Amresh D Hanchate1, Kelly L Stolzmann2, Amy K Rosen3, Aaron S Fink4, Michael Shwartz5, Arlene S Ash6, Hassen Abdulkerim2, Mary Jo V Pugh7, Priti Shokeen2, Ann Borzecki8. 1. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. Electronic address: hanchate@bu.edu. 2. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA. 3. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA. 4. Professor Emeritus of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. 5. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Operations and Technology Management, Boston University School of Management, Boston, MA 02215, USA. 6. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA. 7. South Texas Veterans Health Care System, San Antonio, TX 78229, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX 78229, USA. 8. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC, Bedford, MA 01730, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA.
Abstract
BACKGROUND: Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. METHODS: We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. RESULTS: For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. CONCLUSIONS: Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. INTERPRETATION: Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.
BACKGROUND: Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. METHODS: We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. RESULTS: For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. CONCLUSIONS: Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. INTERPRETATION: Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.
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