Case-Mix for Performance Management: A Risk Algorithm Based on ICD-10-CM.

Background: Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement.

PA and NP productivity in the Veterans Health Administration.

This study assessed the 2014 clinical productivity of 5,959 physician assistants (PAs) and nurse practitioners (NPs) in the US Department of Veterans Affairs' Veterans Health Administration (VHA). Total work relative value units divided by the direct clinical full-time equivalent measured annual productivity, and correlated factors were examined using weighted analysis of variance. PAs and NPs in adult primary care roles were more productive than those in other specialties.

β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?

Importance: The use of perioperative pharmacologic β-blockade in patients at low risk of myocardial ischemic events undergoing noncardiac surgery (NCS) is controversial because of the risk of stroke and hypotension. Published studies have not found a consistent benefit in this cohort.

Objective: To determine the effect of perioperative β-blockade on patients undergoing NCS, particularly those with no risk factors.

Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days.

Objective: To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator

Design: Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care

Patients: Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections

Methods: We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance.

Results: A total of 7.

Predicting potentially avoidable hospitalizations.

Background: Hospitalizations due to ambulatory care sensitive conditions (ACSCs) are widely accepted as an indicator of primary care access and effectiveness. However, broad early intervention to all patients in a health care system may be deemed infeasible due to limited resources.

Objective: To develop a predictive model to identify high-risk patients for early intervention to reduce ACSC hospitalizations, and to explore the predictive power of different variables.

Impact of patient-level risk adjustment on the findings about nurse staffing and 30-day mortality in veterans affairs acute care hospitals.

Background: Studies about nurse staffing and patient outcomes often lack adequate risk adjustment because of limited access to patient information.

Objective: The aim of this study was to examine the impact of patient-level risk adjustment on the associations of unit-level nurse staffing and 30-day inpatient mortality.

Methods: This retrospective cross-sectional study included 284,097 patients discharged during 2007-2008 from 446 acute care nursing units at 128 Veterans Affairs medical centers.

Despite variation in volume, Veterans Affairs hospitals show consistent outcomes among patients with non-postoperative mechanical ventilation.

Objective: To assess the relationship between volume of nonoperative mechanically ventilated patients receiving care in a specific Veterans Health Administration hospital and their mortality.

Design: Retrospective cohort study.

Setting: One-hundred nineteen Veterans Health Administration medical centers.

A hybrid Centers for Medicaid and Medicare service mortality model in 3 diagnoses.

Introduction: Reliance on administrative data sources and a cohort with restricted age range (Medicare 65 y and above) may limit conclusions drawn from public reporting of 30-day mortality rates in 3 diagnoses [acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia (PNA)] from Center for Medicaid and Medicare Services.

Methods: We categorized patients with diagnostic codes for AMI, CHF, and PNA admitted to 138 Veterans Administration hospitals (2006-2009) into 2 groups (less than 65 y or ALL), then applied 3 different models that predicted 30-day mortality [Center for Medicaid and Medicare Services administrative (ADM), ADM+laboratory data (PLUS), and clinical (CLIN)] to each age/diagnosis group. C statistic (CSTAT) and Hosmer Lemeshow Goodness of Fit measured discrimination and calibration.

Variations in efficiency and the relationship to quality of care in the veterans health system.

There is widespread belief that the US health care system could realize significant improvements in efficiency, savings, and patient outcomes if care were provided in a more integrated and accountable way. We examined efficiency and its relationship to quality of care for medical centers run by the Veterans Health Administration of the Department of Veterans Affairs (VA), a national, vertically integrated health care system that is accountable for a large patient population. After devising a statistical model to indicate efficiency, we found that VA medical centers were highly efficient.

Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement.

Background: Elimination of hospital-acquired infections is an important patient safety goal.

Setting: All 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).

Intervention: A centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI).

Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices.

Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis.

Objectives: Hyperglycemia during critical illness is common and is associated with increased mortality. Intensive insulin therapy has improved outcomes in some, but not all, intervention trials. It is unclear whether the benefits of treatment differ among specific patient populations.

Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration.

Historically, the prevalence of smoking and smoking-related illnesses has been higher among veteran patients in the Veterans Health Administration (VHA) in comparison to that of the general population. Although rates of tobacco use have remained high, smoking cessation interventions continued to be greatly underutilized in VHA clinical settings just as they have been nationally. To address tobacco use as a public health priority, VHA has implemented a number of evidence-based national initiatives in recent years.

Recovery of cell wall-deficient organisms from blood does not distinguish between patients with sarcoidosis and control subjects.

Study Objective: To determine if cell wall-deficient forms (CWDF) of mycobacteria can be grown in culture of blood from subjects with sarcoidosis.

Design: A special multicenter study of sarcoidosis (A Case Control Etiologic Study of Sarcoidosis), supported by the National Heart, Lung, and Blood Institute.

Patients And Control Subjects: PATIENTS AND CONTROL SUBJECTS were recruited at 10 institutions in the United States.

Relationship of respiratory symptoms with smoking status and pulmonary function in chronic spinal cord injury.

Objective: The relationship of respiratory symptoms to pulmonary function parameters and smoking status was assessed in subjects with chronic (>1 year) spinal cord injury (SCI).

Methods And Participants: As part of their annual physical examination, subjects were queried regarding respiratory symptoms and underwent pulmonary function studies. The 180 patients who successfully completed pulmonary function testing were evaluated, including 79 subjects with tetraplegia (56 nonsmokers and 23 smokers) and 101 subjects with paraplegia (78 nonsmokers and 23 smokers).