Publications (2)7.79 Total impact
-
Article: Comparing 2 Methods of Assessing 30-Day Readmissions: What is the Impact on Hospital Profiling in the Veterans Health Administration?
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND:: The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure and the 3M Health Information System Division Potentially Preventable Readmissions (PPR) measure are both used for public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing and low-performing hospitals. OBJECTIVES:: To examine how consistently the CMS and PPR methods identify performance outliers, and explore how the PPR preventability component impacts hospital readmission rates, public reporting on CMS' Hospital Compare website, and pay-for-performance under CMS' Hospital Readmission Reduction Program for 3 conditions (acute myocardial infarction, heart failure, and pneumonia). METHODS:: We applied the CMS all-cause model and the PPR software to VA administrative data to calculate 30-day observed FY08-10 VA hospital readmission rates and hospital profiles. We then tested the effect of preventability on hospital readmission rates and outlier identification for reporting and pay-for-performance by replacing the dependent variable in the CMS all-cause model (Yes/No readmission) with the dichotomous PPR outcome (Yes/No preventable readmission). RESULTS:: The CMS and PPR methods had moderate correlations in readmission rates for each condition. After controlling for all methodological differences but preventability, correlations increased to >90%. The assessment of preventability yielded different outlier results for public reporting in 7% of hospitals; for 30% of hospitals there would be an impact on Hospital Readmission Reduction Program reimbursement rates. CONCLUSIONS:: Despite uncertainty over which readmission measure is superior in evaluating hospital performance, we confirmed that there are differences in CMS-generated and PPR-generated hospital profiles for reporting and pay-for-performance, because of methodological differences and the PPR's preventability component.Medical care 04/2013; · 3.24 Impact Factor -
Article: Validity of the AHRQ Patient Safety Indicator "central venous catheter-related bloodstream infections".
[show abstract] [hide abstract]
ABSTRACT: "Central venous catheter-related bloodstream infections" (CR-BSIs) is one of the patient safety indicators (PSI 7) developed by the Agency for Healthcare Research and Quality (AHRQ) to screen for potential safety events. We sought to investigate the validity of this PSI using the medical record as the gold standard. We conducted a retrospective cross-sectional study of all hospitalization records that met the criteria for PSI 7 within Veterans Health Administration (VA) hospitals from fiscal years 2003 to 2007. Trained abstractors used a standardized abstraction tool to review electronic medical records for the presence of a CR-BSI and the clinical circumstances surrounding the event. We determined the validity of this PSI by calculating its positive predictive value (PPV), and analyzed both true and false positive cases. Of 112 reviewed cases, 42 were true events of CR-BSIs, yielding a PPV of 38% (95% CI 29% to 47%). Seventy cases were false positives; these were attributed to correct ICD-9-CM codes but had diagnoses that fell outside the scope of the indicator (n = 28, 40%), coding inaccuracies (n = 21, 30%); and present on admission (POA) diagnoses (n = 21; 30%). Among the 42 patients with CR-BSIs, catheters were left in place for an average of 11 days, and 20% (n = 8) were placed in the femoral position. PSI 7 has relatively poor predictive ability for identifying true events. Coding-related issues were the main reason for the low PPV. Implementing POA codes and using more specific ICD-9-CM codes would improve its validity. As it currently stands, PSI 7 should not be used as a pay-for-performance measure, but should be limited to use in internal quality improvement efforts.Journal of the American College of Surgeons 06/2011; 212(6):984-90. · 4.55 Impact Factor
