Assessing Hospital Quality of Care for Patients with Multimorbidity

摘要 目前，医院很难评估其多病(MM)患者的护理情况。因为多发性疾病 根据定义，通过许多可能的合并症和主要诊断的组合来个体化，任何 单一医院不能确定他们的治疗是否对多发性骨髓瘤患者是最佳的，因为医院不 可以从其他医院获得密切匹配的对照，从而深入了解他们自己的MM如何 患者可能在其他机构过得很好。由于多病患者的病情比其他患者严重得多，所以它 也可能很容易忽视个人不良结果，认为这仅仅是与 多发病。这项建议的目标是帮助医院观察他们的多发性骨髓瘤患者的预后有何不同 来自于在其他机构接受治疗的类似患者。MM的新定义在住院外科和外科手术中的应用 明确定义单一、双重和三重合并症的内科患者，包括 通过限定共病组，这项研究检查了医院在最佳治疗多发性骨髓瘤方面的能力是否存在差异 病人。这项研究的结果将直接作为一种辅助手段，告诉医院他们如何处理他们的 将特定的多发性骨髓瘤患者与他们的患者在其他地方的情况进行比较。该项目将使用 通过新的CMS VRDC(虚拟数据研究中心)从全国范围内申请医疗保险，从而 促进一个大的对照小组对任何给定医院的患者进行近距离比较，并应用新的 在研究人员开发的多元匹配(间接标准化匹配)方法中， 检查多发性骨髓瘤患者的护理质量。使用ISM，我们将产生10个“副本”(或匹配的对照患者 从进入索引医院以外的医院的患者)对于在索引医院的每个MM患者， 允许密切匹配特定的合格共病集合，并密切检查 医院治疗多发性骨髓瘤患者与从其他医院挑选的最匹配的患者进行比较。vbl.使用 多变量匹配，我们还将检查可能与更好的 多发性骨髓瘤患者的预后。该项目有4个目标：目标1：为每一家正在进行研究或 确定他们的多发性骨髓瘤患者的结果是否与匹配的对照组有显著差异。二 将使用对照种群，代表性对照种群和对照种群选自 具有与卓越结果相关的特征的组合的医院(源自AIM 2)。目标2： 确定在治疗多发性骨髓瘤患者时结果特别好或特别差的医院类型 与来自其他医院的两个对照人群的其他密切匹配的患者进行比较。目标3将 检查给医院带来最大问题的特定患者合格共病集合(或类型 医院)。最后，AIM 4将在美国医院的帮助下，为医院开发结果报告 协会。这样的报告将使个别医院第一次深入了解他们的MM 将患者结果与极其相似的MM对照组进行比较。

Abstract At present, it is difficult for hospitals to assess the care of their multimorbid (MM) patients. Since multimorbidity is by definition individualized by many possible combinations of comorbidities and principal diagnoses, any single hospital cannot determine whether their care was optimal for their MM patients, since hospitals do not have access to closely matched controls from other hospitals that may provide insight into how their own MM patients may have fared at other institutions. Since multimorbid patients are far sicker than other patients, it may also be easy to dismiss individual poor outcomes as merely part of the natural pathway associated with multimorbidity. The goal of this proposal is to aid hospitals in observing how their MM patient outcomes differ from similar patients treated at other institutions. Using new definitions of MM in hospitalized surgical and medical patients that specifically define single, double and triple combinations of comorbidities that comprise qualifying comorbidity sets, this study examines whether hospitals vary in their ability to optimally treat MM patients. Results from this study will be directly actionable as an aid to inform hospitals how they fare with their specific MM patients as compared to how their patients may have fared elsewhere. The project will use Medicare claims from the entire country through the new CMS VRDC (Virtual Data Research Center), thereby facilitating a large control group to make close comparisons for any given hospital's patients, and apply new methods in multivariate matching (Indirect Standardization Matching "ISM") developed by the investigators, to examine quality of care for MM patients. Using ISM, we will produce 10 “copies” (or control patients matched from patients admitted to hospitals outside the index hospital) for each MM patient at an index hospital, allowing for close matching of specific qualifying comorbidity sets, and close examination of how well the hospital treats MM patients compared to the closest matched patients selected from other hospitals. Using multivariate matching, we will also examine hospital characteristics that may be associated with better outcomes in MM patients. The project has 4 aims: AIM 1: For every hospital performing study conditions or procedures, determine if their MM patient outcomes are significantly different than matched controls. Two control populations will be utilized, a representative control population and a control population selected from hospitals with a combination of characteristics associated with superior outcomes (derived from AIM 2). AIM 2: Identify types of hospitals that have especially good or especially poor outcomes when treating MM patients as compared to other closely matched patients derived from two control populations at other hospitals. AIM 3 will examine specific patient qualifying comorbidity sets that present the greatest problems for a hospital (or type of hospital). Finally, AIM 4 will develop outcomes reports for hospitals, with the help of the American Hospital Association. Such reports will allow individual hospitals to gain insight, for the first time, into how their MM patient outcomes compare to extremely similar MM controls.