985-01-01 00:00:00