Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough?
Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough?
复制标题
使用 Medicare 索赔数据评估 CABG 手术的提供者质量：效果是否足够好？
作者：
E. Hannan;Michael J. Racz;J. Jollis;E. Peterson
目标
评估临床和管理数据预测死亡率的相对能力和评估CABG手术患者的医院护理质量。
数据来源/研究设置
1991-1992年的数据来自纽约心脏手术报告系统(临床数据)和HCFA的MEDPAR(管理数据)。研究设计/设置/样本：这是一项观察性研究，确定了住院死亡率的重要风险因素，并使用这些变量对医院死亡率进行了风险调整。背景是纽约州所有31家医院，1991-1992年间在这些医院进行了CABG手术。共有13,577名接受单独冠状动脉搭桥术的患者组成了样本，他们在两个数据库中可以匹配。
主要结果衡量标准
医院风险调整后的死亡率、“离群点”医院的识别以及统计模型的区分和校正是主要的结果衡量标准。
主要发现
行政统计模型的部分歧视力量源于将术后并发症错误地编码为并存。去除这些并发症导致模型的C指数恶化(从C=.78降至C=.71和C=.73)。此外，当护理并发症与合并症区别开来时，提供者的绩效评估也发生了很大的变化。增加了几个临床数据元素，大大提高了管理模型的适合性。此外，基于Medicare CABG患者的临床模型仅产生3个异常值，而使用针对所有CABG患者的临床模型确定了8个异常值。
结论
如果在结果研究中使用管理数据库，(1)应努力区分护理并发症和合并症，(2)在评估结果之前，通过将有限数量的临床数据元素添加到管理数据，可以获得更准确的评估，以及(3)医疗保险数据可能具有误导性，因为它们不能反映所有患者的结果。
OBJECTIVES
To assess the relative abilities of clinical and administrative data to predict mortality and to assess hospital quality of care for CABG surgery patients.
DATA SOURCES/STUDY SETTING
1991-1992 data from New York's Cardiac Surgery Reporting System (clinical data) and HCFA's MEDPAR (administrative data). STUDY DESIGN/SETTING/SAMPLE: This is an observational study that identifies significant risk factors for in-hospital mortality and that risk-adjusts hospital mortality rates using these variables. Setting was all 31 hospitals in New York State in which CABG surgery was performed in 1991-1992. A total of 13,577 patients undergoing isolated CABG surgery who could be matched in the two databases made up the sample.
MAIN OUTCOME MEASURES
Hospital risk-adjusted mortality rates, identification of "outlier" hospitals, and discrimination and calibration of statistical models were the main outcome measures.
PRINCIPAL FINDINGS
Part of the discriminatory power of administrative statistical models resulted from the miscoding of postoperative complications as comorbidities. Removal of these complications led to deterioration in the model's C index (from C = .78 to C = .71 and C = .73). Also, provider performance assessments changed considerably when complications of care were distinguished from comorbidities. The addition of a couple of clinical data elements considerably improved the fit of administrative models. Further, a clinical model based on Medicare CABG patients yielded only three outliers, whereas eight were identified using a clinical model for all CABG patients.
CONCLUSIONS
If administrative databases are used in outcomes research, (1) efforts to distinguish complications of care from comorbidities should be undertaken, (2) much more accurate assessments may be obtained by appending a limited number of clinical data elements to administrative data before assessing outcomes, and (3) Medicare data may be misleading because they do not reflect outcomes for all patients.
DOI：
10.1001/jama.1994.03510340051033
发表时间：
1994-03
期刊：
JAMA
影响因子：
--
作者：
E. Hannan;H. Kilburn;Michael J. Racz;E. Shields;M. Chassin
通讯作者：
E. Hannan;H. Kilburn;Michael J. Racz;E. Shields;M. Chassin
影响因子：
3
作者：
Pryor,DB;Califf,RM;HarrellJr,FE;Hlatky,MA;Lee,KL;Mark,DB;Rosati,RA
通讯作者：
Rosati,RA
使用管理数据来筛查医院的高并发症发生率。
DOI：
--
发表时间：
1994
期刊：
Inquiry : a journal of medical care organization, provision and financing
影响因子：
--
作者：
Iezzoni,LI;Daley,J;Heeren,T;Foley,SM;Hughes,JS;Fisher,ES;Duncan,CC;Coffman,GA
通讯作者：
Coffman,GA