Assessing Hospital Quality of Care for Patients with Multimorbidity

摘要 目前，医院很难评估他们的多病（MM）患者的护理。自从多莫尔 根据定义，通过多种可能的合并症和主要诊断组合进行个体化，任何 单个医院不能确定他们的护理是否对MM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，这些对照可能会深入了解他们自己的MM 病人可能在其他机构过得很好。由于多病患者比其他患者病情严重得多， 也可能很容易忽视个别不良结果，认为这仅仅是与以下疾病相关的自然途径的一部分： 多重性该提案的目的是帮助医院观察MM患者的结局如何不同 在其他机构接受治疗的类似患者。在住院手术和住院治疗中使用MM的新定义 明确定义合并症的单一、双重和三重组合的医学患者，包括 合格的合并病例集，这项研究检查了医院是否在最佳治疗MM的能力方面存在差异 患者这项研究的结果将直接作为一种援助，告知医院他们如何与他们的 特定MM患者与他们的患者在其他地方的表现相比。该项目将使用 医疗保险索赔从整个国家通过新的CMS VRDC（虚拟数据研究中心），从而 方便大型对照组对任何给定医院的患者进行密切比较，并应用新的 研究者开发的多变量匹配（间接标准化匹配“ISM”）方法， 检查MM患者的护理质量。使用ISM，我们将产生10个“拷贝”（或对照患者匹配 来自索引医院以外医院收治的患者）， 允许密切匹配特定的合格的comorbits集，并密切检查如何以及 与从其他医院选择的最接近匹配的患者相比，医院治疗MM患者。使用 多变量匹配，我们还将检查医院的特点，可能与更好的 MM患者的结局。该项目有4个目标：目标1：为每个医院进行研究的条件或 程序，确定他们的MM患者的结果是否与匹配的对照组显著不同。两 将使用对照群体、代表性对照群体和选自以下的对照群体： 具有与上级结局相关的特征组合的医院（源自AIM 2）。目标2： 确定在治疗MM患者时结局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。AIM 3将 检查特定患者资格的合并症集，这些合并症集对医院（或 医院）。最后，AIM 4将在美国医院的帮助下为医院编写成果报告。 协会这样的报告将使个别医院能够第一次深入了解他们的MM 患者结局与极其相似的MM对照相比。

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.