Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data
Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data
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DOI：
10.1097/mlr.0000000000000052
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发表时间：
2014-02-01
期刊：
影响因子：
3
通讯作者：
Chan, Kitty S.
中科院分区：
文献类型：
--
作者：
Segal, Jodi B.;Bridges, John F. P.;Chan, Kitty S.
背景：卫生保健质量经常被描述为代表卫生保健系统的整体性能的措施。尽管越来越多的关注过度使用的医疗资源，很少有经验的综合措施overuse.Objective：要确定一组可能的指标，可以操作的索赔数据和描述这些指标的变化在医院转诊regions.Design：使用环境扫描，我们确定了已公布的描述过度使用的程序。我们评估了每种手术的可行性，以衡量索赔和开发算法的发生率的程序不太可能受益的患者。使用2008年5%的医疗保险索赔样本，我们计算了汇总统计数据，以说明不同HRR使用情况的差异。结果：共有613项程序被确定为过度使用; 20项程序的频率和差异很大，可以作为系统性过度使用的可能衡量标准。其中包括13项诊断测试，2项筛查测试，1项监测测试和4项治疗程序。不同HRR的使用情况差异很大。例如，1名HRR在1000名受益人中的80名中使用计算机断层扫描诊断鼻窦炎（HRR的平均使用率为14/1000）。在1，451，142受益人中，14%至少有一个过度使用事件（范围，8.4%-27%）。结论：我们确定了一组过度使用的程序，可作为过度使用的措施，并表现出显着的差异，在他们的使用。这意味着，可以根据这些指标建立一个过度使用指数，揭示区域内过度使用的系统模式。或者，这些指标在质量改进工作中可能很有价值。
Background:Health care quality is frequently described with measures representing the overall performance of a health care system. Despite the growing attention to overuse of health care resources, there is little experience with aggregate measures of overuse.Objective:To identify a set of possible indicators of overuse that can be operationalized with claims data and to describe variation in these indicators across the hospital referral regions (HRRs).Design:Using an environmental scan, we identified published descriptions of overused procedures. We assessed each procedure's feasibility for measurement with claims and developed algorithms for occurrences of procedures in patients unlikely to benefit. Using a 5% sample of Medicare claims from 2008, we calculated summary statistics to illustrate variance in the use across HRRs.Results:A total of 613 procedures were identified as overused; 20 had abundant frequency and variance to be possible measures of systematic overuse. These included 13 diagnostic tests, 2 tests for screening, 1 for monitoring, and 4 therapeutic procedures. The usage varied markedly across HRRs. For illustration, 1 HRR used computed tomography for rhinosinusitis diagnosis in 80 of 1000 beneficiaries (mean usage across HRRs was 14/1000). Among 1,451,142 beneficiaries, 14% had at least one overuse event (range, 8.4%-27%).Conclusions:We identified a set of overused procedures that may be used as measures of overuse and that demonstrate significant variance in their usage. The implication is that an index of overuse might be built from these indicators that would reveal systematic patterns of overuse within regions. Alternatively, these indicators may be valuable in the quality improvement efforts.