Screening inpatient quality using post-discharge events

被引:22
作者
Iezzoni, LI
Mackiernan, YD
Cahalane, MJ
Phillips, RS
Davis, RB
Miller, K
机构
[1] Beth Israel Deaconess Med Ctr, Dept Med, Div Gen Med & Primary Care, Boston, MA 02215 USA
[2] Harvard Univ, Sch Med, Cambridge, MA 02138 USA
[3] Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA
关键词
complications; hospital quality; length of stay;
D O I
10.1097/00005650-199904000-00008
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BACKGROUND. Decreasing hospital lengths of stay (LOS) hamper efforts to detect and to definitively treat complications of care. Patients leave before some complications are identified. OBJECTIVES. TO develop a computerized method to screen for hospital complications using readily available administrative data from outpatient and nonacute care within 90 days of discharge. DESIGN. We developed the Complications Screening Program for Outpatient data (CSP-O) by using diagnosis and procedure codes from Medicare Part A and B claims to define 50 complication screens. Seventeen apply to specific procedural cases, and 33 apply to all adult, acute, medical, or surgical hospitalizations. The CSP-O algorithm examined outpatient, physician office, home health agency, and hospice claims within 90 days following discharge. SUBJECTS. Seven hundred thirty nine thousand, two hundred and forty eight discharges of Medicare beneficiaries (age range, greater than or equal to 65 years) were admitted to 515 hospitals nationwide in 1994 RESULTS. Complete 90-day, post-discharge windows were present for 62.8% of all and 68.5% of procedural cases. The 33 general screens flagged 13.6% of all cases; only 1.8% of procedural cases were flagged by the 17 procedural screens. When we allowed the CSP-O algorithm to scan information from acute hospital readmissions, flag rates rose to 32.8% for general and 8.7% for procedural complications. Controlling for patient and hospital characteristics, flag rates were considerably higher among the very old and at small and for-profit institutions. CONCLUSIONS. Whereas several CSP-O findings have construct validity, limitations of claims raise concerns. Regardless of the CSPO's ultimate utility, examining post-discharge experiences to identify inpatient complications remains important as LOSs fall.
引用
收藏
页码:384 / 398
页数:15
相关论文
共 48 条
  • [1] A conceptual framework for the study of early readmission as an indicator of quality of care
    Ashton, CM
    Wray, NP
    [J]. SOCIAL SCIENCE & MEDICINE, 1996, 43 (11) : 1533 - 1541
  • [2] THE ASSOCIATION BETWEEN THE QUALITY OF INPATIENT CARE AND EARLY READMISSION
    ASHTON, CM
    KUYKENDALL, DH
    JOHNSON, ML
    WRAY, NP
    WU, L
    [J]. ANNALS OF INTERNAL MEDICINE, 1995, 122 (06) : 415 - 421
  • [3] INCIDENCE OF ADVERSE DRUG EVENTS AND POTENTIAL ADVERSE DRUG EVENTS - IMPLICATIONS FOR PREVENTION
    BATES, DW
    CULLEN, DJ
    LAIRD, N
    PETERSEN, LA
    SMALL, SD
    SERVI, D
    LAFFEL, G
    SWEITZER, BJ
    SHEA, BF
    HALLISEY, R
    VANDERVLIET, M
    NEMESKAL, R
    LEAPE, LL
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (01): : 29 - 34
  • [4] Beggs V L, 1996, Best Pract Benchmarking Healthc, V1, P180
  • [5] INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED-PATIENTS - RESULTS OF THE HARVARD MEDICAL-PRACTICE STUDY-I
    BRENNAN, TA
    LEAPE, LL
    LAIRD, NM
    HEBERT, L
    LOCALIO, AR
    LAWTHERS, AG
    NEWHOUSE, JP
    WEILER, PC
    HIATT, HH
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1991, 324 (06) : 370 - 376
  • [6] HOSPITAL CHARACTERISTICS ASSOCIATED WITH ADVERSE EVENTS AND SUBSTANDARD CARE
    BRENNAN, TA
    HEBERT, LE
    LAIRD, NM
    LAWTHERS, A
    THORPE, KE
    LEAPE, LL
    LOCALIO, AR
    LIPSITZ, SR
    NEWHOUSE, JP
    WEILER, PC
    HIATT, HH
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (24): : 3265 - 3269
  • [7] Daley J, 1997, J AM COLL SURGEONS, V185, P328, DOI 10.1016/S1072-7515(01)00939-5
  • [8] Clinical quality measurement - Comparing chart review and automated methodologies
    Dresser, MVB
    Feingold, L
    Rosenkranz, SL
    Coltin, KL
    [J]. MEDICAL CARE, 1997, 35 (06) : 539 - 552
  • [9] EPSTEIN AM, 1991, INQUIRY-J HEALTH CAR, V28, P19
  • [10] THE ACCURACY OF MEDICARES HOSPITAL CLAIMS DATA - PROGRESS HAS BEEN MADE, BUT PROBLEMS REMAIN
    FISHER, ES
    WHALEY, FS
    KRUSHAT, WM
    MALENKA, DJ
    FLEMING, C
    BARON, JA
    HSIA, DC
    [J]. AMERICAN JOURNAL OF PUBLIC HEALTH, 1992, 82 (02) : 243 - 248