Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction.

Objectives: To characterize hospital phenotypes by their combined utilization pattern of percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG) procedures, and intensive care unit (ICU) admissions for patients hospitalized for acute myocardial infarction (AMI).

Research Design: Using the Premier Analytical Database, we identified 129,138 hospitalizations for AMI from 246 hospitals with the capacity for performing open-heart surgery during 2010-2013. We calculated year-specific, risk-standardized estimates of PCI procedure rates, CABG procedure rates, and ICU admission rates for each hospital, adjusting for patient clinical characteristics and within-hospital correlation of patients.

"Phenotyping" hospital value of care for patients with heart failure.

Objective: To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally.

Data Source: Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005-2011 Premier database.

Study Design: Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression.

Measuring Adverse Events in Hospitalized Patients: An Administrative Method for Measuring Harm.

Context: Current methods for tracking harm either require costly full manual chart review (FMCR) or rely on proxy methods that have questionable accuracy. We propose an administrative measure of harm detection that uses electronically captured data.

Objective: Determine the level of agreement on harm event occurrence when harm is detected based on an administrative harm measurement tool (AHMT) compared with FMCR.

Making hospital mortality measurement more meaningful: incorporating advance directives and palliative care designations.

Accounting for patients admitted to hospitals at the end of a terminal disease process is key to signaling care quality and identifying opportunities for improvement. This study evaluates the benefits and caveats of incorporating care-limiting orders, such as do not resuscitate (DNR) and palliative care (PC) information, in a general multivariate model of mortality risk, wherein the unit of observation is the patient hospital encounter. In a model of the mortality gap (observed - expected from the baseline model), DNR explains 8% to 24% of the gap variation.