Using Clinically-Enhanced Claims Data to Guide Selection of Coronary Procedures

使用临床增强的索赔数据来指导冠状动脉手术的选择

• 批准号: 8054107
• 负责人: Barbara Dennison
• 金额: $ 142.28万
• 依托单位: NYSDOH/HEALTH RESEARCH, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8054107
• 关键词: Using; Clinically; Enhanced; Claims; Data

DESCRIPTION (provided by applicant): The goal of this research program is to examine the comparative effectiveness of coronary artery bypass graft (CABG) procedures and percutaneous coronary artery interventions (PCI). This will be done by clinical enhancement of the New York State's Statewide Planning and Research Cooperative System (SPARCS) acute care hospital discharge database with hospital numerical laboratory data. Laboratory data will permit refinement of patient risk adjustment, provide full accountability of complications, and validate the accuracy of present-on-admission coding. Complete data sets from hospitals recruited into the project will allow analyses of 1) factors that influence whether coronary artery revascularization is performed by open surgical intervention or percutaneously, 2) short-term and long-term clinical outcomes of each chosen intervention by subsets of patients and subsets of hospitals, and 3) how alterations in selection of patients, procedures, and sites can improve short-term and long-term clinical outcomes of patients undergoing the different treatment options. Clinical outcomes will employ risk adjusted mortality rates, risk-adjusted length of stay in acute hospital facilities, and readmission/emergency department visits within 30 days of the index procedure. Precise risk adjustment will allow patient-level propensity matching models to be used, and clinical outcomes assessment can then be used for evaluation of hospital effectiveness. Year 1 will be invested in recruitment of participating hospitals and laboratory data enhancement of the SPARCS database, Year 2 will be used for refinement of protocols and initial analyses of data, and Year 3 will be devoted to final analyses with published reports and presentations. Results of these analytical evaluations can then be employed to provide feedback to providers so that optimum treatment strategies can be adopted for improved patient care using the comparative effectiveness paradigm. PUBLIC HEALTH RELEVANCE: This project is designed to make hospital billing data collected by states more useful for studies of the comparative benefits of alternative medical treatments by linking billing records to laboratory test results obtained directly from hospitals' electronic databases. To demonstrate the value of the resulting clinically- enhanced billing database in guiding medical treatment decisions, patient outcomes after treatment of heart artery blockage by surgery and by balloon angioplasty will be compared using clinically-enhanced data and using complete clinical data from difficult-to-maintain cardiac registries. Successful development and use of new, relatively inexpensive to maintain enhanced billing databases to guide improvements in medical care will provide an important tool to ensure that each patient receives the right treatment performed in the right way at the right time.

描述(由申请人提供)：本研究计划的目标是检验冠状动脉搭桥术(CABG)和经皮冠状动脉介入治疗(PCI)的比较效果。这将通过临床增强纽约州全州规划和研究合作系统(SPARCS)的急性护理医院出院数据库和医院数字实验室数据来实现。实验室数据将允许改进患者风险调整，提供全面的并发症责任，并验证入院时呈现编码的准确性。该项目招募的医院的完整数据集将允许分析1)影响冠状动脉血运重建是通过开放手术干预还是经皮进行的因素，2)按患者子组和医院子组划分的每个选定干预的短期和长期临床结果，以及3)患者选择、程序和地点的改变如何改善接受不同治疗方案的患者的短期和长期临床结果。临床结果将使用风险调整后的死亡率、在急性医院设施中的风险调整后的住院时间以及在指数程序的30天内再次住院/急诊科就诊。精确的风险调整将允许使用患者水平的倾向匹配模型，然后临床结果评估可以用于评估医院的有效性。第1年将用于招募参与的医院和加强SPARCS数据库的实验室数据，第2年将用于完善方案和初步数据分析，第3年将专门用于发表报告和介绍的最终分析。然后可以使用这些分析评估的结果来向提供者提供反馈，以便可以采用最佳治疗策略来使用比较有效性范例来改善患者护理。 公共卫生相关性：该项目旨在通过将账单记录与直接从医院电子数据库获得的实验室测试结果联系起来，使各州收集的医院账单数据更有助于研究替代医疗的比较效益。为了证明最终的临床增强账单数据库在指导医疗决策方面的价值，将使用临床增强数据和使用来自难以维护的心脏登记的完整临床数据来比较手术和球囊血管成形术治疗心脏动脉阻塞后的患者结果。成功开发和使用新的、维护成本相对较低的增强账单数据库，以指导医疗保健的改进，将提供一个重要工具，确保每个患者在正确的时间以正确的方式接受正确的治疗。

项目成果

The value of adding laboratory data to coronary artery bypass grafting registry data to improve models for risk-adjusting provider mortality rates.

将实验室数据添加到冠状动脉旁路移植登记数据中以改进风险调整提供者死亡率模型的价值。

• DOI: 10.1016/j.athoracsur.2014.08.043
• 发表时间: 2015
• 期刊: The Annals of thoracic surgery
• 作者: Hannan,EdwardL;Qian,Feng;Pine,Michael;Fry,DonaldE;Whitman,Kay;Dennison,BarbaraA
• 通讯作者: Dennison,BarbaraA

Can Adding Laboratory Values Improve Risk-Adjustment Mortality Models Using Clinical Percutaneous Cardiac Intervention Registry Data?

使用临床经皮心脏介入登记数据添加实验室值能否改善风险调整死亡率模型？

• 发表时间: 2015
• 期刊: The Journal of invasive cardiology
• 作者: Qian,Feng;Hannan,EdwardL;Pine,Michael;Fry,DonaldE;Whitman,Kay;Dennison,BarbaraA
• 通讯作者: Dennison,BarbaraA