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Validation of risk adjustment models for in-hospital percutaneous transluminal coronary angioplasty mortality on an independent data set

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 692-697页

作者： Moscucci, M O'Connor, GT Ellis, SG Malenka, DJ Sievers, J Bates, ER Muller, DWM Werns, SW Rogers, EK Karavite, D Eagle, KA Univ Michigan Med Ctr Heart Care Program Ann Arbor MI 48109 USA St Vincent Hosp Darlinghurst NSW Australia Cleveland Clin Cleveland OH 44106 USA Dartmouth Hitchcock Med Ctr Lebanon NH 03766 USA

OBJECTIVES We sought to validate recently proposed risk adjustment models for in-hospital percutaneous transluminal coronary angioplasty (PTCA) mortality on an independent data set of high risk patients undergoing PTCA. BACKGROUND Risk adjustment models for PTCA mortality have recently been reported, but external validation on independent data sets and on high risk patient groups is lacking. METHODS Between July 1, 1994 and June 1, 1996, 1,476 consecutive procedures were performed on a high risk patient group characterized by a high incidence of cardiogenic shock (3.3%) and acute myocardial infarction (14.3%). Predictors of in-hospital mortality were identified using multivariate logistic regression analysis. Two external models of in-hospital mortality, one developed by the Northern New England Cardiovascular Disease Study Group (model NNE) and the other by the Cleveland Clinic (model CC), were compared using receiver operating characteristic (ROC) curve analysis. RESULTS In this patient group, an overall in-hospital mortality rate of 3.4% was observed. Multivariate regression analysis identified risk factors for death in the hospital that were similar to the risk factors identified by the two external models. When fitted to the data set, both external models had an area under the ROC curve >0.85, indicating overall excellent model discrimination, and both models were accurate in predicting mortality in different patient subgroups. There was a trend toward a greater ability to predict mortality for model NNE as compared with model CC, but the difference was not significant. CONCLUSIONS Predictive models for PTCA mortality yield comparable results when applied to patient groups other than the one on which the original model was developed. The accuracy of the two models tested in adjusting for the relatively high mortality rate observed in this patient group supports their application in quality assessment or duality improvement efforts. (J Am Coll Cardiol 1999;34:69

关键词：血管成形术气囊冠状动脉/死亡率血管成形术气囊冠状动脉/统计学和数值数据冠心病/死亡率冠心病/治疗诊断相关患者组/统计学和数值数据医院死亡率 Logistic模型密执安/流行病学比值比预后 ROC曲线结果可重复性风险调节/统计学和数值数据危险因素老年人女(雌)性人类男(雄)性中年人

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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The changing status of inpatient dermatology at American academic dermatology programs

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JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 1999年第5期40卷 755-757页

作者： Kirsner, RS Yang, DG Kerdel, FA Univ Miami Sch Med Dept Dermatol & Cutaneous Surg Miami FL USA Univ Miami Sch Med Dept Epidemiol & Publ Hlth Miami FL USA

Background: Changes in health care delivery financing such as the adoption of the diagnosis-related groups (DRG) in 1983 has affected inpatient services of dermatology programs across the United States. Objective: The purpose of this study was to define the present status of inpatient dermatology at academic medical centers compared with 1982. Methods: Questionnaires inquiring about the state of inpatient service were sent to the chairpersons of each dermatology residency program in the United States. Results: Of the 71 programs responding, 79% reported a reduction in inpatient activity. Nearly half of the dermatology programs with dedicated dermatology beds in 1982 reported not continuing to have these in 1997 (41 to 24). The average number of patients admitted for skin disease decreased from 119 in 1982 to 36.5 in 1997, and the average daily census decreased from 8.9 to 2.2. Conclusion: There has been a decline in the number of patients hospitalized by academic dermatology departments and a shift of some patients hospitalized to beds where the attending is other than a dermatologist.

关键词：医学科学研究中心/统计学和数值数据门诊医疗/统计学和数值数据皮肤病学/教育皮肤病学/统计学和数值数据诊断相关患者组/统计学和数值数据医院病床数/统计学和数值数据住院/统计学和数值数据保险健康/统计学和数值数据实习医师和住院医师职务病人入院/统计学和数值数据皮肤疾病/流行病学皮肤疾病/治疗美国/流行病学人类

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Adolescent psychiatric in-patients - A high-risk group for premature death

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BRITISH JOURNAL OF PSYCHIATRY 2000年第2期176卷 121-125页

作者： Kjelsberg, E Ctr Child & Adolescent Psychiat N-0319 Oslo Norway

Background Research has demonstrated increased mortality rates in adolescent psychiatric in-patients. Aims To investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age. Method A nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15-33 years after first hospitalisation by record linkage to the National Death Cause Registry Results The SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated. Conclusions Abroad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients. Declaration of interest Funded by a grant from the Foundation for Health and Rehabilitation through the Norwegian Council for Mental Health.

关键词：年龄因素死亡原因队列研究诊断相关患者组/统计学和数值数据住院病人/统计学和数值数据精神障碍/死亡率挪威/流行病学危险因素青少年女(雌)性人类男(雄)性

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The relationship between the geographic density of alcohol outlets and alcohol-related hospital admissions in San Diego County

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JOURNAL OF COMMUNITY HEALTH 2000年第1期25卷 79-88页

作者： Tatlow, JR Clapp, JD Hohman, MM San Diego State Univ Sch Social Work San Diego CA 92182 USA San Diego State Univ Sch Publ Hlth San Diego CA 92182 USA

Increasing concerns regarding the cost of medical care have led to research that has found a relationship between alcohol abuse, increased medical problems, longer hospital stays, and higher medical costs. Research has also found a positive relationship between alcohol availability and crime, car accidents, and liver cirrhosis deaths. One area of interest is how alcohol availability, as measured by the number of alcohol outlets, is related to medical care needs. The purpose of this study was to examine the relationship between the geographic density of alcohol outlets and the number of alcohol-related hospital admissions. alcohol-related ICD-9 codes were selected based on epidemiologic research in the literature to determine alcohol-related morbidity from the California Discharge Data System, which collects information on all hospital admissions and discharges in California. In San Diego County, in 1996, 3,759 admissions were alcohol-related. Alcohol-related admissions for each zip code were compared to the number of liquor licenses that were held by each zip code through a multiple regression analysis. The regression model demonstrated that the number of liquor outlets was a significant predictor of alcohol-related hospital admissions, net of other predictors. Implications are discussed, including regulation of alcohol availability, which may have a beneficial impact on alcohol morbidity.

关键词：年龄分布酒精性饮料/供应和分配酒精中毒/流行病学酒精中毒/病因学加利福尼亚/流行病学商业/统计学和数值数据诊断相关患者组/统计学和数值数据最小二乘法分析许可证/统计学和数值数据年患病率多元分析需求估价病人入院/统计学和数值数据试验预期值居住特征/统计学和数值数据危险因素性别分布成年人老年人女(雌)性人类男(雄)性中年人

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An analysis of trends in average length of stay in Maryland hospitals, 1980-1988

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Journal of Health and Social Policy 1992年第1期4卷 77-95页

作者： Basu, J. Maryland Hlth Res Planning Commissio Baltimore MD 21215-2299 4201 Patterson Avenue United States

Nationally, the introduction of the Medicare Prospective Payment System (PPS) in 1983 caused a substantial change in average length of stay (ALOS) trends in hospitals. This resulted from an average decline in DRG-specific length of stay, partially offset by an increase in the relative contributions of DRGs with longer length of stay. The study finds that the interaction of these two opposing forces was present m Maryland as well as in the United States during the early and mid- 1980's although Maryland was not under PPS. The analysis also indicates that these post-PPS ALOS trends tapered off gradually during 1985-1988, although the trends still continued to show the same pattern of movement.

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Resource utilization in home health care: Results of a prospective study

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Home Health Care Services Quarterly 1994年第1期15卷 19-41页

作者： Trisolini, Michael G. Parks Thomas, Cindy Cashman, Suzanne B. Payne, Susan M. C. Boston University School of Public Health Boston United States Boston University School of Public Health Boston United States Center for Community Responsive Care Boston University School of Public Health Boston United States Boston University School of Public Health Boston United States

Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix. © 1994 Taylor & Francis Group, LLC.

关键词：波士顿社区保健护理/人力社区保健护理/统计学和数值数据数据收集诊断相关患者组/统计学和数值数据集中研讨小组卫生资源/利用家庭医疗保健服务/分类家庭医疗保健服务/经济学家庭医疗保健服务/利用出诊/经济学出诊/利用护士/利用前瞻性研究回归分析时间和运动研究

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Hospital Choice of Medicare Beneficiaries in a Rural Market: Why Not the Closest?

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The Journal of Rural Health 1991年第2期7卷 134-152页

作者： Adams, E. Kathleen Wright, George E. Lexington Massachusetts 02173 24 Hartwell Ave United States

ABSTRACT: As part of a larger study of hospital choice, the travel patterns of more than 12,000 Medicare beneficiaries residing in three overlapping rural areas were examined. During 1986 these Medicare beneficiaries were admitted to one of 53 hospitals in an area that encompassed parts of Minnesota, North Dakota, and South Dakota. Information on ZIP code of residence, closest hospital, and hospital of admission were used to analyze hospital choices of the Medicare rural elderly residing in this area. Tosummarize their travel patterns, the admitting hospital was categorized based on whether it was urban or rural, its size and whether or not it was the closest facility. Findings indicated that 60 percent of these rural Medicare beneficiaries used hospital services at their closest rural hospital, regardless of its size. However, 79 percent of those whose closest hospital was larger than 75 beds used it, while only 54 percent of those whose closest rural hospital was fewer than 75 beds obtained services there. Overall, 30 percent of those residing in this rural market area went to an urban hospital. These patterns appeared to reflect an evaluation by the physician and/or individual of the relative attractiveness of the local hospital versus alternatives available, as well as the individual's characteristics. Travel patterns varied by the beneficiary's age as well as his or her relative complexity of illness, as measured by a Disease Staging methodology. Findings have implications for the provision and financing of hospital services in rural areas. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：卫生服务范围/统计学和数值数据数据收集诊断相关患者组/统计学和数值数据卫生服务易得程度/统计学和数值数据医院乡村/统计学和数值数据医院乡村/利用 Medicare/利用明尼苏达北达科他病人接受卫生保健的程度/统计学和数值数据研究设计南达科他时间因素旅行/统计学和数值数据美国老年人人类

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HOW MUCH CHANGE IN THE CASE MIX INDEX IS DRG CREEP

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JOURNAL OF HEALTH ECONOMICS 1990年第4期9卷 411-428页

作者： CARTER, GM NEWHOUSE, JP RELLES, DA HARVARD UNIV CAMBRIDGEMA 02138

We re-abstracted a nationally representative sample of 7,887 Medicare charts to determine how much of the change in Medicare's Case Mix Index between 1986 and 1987 was true change in the complexity of cases and how much was upcoding or ‘DRG creep’. About two-thirds of the change is true. Most of the remaining third is attributable to a general change in the completeness of coding; some is attributable to changes in the Grouper program. Thus, most of the additional $1 billion paid to hospitals because of the Case Mix Index change appears justified by the additional complexity of patients hospitalized.

关键词：摘要和索引(主题)/标准数据收集诊断相关患者组/统计学和数值数据评价研究(主题) 最小二乘法分析病案/标准病案室医院/标准 Medicare/统计学和数值数据超额付费患者 DRG/统计学和数值数据专业评审组织美国

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