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Measuring quality of care in moderate and late preterm infants. J Perinatol 2022; 42:1294-1300. [PMID: 35354940 PMCID: PMC9522891 DOI: 10.1038/s41372-022-01377-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine quality measures for moderate and late preterm (MLP) infants. STUDY DESIGN By prospectively analyzing Vermont Oxford Network's all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants. RESULT We studied 376,219 MLP (30-36 weeks GA) and 57,595 extremely/very preterm (25-29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r = 0.47). There was weak correlation among survival (r = 0.19), no pneumothorax (r = 0.35), and no infection after 3 days (r = 0.45), but strong correlation among human milk at discharge (r = 0.79) and no hypothermia (r = 0.76). CONCLUSION Modest correlation among hospital care measures in two preterm populations suggests the need for MLP-specific care measures.
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Suls J, Salive ME, Koroukian SM, Alemi F, Silber JH, Kastenmüller G, Klabunde CN. Emerging approaches to multiple chronic condition assessment. J Am Geriatr Soc 2022; 70:2498-2507. [PMID: 35699153 PMCID: PMC9489607 DOI: 10.1111/jgs.17914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 01/01/2023]
Abstract
Older adults experience a higher prevalence of multiple chronic conditions (MCCs). Establishing the presence and pattern of MCCs in individuals or populations is important for healthcare delivery, research, and policy. This report describes four emerging approaches and discusses their potential applications for enhancing assessment, treatment, and policy for the aging population. The National Institutes of Health convened a 2-day panel workshop of experts in 2018. Four emerging models were identified by the panel, including classification and regression tree (CART), qualifying comorbidity sets (QCS), the multimorbidity index (MMI), and the application of omics to network medicine. Future research into models of multiple chronic condition assessment may improve understanding of the epidemiology, diagnosis, and treatment of older persons.
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Affiliation(s)
- Jerry Suls
- Feinstein Institutes for Medical Research/Northwell Health (previously National Cancer Institute)New York CityNew YorkUSA
| | | | | | | | | | - Gabi Kastenmüller
- Helmholtz Zentrum MünchenInstitute for Computational BiologyOberschleißheimGermany
| | - Carrie N. Klabunde
- Office of Disease PreventionNational Institutes of HealthBethesdaMarylandUSA
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McGrath BM, Takamine L, Hogan CK, Hofer TP, Rosen AK, Sussman JB, Wiitala WL, Ryan AM, Prescott HC. Interpretability, credibility, and usability of hospital-specific template matching versus regression-based hospital performance assessments; a multiple methods study. BMC Health Serv Res 2022; 22:739. [PMID: 35659234 PMCID: PMC9166576 DOI: 10.1186/s12913-022-08124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hospital-specific template matching (HS-TM) is a newer method of hospital performance assessment. OBJECTIVE To assess the interpretability, credibility, and usability of HS-TM-based vs. regression-based performance assessments. RESEARCH DESIGN We surveyed hospital leaders (January-May 2021) and completed follow-up semi-structured interviews. Surveys included four hypothetical performance assessment vignettes, with method (HS-TM, regression) and hospital mortality randomized. SUBJECTS Nationwide Veterans Affairs Chiefs of Staff, Medicine, and Hospital Medicine. MEASURES Correct interpretation; self-rated confidence in interpretation; and self-rated trust in assessment (via survey). Concerns about credibility and main uses (via thematic analysis of interview transcripts). RESULTS In total, 84 participants completed 295 survey vignettes. Respondents correctly interpreted 81.8% HS-TM vs. 56.5% regression assessments, p < 0.001. Respondents "trusted the results" for 70.9% HS-TM vs. 58.2% regression assessments, p = 0.03. Nine concerns about credibility were identified: inadequate capture of case-mix and/or illness severity; inability to account for specialized programs (e.g., transplant center); comparison to geographically disparate hospitals; equating mortality with quality; lack of criterion standards; low power; comparison to dissimilar hospitals; generation of rankings; and lack of transparency. Five concerns were equally relevant to both methods, one more pertinent to HS-TM, and three more pertinent to regression. Assessments were mainly used to trigger further quality evaluation (a "check oil light") and motivate behavior change. CONCLUSIONS HS-TM-based performance assessments were more interpretable and more credible to VA hospital leaders than regression-based assessments. However, leaders had a similar set of concerns related to credibility for both methods and felt both were best used as a screen for further evaluation.
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Affiliation(s)
- Brenda M. McGrath
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Linda Takamine
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Cainnear K. Hogan
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Timothy P. Hofer
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Amy K. Rosen
- grid.410370.10000 0004 4657 1992VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Surgery, Boston University School of Medicine, Boston, MA USA
| | - Jeremy B. Sussman
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Wyndy L. Wiitala
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Andrew M. Ryan
- grid.214458.e0000000086837370Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Hallie C. Prescott
- grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
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Stolzmann K, Lew RA, Miller CJ, Kim B, Wu H, Bauer MS. Does balancing site characteristics result in balanced population characteristics in a cluster-randomized controlled trial? HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022. [DOI: 10.1007/s10742-022-00271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vincent BM, Molling D, Escobar GJ, Hofer TP, Iwashyna TJ, Liu VX, Rosen AK, Ryan AM, Seelye S, Wiitala WL, Prescott HC. Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System. Med Care 2021; 59:1090-1098. [PMID: 34629424 PMCID: PMC8802232 DOI: 10.1097/mlr.0000000000001645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings. OBJECTIVE The objective of this study was to test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) health care system and determine power to detect greater-than-expected 30-day mortality. RESEARCH DESIGN Observational cohort study with hospital-specific template matching assessment. For each VA hospital, the 30-day mortality of a representative subset of hospitalizations was compared with the pooled mortality from matched hospitalizations at a set of comparison VA hospitals treating sufficiently similar patients. The simulation was used to determine power to detect greater-than-expected mortality. SUBJECTS A total of 556,266 hospitalizations at 122 VA hospitals in 2017. MEASURES A number of comparison hospitals identified per hospital; 30-day mortality. RESULTS Each hospital had a median of 38 comparison hospitals (interquartile range: 33, 44) identified, and 116 (95.1%) had at least 20 comparison hospitals. In total, 8 hospitals (6.6%) had a significantly lower 30-day mortality than their benchmark, 5 hospitals (4.1%) had a significantly higher 30-day mortality, and the remaining 109 hospitals (89.3%) were similar to their benchmark. Power to detect a standardized mortality ratio of 2.0 ranged from 72.5% to 79.4% for a hospital with the fewest (6) versus most (64) comparison hospitals. CONCLUSIONS Hospital-specific template matching may be feasible for assessing hospital performance in the diverse VA health care system, but further refinements are needed to optimize the approach before operational use. Our findings are likely applicable to other large and diverse multihospital systems.
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Affiliation(s)
| | - Daniel Molling
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Gabriel J. Escobar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy P. Hofer
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Theodore J. Iwashyna
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Survey Research Center, Institute for Social Research, Ann Arbor, MI
| | - Vincent X Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Amy K. Rosen
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Andrew M. Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Sarah Seelye
- VA Center for Clinical Management Research, Ann Arbor, MI
| | | | - Hallie C. Prescott
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Molling D, Vincent BM, Wiitala WL, Escobar GJ, Hofer TP, Liu VX, Rosen AK, Ryan AM, Seelye S, Prescott HC. Developing a template matching algorithm for benchmarking hospital performance in a diverse, integrated healthcare system. Medicine (Baltimore) 2020; 99:e20385. [PMID: 32541458 PMCID: PMC7302661 DOI: 10.1097/md.0000000000020385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Template matching is a proposed approach for hospital benchmarking, which measures performance based on matching a subset of comparable patient hospitalizations from each hospital. We assessed the ability to create the required matched samples and thus the feasibility of template matching to benchmark hospital performance in a diverse healthcare system.Nationwide Veterans Affairs (VA) hospitals, 2017.Observational cohort study.We used administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017. A standardized template of 300 hospitalizations was selected, and then 300 hospitalizations were matched to the template from each hospital.There was substantial case-mix variation across VA hospitals, which persisted after excluding small hospitals, hospitals with primarily psychiatric admissions, and hospitalizations for rare diagnoses. Median age ranged from 57 to 75 years across hospitals; percent surgical admissions ranged from 0.0% to 21.0%; percent of admissions through the emergency department, 0.1% to 98.7%; and percent Hispanic patients, 0.2% to 93.3%. Characteristics for which there was substantial variation across hospitals could not be balanced with any matching algorithm tested. Although most other variables could be balanced, we were unable to identify a matching algorithm that balanced more than ∼20 variables simultaneously.We were unable to identify a template matching approach that could balance hospitals on all measured characteristics potentially important to benchmarking. Given the magnitude of case-mix variation across VA hospitals, a single template is likely not feasible for general hospital benchmarking.
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Affiliation(s)
- Daniel Molling
- VA Center for Clinical Management Research, Ann Arbor, MI
| | | | | | - Gabriel J. Escobar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy P. Hofer
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Amy K. Rosen
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Andrew M. Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Sarah Seelye
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Hallie C. Prescott
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan
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Silber JH, Rosenbaum PR, Pimentel SD, Calhoun S, Wang W, Sharpe JE, Reiter JG, Shah SA, Hochman LL, Even-Shoshan O. Comparing Resource Use in Medical Admissions of Children With Complex Chronic Conditions. Med Care 2019; 57:615-624. [PMID: 31268953 PMCID: PMC6652225 DOI: 10.1097/mlr.0000000000001149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with complex chronic conditions (CCCs) utilize a disproportionate share of hospital resources. OBJECTIVE We asked whether some hospitals display a significantly different pattern of resource utilization than others when caring for similar children with CCCs admitted for medical diagnoses. RESEARCH DESIGN Using Pediatric Health Information System data from 2009 to 2013, we constructed an inpatient Template of 300 children with CCCs, matching these to 300 patients at each hospital, thereby performing a type of direct standardization. SUBJECTS Children with CCCs were drawn from a list of the 40 most common medical principal diagnoses, then matched to patients across 40 Children's Hospitals. MEASURES Rate of intensive care unit admission, length of stay, resource cost. RESULTS For the Template-matched patients, when comparing resource use at the lower 12.5-percentile and upper 87.5-percentile of hospitals, we found: intensive care unit utilization was 111% higher (6.6% vs. 13.9%, P<0.001); hospital length of stay was 25% higher (2.4 vs. 3.0 d/admission, P<0.001); and finally, total cost per patient varied by 47% ($6856 vs. $10,047, P<0.001). Furthermore, some hospitals, compared with their peers, were more efficient with low-risk patients and less efficient with high-risk patients, whereas other hospitals displayed the opposite pattern. CONCLUSIONS Hospitals treating similar patients with CCCs admitted for similar medical diagnoses, varied greatly in resource utilization. Template Matching can aid chief quality officers benchmarking their hospitals to peer institutions and can help determine types of their patients having the most aberrant outcomes, facilitating quality initiatives to target these patients.
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Affiliation(s)
- Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- Departments of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA
| | | | - Shawna Calhoun
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Wei Wang
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - James E. Sharpe
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shivani A. Shah
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lauren L. Hochman
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Orit Even-Shoshan
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
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Vincent BM, Wiitala WL, Luginbill KA, Molling DJ, Hofer TP, Ryan AM, Prescott HC. Template matching for benchmarking hospital performance in the veterans affairs healthcare system. Medicine (Baltimore) 2019; 98:e15644. [PMID: 31096485 PMCID: PMC6531221 DOI: 10.1097/md.0000000000015644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Comparing hospital performance in a health system is traditionally done with multilevel regression models that adjust for differences in hospitals' patient case-mix. In contrast, "template matching" compares outcomes of similar patients at different hospitals but has been used only in limited patient settings.Our objective was to test a basic template matching approach in the nationwide Veterans Affairs healthcare system (VA), compared with a more standard regression approach.We performed various simulations using observational data from VA electronic health records whereby we randomly assigned patients to "pseudo hospitals," eliminating true hospital level effects. We randomly selected a representative template of 240 patients and matched 240 patients on demographic and physiological factors from each pseudo hospital to the template. We varied hospital performance for different simulations such that some pseudo hospitals negatively impacted patient mortality.Electronic health record data of 460,213 hospitalizations at 111 VA hospitals across the United States in 2015.We assessed 30-day mortality at each pseudo hospital and identified lowest quintile hospitals by template matching and regression. The regression model adjusted for predicted 30-day mortality (as a measure of illness severity).Regression identified the lowest quintile hospitals with 100% accuracy compared with 80.3% to 82.0% for template matching when systematic differences in 30-day mortality existed.The current standard practice of risk-adjusted regression incorporating patient-level illness severity was better able to identify lower-performing hospitals than the simplistic template matching algorithm.
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Affiliation(s)
- Brenda M. Vincent
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Wyndy L. Wiitala
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Kaitlyn A. Luginbill
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Daniel J. Molling
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Timothy P. Hofer
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation
| | - Andrew M. Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Hallie C. Prescott
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation
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Practice Style Variation in Medicaid and Non-Medicaid Children With Complex Chronic Conditions Undergoing Surgery. Ann Surg 2019; 267:392-400. [PMID: 27849665 DOI: 10.1097/sla.0000000000002061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With differential payment between Medicaid and Non-Medicaid services, we asked whether style-of-practice differs between similar Medicaid and Non-Medicaid children with complex chronic conditions (CCCs) undergoing surgery. SUMMARY OF BACKGROUND DATA Surgery in children with CCCs accounts for a disproportionately large percentage of resource utilization at major children's hospitals. METHODS A matched cohort design, studying 23,582 pairs of children with CCCs undergoing surgery (Medicaid matched to Non-Medicaid within the same hospital) from 2009 to 2013 in 41 Children's Hospitals. Patients were matched on age, sex, principal procedure, CCCs, and other characteristics. RESULTS Median cost in Medicaid patients was $21,547 versus $20,527 in Non-Medicaid patients (5.0% higher, P < 0.001). Median paired difference in cost (Medicaid minus Non-Medicaid) was $320 [95% confidence interval (CI): $208, $445], (1.6% higher, P < 0.001). 90th percentile costs were $133,640 versus $127,523, (4.8% higher, P < 0.001). Mean paired difference in length of stay (LOS) was 0.50 days (95% CI: 0.36, 0.65), (P < 0.001). ICU utilization was 2.8% higher (36.7% vs 35.7%, P < 0.001). Finally, in-hospital mortality pooled across all pairs was higher in Medicaid patients (0.38% vs 0.22%, P = 0.002). After adjusting for multiple testing, no individual hospital displayed significant differences in cost between groups, only 1 hospital displayed significant differences in LOS and 1 in ICU utilization. CONCLUSIONS Treatment style differences between Medicaid and Non-Medicaid children were small, suggesting little disparity with in-hospital surgical care for patients with CCCs operated on within Children's Hospitals. However, in-hospital mortality, although rare, was slightly higher in Medicaid patients and merits further investigation.
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Incorporating Longitudinal Comorbidity and Acute Physiology Data in Template Matching for Assessing Hospital Quality: An Exploratory Study in an Integrated Health Care Delivery System. Med Care 2018; 56:448-454. [PMID: 29485529 DOI: 10.1097/mlr.0000000000000891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to build on the template-matching methodology by incorporating longitudinal comorbidities and acute physiology to audit hospital quality. STUDY SETTING Patients admitted for sepsis and pneumonia, congestive heart failure, hip fracture, and cancer between January 2010 and November 2011 at 18 Kaiser Permanente Northern California hospitals. STUDY DESIGN We generated a representative template of 250 patients in 4 diagnosis groups. We then matched between 1 and 5 patients at each hospital to this template using varying levels of patient information. DATA COLLECTION Data were collected retrospectively from inpatient and outpatient electronic records. PRINCIPAL FINDINGS Matching on both present-on-admission comorbidity history and physiological data significantly reduced the variation across hospitals in patient severity of illness levels compared with matching on administrative data only. After adjustment for longitudinal comorbidity and acute physiology, hospital rankings on 30-day mortality and estimates of length of stay were statistically different from rankings based on administrative data. CONCLUSIONS Template matching-based approaches to hospital quality assessment can be enhanced using more granular electronic medical record data.
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Reyes MA, Paulus E. The Landscape of Quality Measures and Quality Improvement for the Care of Hospitalized Children in the United States: Efforts Over the Last Decade. Hosp Pediatr 2017; 7:739-747. [PMID: 29122889 DOI: 10.1542/hpeds.2017-0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mario A Reyes
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida; and
- Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Evan Paulus
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida; and
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Silber JH, Rosenbaum PR, McHugh MD, Ludwig JM, Smith HL, Niknam BA, Even-Shoshan O, Fleisher LA, Kelz RR, Aiken LH. Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk. JAMA Surg 2017; 151:527-36. [PMID: 26791112 DOI: 10.1001/jamasurg.2015.4908] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The literature suggests that hospitals with better nursing work environments provide better quality of care. Less is known about value (cost vs quality). OBJECTIVES To test whether hospitals with better nursing work environments displayed better value than those with worse nursing environments and to determine patient risk groups associated with the greatest value. DESIGN, SETTING, AND PARTICIPANTS A retrospective matched-cohort design, comparing the outcomes and cost of patients at focal hospitals recognized nationally as having good nurse working environments and nurse-to-bed ratios of 1 or greater with patients at control group hospitals without such recognition and with nurse-to-bed ratios less than 1. This study included 25 752 elderly Medicare general surgery patients treated at focal hospitals and 62 882 patients treated at control hospitals during 2004-2006 in Illinois, New York, and Texas. The study was conducted between January 1, 2004, and November 30, 2006; this analysis was conducted from April to August 2015. EXPOSURES Focal vs control hospitals (better vs worse nursing environment). MAIN OUTCOMES AND MEASURES Thirty-day mortality and costs reflecting resource utilization. RESULTS This study was conducted at 35 focal hospitals (mean nurse-to-bed ratio, 1.51) and 293 control hospitals (mean nurse-to-bed ratio, 0.69). Focal hospitals were larger and more teaching and technology intensive than control hospitals. Thirty-day mortality in focal hospitals was 4.8% vs 5.8% in control hospitals (P < .001), while the cost per patient was similar: the focal-control was -$163 (95% CI = -$542 to $215; P = .40), suggesting better value in the focal group. For the focal vs control hospitals, the greatest mortality benefit (17.3% vs 19.9%; P < .001) occurred in patients in the highest risk quintile, with a nonsignificant cost difference of $941 per patient ($53 701 vs $52 760; P = .25). The greatest difference in value between focal and control hospitals appeared in patients in the second-highest risk quintile, with mortality of 4.2% vs 5.8% (P < .001), with a nonsignificant cost difference of -$862 ($33 513 vs $34 375; P = .12). CONCLUSIONS AND RELEVANCE Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients. These results do not suggest that improving any specific hospital's nursing environment will necessarily improve its value, but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.
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Affiliation(s)
- Jeffrey H Silber
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia3Leonard Davis Institute of Health Economics, University of Penns
| | - Paul R Rosenbaum
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia7Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia
| | - Matthew D McHugh
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia4Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia8School of Nursing, University of Pennsylvania, Philadelphia
| | - Justin M Ludwig
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Herbert L Smith
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia9Population Studies Center, University of Pennsylvania, Philadelphia10Department of Sociology, School of Arts and Sciences, University of Pennsylvania, Philadelphia
| | - Bijan A Niknam
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Orit Even-Shoshan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia5Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lee A Fleisher
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia6Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R Kelz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia11Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Linda H Aiken
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia4Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia8School of Nursing, University of Pennsylvania, Philadelphia9Population Studies C
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Koyawala N, Silber JH, Rosenbaum PR, Wang W, Hill AS, Reiter JG, Niknam BA, Even-Shoshan O, Bloom RD, Sawinski D, Nazarian S, Trofe-Clark J, Lim MA, Schold JD, Reese PP. Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation. J Am Soc Nephrol 2017; 28:2188-2200. [PMID: 28320767 DOI: 10.1681/asn.2016070768] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/24/2017] [Indexed: 12/24/2022] Open
Abstract
Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26; P<0.01) and death or allograft failure (HR, 1.18; 95% CI, 1.09 to 1.28; P<0.001). Results for death as well as death or allograft failure were generally consistent among elderly and nonelderly subgroups and among pairs receiving oral prednisone. Compared with rATG recipients, basiliximab recipients had higher risk of death (HR, 1.08; 95% CI, 1.01 to 1.16; P=0.03) and death or lymphoma (HR, 1.12; 95% CI, 1.01 to 1.23; P=0.03), although these differences were not confirmed in subgroup analyses. One-year resource utilization was slightly lower among alemtuzumab recipients than among rATG recipients, but did not differ between basiliximab and rATG recipients. This observational evidence indicates that, compared with alemtuzumab and basiliximab, rATG associates with lower risk of adverse outcomes, including mortality.
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Affiliation(s)
| | - Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics
| | - Paul R Rosenbaum
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Wang
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander S Hill
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph G Reiter
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bijan A Niknam
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Orit Even-Shoshan
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Roy D Bloom
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | - Deirdre Sawinski
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | | | - Jennifer Trofe-Clark
- Renal Electrolyte and Hypertension Division, Department of Medicine, and.,Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Mary Ann Lim
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Peter P Reese
- Renal Electrolyte and Hypertension Division, Department of Medicine, and .,Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Silber JH, Rosenbaum PR, Calhoun SR, Reiter JG, Hill AS, Even-Shoshan O, Greeley WJ. Outcomes, ICU Use, and Length of Stay in Chronically Ill Black and White Children on Medicaid and Hospitalized for Surgery. J Am Coll Surg 2017; 224:805-814. [PMID: 28167226 DOI: 10.1016/j.jamcollsurg.2017.01.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND With increasing Medicaid coverage, it has become especially important to determine whether racial differences exist within the Medicaid system. We asked whether disparities exist in hospital practice and patient outcomes between matched black and white Medicaid children with chronic conditions undergoing surgery. STUDY DESIGN We conducted a matched cohort study, matching 6,398 pairs within states on detailed patient characteristics using data from 25 states contributing adequate Medicaid Analytic eXtract claims for admissions of children with chronic conditions undergoing the same surgical procedures between January 1, 2009 and November 30, 2010 for ages 1 to 18 years. RESULTS The black patient 30-day revisit rate was 19.3% vs 19.8% in matched white patients (p = 0.61), 30-day readmission rates were 7.0% vs 6.9% (p = 0.43), and 30-day mortality rates were 0.38% vs 0.19% (p = 0.06), respectively. A higher percentage of black patients exceeded their own state's individual median length of stay (44.0% vs 39.6%; p < 0.001) and median ICU length of stay (25.9% vs 23.8%; p < 0.001). Intensive care unit use was higher in black patients (25.9% vs 23.8%; p < 0.001). After adjusting for multiple testing, only 2 states were found to differ significantly by race (New York for length of stay and New Jersey for ICU use). CONCLUSIONS We did not observe disparities in 30-day revisits and readmissions for chronically ill children in Medicaid undergoing surgery, and only slight differences in length of stay, ICU length of stay, and use of the ICU, where blacks displayed somewhat elevated rates compared with white controls.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
| | - Paul R Rosenbaum
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Shawna R Calhoun
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joseph G Reiter
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexander S Hill
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Orit Even-Shoshan
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - William J Greeley
- Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA
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16
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Silber JH, Rosenbaum PR, Calhoun SR, Reiter JG, Hill AS, Guevara JP, Zorc JJ, Even-Shoshan O. Racial Disparities in Medicaid Asthma Hospitalizations. Pediatrics 2017; 139:e20161221. [PMID: 28025238 DOI: 10.1542/peds.2016-1221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Black children with asthma comprise one-third of all asthma patients in Medicaid. With increasing Medicaid coverage, it has become especially important to monitor Medicaid for differences in hospital practice and patient outcomes by race. METHODS A multivariate matched cohort design, studying 11 079 matched pairs of children in Medicaid (black versus white matched pairs from inside the same state) admitted for asthma between January 1, 2009 and November 30, 2010 in 33 states contributing adequate Medicaid Analytic eXtract claims. RESULTS Ten-day revisit rates were 3.8% in black patients versus 4.2% in white patients (P = .12); 30-day revisit and readmission rates were also not significantly different by race (10.5% in black patients versus 10.8% in white patients; P = .49). Length of stay (LOS) was also similar; both groups had a median stay of 2.0 days, with a slightly lower percentage of black patients exceeding their own state's median LOS (30.2% in black patients versus 31.8% in white patients; P = .01). The mean paired difference in LOS was 0.00 days (95% confidence interval, -0.08 to 0.08). However, ICU use was higher in black patients than white patients (22.2% versus 17.5%; P < .001). After adjusting for multiple testing, only 4 states were found to differ significantly, but only in ICU use, where blacks had higher rates of use. CONCLUSIONS For closely matched black and white patients, racial disparities concerning asthma admission outcomes and style of practice are small and generally nonsignificant, except for ICU use, where we observed higher rates in black patients.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, and
- Departments of Pediatrics
- Anesthesiology and Critical Care, School of Medicine
- Health Care Management, and
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul R Rosenbaum
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
- Statistics, The Wharton School, and
| | | | | | | | - James P Guevara
- Departments of Pediatrics
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
- Divisions of General Pediatrics, and
| | - Joseph J Zorc
- Departments of Pediatrics
- Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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17
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Silber JH, Rosenbaum PR, Wang W, Calhoun S, Guevara JP, Zorc JJ, Even-Shoshan O. Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions. Pediatrics 2016; 138:peds.2016-0371. [PMID: 27385812 DOI: 10.1542/peds.2016-0371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES With American children experiencing increased Medicaid coverage, it has become especially important to determine if practice patterns differ between Medicaid and non-Medicaid patients. Auditing such potential differences must carefully compare like patients to avoid falsely identifying suspicious practice patterns. We asked if we could observe differences in practice patterns between Medicaid and non-Medicaid patients admitted for asthma inside major children's hospitals. METHODS A matched cohort design, studying 17 739 matched pairs of children (Medicaid to non-Medicaid) admitted for asthma in the same hospital between April 1, 2011 and March 31, 2014 in 40 Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System database. Patients were matched on age, sex, asthma severity, and other patient characteristics. RESULTS Medicaid patient median cost was $4263 versus $4160 for non-Medicaid patients (P < .001). Additionally, the median cost difference (Medicaid minus non-Medicaid) between individual pairs was only $84 (95% confidence interval: 44 to 124), and the mean cost difference was only $49 (95% confidence interval: -72 to 170). The 90th percentile costs were also similar between groups ($10 710 vs $10 948; P < .07). Length of stay (LOS) was also very similar; both groups had a median stay of 1 day, with a similar percentage of patients exceeding the 90th percentile of individual hospital LOS (7.1% vs 6.7%; P = .14). ICU use was also similar (10.1% vs 10.6%; P = .12). CONCLUSIONS For closely matched patients within the same hospital, Medicaid status did not importantly influence costs, LOS, or ICU use.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, Departments of Pediatrics, and Anesthesiology and Critical Care, Perelman School of Medicine, Departments of Health Care Management, and Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Paul R Rosenbaum
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA Statistics, The Wharton School, and
| | | | | | - James P Guevara
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA Divisions of General Pediatrics, and
| | - Joseph J Zorc
- Departments of Pediatrics, and Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia PA
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18
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Silber JH, Satopää VA, Mukherjee N, Rockova V, Wang W, Hill AS, Even-Shoshan O, Rosenbaum PR, George EI. Improving Medicare's Hospital Compare Mortality Model. Health Serv Res 2016; 51 Suppl 2:1229-47. [PMID: 26987446 DOI: 10.1111/1475-6773.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To improve the predictions provided by Medicare's Hospital Compare (HC) to facilitate better informed decisions regarding hospital choice by the public. DATA SOURCES/SETTING Medicare claims on all patients admitted for Acute Myocardial Infarction between 2009 through 2011. STUDY DESIGN Cohort analysis using a Bayesian approach, comparing the present assumptions of HC (using a constant mean and constant variance for all hospital random effects), versus an expanded model that allows for the inclusion of hospital characteristics to permit the data to determine whether they vary with attributes of hospitals, such as volume, capabilities, and staffing. Hospital predictions are then created using directly standardized estimates to facilitate comparisons between hospitals. DATA COLLECTION/EXTRACTION METHODS Medicare fee-for-service claims. PRINCIPAL FINDINGS Our model that included hospital characteristics produces very different predictions from the current HC model, with higher predicted mortality rates at hospitals with lower volume and worse characteristics. Using Chicago as an example, the expanded model would advise patients against seeking treatment at the smallest hospitals with worse technology and staffing. CONCLUSION To aid patients when selecting between hospitals, the Centers for Medicare and Medicaid Services (CMS) should improve the HC model by permitting its predictions to vary systematically with hospital attributes such as volume, capabilities, and staffing.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.,The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA.,Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA.,Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Ville A Satopää
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Nabanita Mukherjee
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Veronika Rockova
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Wei Wang
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexander S Hill
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Orit Even-Shoshan
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Paul R Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.,Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Edward I George
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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19
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Silber JH, Rosenbaum PR, Ross RN, Ludwig JM, Wang W, Niknam BA, Hill AS, Even-Shoshan O, Kelz RR, Fleisher LA. Indirect Standardization Matching: Assessing Specific Advantage and Risk Synergy. Health Serv Res 2016; 51:2330-2357. [PMID: 26927625 DOI: 10.1111/1475-6773.12470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop a method to allow a hospital to compare its performance using its entire patient population to the outcomes of very similar patients treated elsewhere. DATA SOURCES/SETTING Medicare claims in orthopedics and common general, gynecologic, and urologic surgery from Illinois, New York, and Texas from 2004 to 2006. STUDY DESIGN Using two example "focal" hospitals, each hospital's patients were matched to 10 very similar patients selected from 619 other hospitals. DATA COLLECTION/EXTRACTION METHODS All patients were used at each focal hospital, and we found the 10 closest matched patients from control hospitals with exactly the same principal procedure as each focal patient. PRINCIPAL FINDINGS We achieved exact matches on all procedures and very close matches for other patient characteristics for both hospitals. There were few to no differences between each hospital's patients and their matched control patients on most patient characteristics, yet large and significant differences were observed for mortality, failure-to-rescue, and cost. CONCLUSION Indirect standardization matching can produce fair audits of quality and cost, allowing for a comprehensive, transparent, and relevant assessment of all patients at a focal hospital. With this approach, hospitals will be better able to benchmark their performance and determine where quality improvement is most needed.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.,The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA.,Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA.,Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Paul R Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.,Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Richard N Ross
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justin M Ludwig
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Wei Wang
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bijan A Niknam
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexander S Hill
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Orit Even-Shoshan
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.,Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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20
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Rahman NH, Tanaka H, Shin SD, Ng YY, Piyasuwankul T, Lin CH, Ong MEH. Emergency medical services key performance measurement in Asian cities. Int J Emerg Med 2015; 8:12. [PMID: 25932052 PMCID: PMC4412872 DOI: 10.1186/s12245-015-0062-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. Findings The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. Conclusions There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.
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Affiliation(s)
- Nik Hisamuddin Rahman
- Department of Emergency Medicine, School of Medical Sciences, University Sains Malaysia, Kota Bharu, 16150 Malaysia
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Chih-Hao Lin
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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